Roux-en-Y Gastric Bypass
Roux-en-Y is a commonly performed gastric bypass surgery appropriate for some obese patients with a BMI of 40 or higher.
During Roux-en-Y surgery, sometimes referred to as RYGB, stomach size is reduced by creating a pouch in the upper portion of the organ. The small intestine is then divided into two limbs. The Roux limb, the middle portion of the small intestine, is connected to the newly formed stomach pouch, bypassing both the lower stomach and a section of the small intestine. This allows the digestive juices produced in the lower portion of the stomach to flow directly into the biliopancreatic limb. A Y intersection is then created by reattaching the biliopancreatic limb below the Roux limb.
The Roux-en-Y procedure may be performed through an open incision or laparoscopically, depending on the needs of the patient.
Advantages of Roux-en-Y
Roux-en-Y combines a restrictive approach (stomach pouch) with a malabsorption approach (intestinal bypass). The reduced stomach capacity means food intake is limited to approximately two tablespoons at a time and intestinal bypass results in diminished absorption of calories and nutrients. However, most of the small intestine remains intact so the risk of diarrhea is greatly reduced. Roux-en-Y patients are also less likely to experience protein deficiency than those who undergo other more aggressive gastric surgeries.
A recent 10-year Veteran Affairs study found that over 70 percent of RYGB patients experienced a weight loss of 20 percent or more. Roux-en-Y is less aggressive than the duodenal switch procedure and has been shown to reverse many weight-related medical conditions.
Disadvantages of Roux-en-Y
As with any surgical procedure, there are risks associated with Roux-en-y, but the procedure has fewer risks than more aggressive bypass surgeries. Possible complications include bleeding, dehydration, constipation, stomach pouch ulceration, herniation and dumping syndrome (process where food and digestive juices move too quickly into the small intestine).
Many complications after gastric bypass surgery can be avoided by strict adherence to the prescribed dietary guidelines.
Roux-en-Y dietary guidelines
Guidelines may vary depending on physician preference and patient needs, but typically,
after surgery, patients are limited to clear liquids for one to two days. If well tolerated, the diet is gradually increased to full liquids and later, a pureed diet and soft foods. After two months, small amounts of solid foods are allowed.
Vitamin and mineral supplements are needed since absorption is diminished.