Recognizing the Pros and Cons of Roux-en-Y Weight Loss Surgery

Roux-en-Y (often abbreviated RNY, and pronounced roo-en-why) gastric bypass surgery is known as the gold standard of weight loss surgeries. Approximately 80 percent of all surgeries performed in the United States currently are Roux-en-Y.

In the 1980s, the term stomach stapling referred to the weight loss procedure known as vertical banded gastroplasty (VBG). Unfortunately, some people use the term stomach stapling for gastric bypass as well, which is an entirely different procedure. The failure rate with VBG was very high, so when people associate gastric bypass surgery with VBG by calling them both stomach stapling, patients sometimes have the impression that gastric bypass has a high failure rate as well — which is not the case.

What is it?

A Roux-en-Y gastric bypass makes the stomach smaller and bypasses some of the small intestines. The stomach is made smaller by dividing the stomach with staples into two compartments or by partitioning the stomach with staples. Today, surgeons commonly divide the stomach while partitioning it. In the laparoscopic procedure, the stomach must be divided. The smaller stomach is referred to as the pouch. The size of the pouch is about 1 to 2 ounces (between 15 and 20 cc's), or roughly the size of an egg. (As a contrast, the size of a normal stomach is about the size of a football.)

The small intestines are divided at a certain length by using a stapler. Of the two cut ends of small intestine, the intestine that was farther away is brought up to the new stomach pouch, and this new hookup is called a gastrojejunostomy. Some people also refer to this as the proximal anastomosis. The other cut end of small intestine is then plugged back into the intestine to complete the circuit, and this is called the distal anastomosis. The small intestine that is attached to the stomach is known as the Roux limb. The other cut end of small intestine is known as the biliopancreatic limb, because it contains the bile from the liver and the enzymes to digest food from the pancreas. When the biliopancreatic limb joins the Roux limb, the small intestine is known as the common channel, and this is where the majority of the food is digested and calories are absorbed.

When you have Roux-en-Y surgery, after you chew food and it mixes with saliva in your mouth, the food goes down the esophagus into the new stomach pouch and then into the small intestine. The bile and other enzymes don't join the food until further down the intestines, so there is less time for food digestion and calorie absorption.

Who does it work for?

If you need help with portion control, you may be a good candidate for a Roux-en-Y. The small pouch will keep you from overeating. When you eat more than your pouch holds, you'll feel a pain or discomfort in your chest and will likely throw up the food.

What are the pros and cons?

Here are the advantages the Roux-en-Y gastric bypass surgery offers to patients:

  • Up to 96 percent of patients see a cure or improvement of their diabetes.
  • Up to 90 percent of patients see a cure or improvement of their high blood pressure.
  • Up to 80 percent of patients see a cure or improvement in their sleep apnea.
  • Patients see a lessening of pain related to osteoarthritis.
  • Patients see a lessening of their gastric reflux symptoms.
  • Some patients see an improvement in their fertility.
  • Patients experience great weight loss. Patients can maintain an average of 65 to 70 percent of excess weight loss at five years after surgery. In other words, they can expect to lose 65 to 70 percent of the amount that they're overweight.
  • Patients experience better long-term weight loss than with diet, exercise and medication.
  • On average, patients experience more weight loss than with behavioral modification.
  • Patients are less likely to gain back the weight they've lost than are patients of some of the other weight loss procedures.
  • Patients experience rapid weight loss, and they can achieve most of the weight loss within the first year.
  • The small gastric pouch forces patients to modify their diets.
  • Some patients experience what's known as the dumping syndrome (a major discomfort!) if they eat something too high in sugar or fat.

Though it's the most popular form of weight loss surgery performed today, Roux-en-Y does have drawbacks:

  • Because the stomach is divided and the small intestines are rerouted, leakages can occur right after surgery.
  • Because Roux-en-Y is surgery, it can involve complications such as pulmonary embolism (a blood clot to the lungs), bleeding, infection, stricture (a severe narrowing of the hookup of the stomach to the intestine due to scar tissue), hernia, and even death.
  • Ulcers can occur at the hookup of the stomach to the intestine.
  • You may regain some of the weight you've lost if you don't watch your diet and follow an exercise regimen.
  • You may have gas, and it could smell worse than it did before surgery (though your doctor can help with this).
  • For the rest of your life, you're at a slight risk for intestinal obstruction.
  • You have to modify your diet.
  • You may experience more-frequent bowel movements.
  • You may experience nutritional deficiencies and, therefore, you have to take nutritional supplements for the rest of your life.
  • You may experience the sickening sensations of dumping syndrome if you eat something too high in sugar or fat.
  • The surgery to reverse Roux-en-Y gastric bypass is more difficult than Roux-en-Y itself, so the reversal surgery is not readily performed.

After your gastric bypass, call your surgeon if you experience any abdominal problems or any other new concerns. He may have seen a similar problem in other patients.

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