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Roux-en-Y Gastric Bypass—Laparoscopic Surgery

(Bariatric Surgery; Weight-Reduction Surgery)

Definition

Roux-en-Y gastric bypass is a surgery for obesity . It changes the size of the stomach and small intestine to cause weight loss by:
  • Restricting food intake—creates a small pouch to serve as the stomach, so you cannot eat as much
  • Making the body unable to absorb as many calories from the food—bypassing the first part of the small intestine, where many of the calories from food are usually absorbed
Roux-en-Y Gastric Bypass
Roux en Y
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

The surgery treats severe obesity. A calculation called body mass index ( BMI ) is used to determine how overweight or obese you are. A normal BMI is 18.5-25.
Roux-en-Y gastric bypass is a weight loss option for people with:
  • BMI greater than 40
  • BMI 35-39.9 and a life-threatening condition or severe physical limitations that affect employment, movement, and family life
The success of gastric bypass surgery depends on your commitment to lifelong health habits. If lifestyle changes are made and maintained, the benefits of bariatric surgery include:
  • Long-term weight reduction
  • Improvement in many obesity-related conditions
  • Improved movement and stamina
  • Enhanced mood, self-esteem, and quality of life

Possible Complications

If you are planning to have Roux-en-Y gastric bypass, your doctor will review a list of possible complications, which may include:
  • Bleeding
  • Infection
  • Blood clots
  • Pulmonary embolism
  • Hernia formation
  • Bowel obstruction
  • Breakdown of the staples, allowing leakage of stomach juices into the abdomen
  • Diarrhea, abdominal cramping, and vomiting
  • Dumping syndrome—This occurs after eating sweets, when food moves too quickly through the small intestine causing sweating, fatigue, lightheadedness, cramping, and diarrhea .
  • The need for additional surgery
  • Complications of general anesthesia
  • Death
Long-term complications include vomiting and gallstones.
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:

What to Expect

Prior to Procedure

Each bariatric surgery program has specific requirements. Your program will likely include the following:
  • Thorough physical exam and review of medical history
  • Ongoing consultations with a registered dietitian
  • Mental health evaluation and counseling
Leading up to your procedure:
  • Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelets
  • Do not start taking any new medications, herbs, or supplements without talking to your doctor.
  • Arrange for a ride to and from the hospital.
  • Arrange for help at home as you recover.
  • You might take antibiotics before coming to the hospital.
  • You might take laxatives and/or an enema to clear your intestines.
  • The night before your surgery, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor.
  • Shower or bathe the morning of your surgery.

Anesthesia

General anesthesia will be used. You will be asleep.

Description of Procedure

To prepare you for surgery, an IV will be placed in your arm. You will receive fluids and medications through this line during the procedure. A breathing tube will be placed through your mouth and into your throat. This will help you breathe during surgery. You will also have a catheter placed in your bladder to drain urine.
Several small cuts will be made in the abdomen. Gas will be pumped in to inflate your abdomen. This will make it easier for the doctor to see. A laparoscope and surgical tools will be inserted through the incisions. A laparoscope is a thin, lighted tool with a tiny camera. It sends images of your abdominal cavity to a monitor in the operating room. Your doctor will operate while viewing the area on this monitor.
Surgical staples will be used to create a small pouch at the top of your stomach. This pouch, which can hold about one cup of food, will be your new, smaller stomach. A normal stomach can hold 4-6 cups of food.
Next, the small intestine will be cut and attached to the new pouch. With the intestinal bypass, food will now move from the new stomach pouch to the middle section of the small intestine. It will skip the lower stomach and the upper section of the small intestine.
Finally, the upper section of the small intestine will be attached to the middle section of the small intestine. This will allow fluid that the lower stomach makes to move down the upper section of the small intestine and into the middle section.
When the bypass is completed, the incisions will be closed with staples or stitches.
Be aware that in some cases, the doctor may need to switch to an open surgery . During an open surgery, a larger cut in the abdomen will be made to do the surgery.
Roux-en-Y Gastric Bypass
Roux-en-Y
Copyright © Nucleus Medical Media, Inc.

After Procedure

You will be taken to the recovery area for monitoring. You will also be given pain medication.

How Long Will It Take?

About two hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 2-5 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital
While you are recovering at the hospital, you may receive the following care:
  • Pain medication will be given as needed.
  • Your diet:
    • On the day of surgery—You will not be given food or drinks.
    • On the day after surgery—You will have an x-ray to check for leaks from the stomach pouch. For this test, you will drink a special liquid while x-rays are taken.
      • If the upper GI x-ray is normal, you will be given 30 milliliters (mL) of liquids every 20 minutes.
      • If leaks are found, you will receive nutrition through an IV until the leaks are fixed.
    • On the second day after surgery—You will take 1-2 tablespoons of pureed food or 1-2 ounces of liquids every 20 minutes.
    While in the hospital, you may be asked to do the following:
    • Use an incentive spirometer to help you take deep breaths. This helps prevent lung problems.
    • Wear elastic surgical stockings or boots to promote blood flow in your legs.
    • Get up and walk daily.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
You will need to practice lifelong healthy eating and exercising habits. Keep in mind after your surgery:
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • You may be out of work for 2-6 weeks after gastric bypass surgery.
  • Do not drive or lift anything heavy until your doctor tells you it is safe. This may be up two weeks or more.
  • Walk as soon as possible, with a goal of exercising daily.
  • You may have emotional ups and downs after this surgery.
  • You will meet regularly with your healthcare team for monitoring and support.
Your new stomach is the size of a small egg. It is slow to empty, causing you to feel full quickly. Therefore, you need to eat very small amounts and eat very slowly:
  • You will begin with 4-6 meals per day. A meal is two ounces of food.
  • For the first 4-6 weeks after surgery, all food must be pureed.
  • When you move to solid foods, they must be chewed well.
  • When making food choices, you will need to consume enough protein.
  • Avoid sweets and fatty foods.
  • Eating too much or too quickly can cause vomiting or intense pain under your breastbone. Most people quickly learn how much food they can eat.

Call Your Doctor

Call your doctor if any of these occur:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Persistent cough , shortness of breath, or chest pain
  • Worsening abdominal pain
  • Blood in the stool
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • Persistent nausea and/or vomiting
  • Pain and/or swelling in your feet, calves, or legs; sudden shortness of breath or chest pain
  • New or worsening symptoms
If you think you have an emergency, call for medical help right away.

RESOURCES

American Society for Metabolic and Bariatric Surgery http://asmbs.org

Weight Control Information Network http://www.win.niddk.nih.gov

CANADIAN RESOURCES

BC Health Guide, British Columbia Ministry of Health http://www.bchealthguide.org

Canadian Laparoscopic Weight Loss Surgery http://www.weightlosssurgery.ca

References

Gastrointestinal surgery for severe obesity. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://win.niddk.nih.gov/publications/gastric.htm. Updated June 2011. Accessed December 9, 2013.

Maciejewski ML, Livingston EH, et al. Survival among high-risk patients after bariatric surgery. JAMA. 2011;305(23):2419-2426.

Obesity risks add to complications of gastric bypass [news release]. Duke University Medical Center website. Available at: http://www.dukemednews.org/news/article.php?id=7217. Accessed December 9, 2013.

Roux-en-Y gastric bypass. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/procedure%5Ftreatment/gastric%5Fbypass%5Fsurgery/roux-en-y.aspx. Accessed December 9, 2013.

Roux-en-Y gastric bypass. Columbia University Medical Center website. Available at: http://obesitymd.org/gastric.html. Accessed December 9, 2013.

Roux-en-Y gastric bypass weight-loss surgery. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/gastroenterology/roux-en-y%5Fgastric%5Fbypass%5Fweight-loss%5Fsurgery%5F135,65. Accessed December 9, 2013.

9/2/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445-454.

6/24/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253(3):484-487.

1/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jensen M, Ryan D, et al. 2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. Nov 12 2013.

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