Roux-en-Y Gastric Bypass
Roux-en-Y Gastric Bypass (RYGB)
The RYGB is known as the gold standard of weight loss operations. It is a procedure that has been performed for more than 50 years. Its long-term efficacy and safety is well established and documented in medical literature.
What is the RYGB?
In this procedure, Dr Willingham will divide your stomach into two to create a smaller stomach that will hold approximately 80ml. It will be similar in size to a large egg and is known as the ‘pouch’. This pouch will become your new ‘working’ stomach. The small bowel is then divided into two and reconfigured in a way that leaves a Y-shaped segment. This segment will be anastomosed (joined) to the new pouch, bypassing approximately 150-200cm of the top part of the small bowl to complete the circuit. Nothing is removed from your body during this procedure. This technique differs from the One Anastomosis Gastric Bypass as it requires two joins, instead of just one. It is a procedure that can be performed either robotically or laparoscopically (keyhole surgery), leaving you with approximately five small incisions (cuts) in your abdomen.
How does the RYGB help you?
This procedure combines both food restriction and decreased calorie absorption, resulting in significant weight loss. Your stomach will decrease in capacity from approximately 1500ml to 80ml, reducing the amount of food you can eat. Additionally, because 150-200cm of your bowel is bypassed, less of the food eaten is absorbed. Your satiety hormone, leptin, will increase, and your hunger hormone, ghrelin, will decrease, causing you to feel less hunger, and fuller for longer. Other hormones are also affected, improving blood sugar control and diabetes.
Advantages of the RYGB
- Better weight loss results than the Sleeve Gastrectomy and may reduce your excess weight by 70-80%
- More powerful positive effect on diabetes than the Sleeve Gastrectomy. It can reduce its severity or may reverse it completely (the outcome is dependent on how long you have had diabetes and used insulin)
- Can improve other obesity related conditions such as high blood pressure, high cholesterol, sleep apnoea, and osteoarthritis symptoms
- Will frequently resolve reflux
- Less risk of weight regain due to intolerance of fatty or sugary foods, leading to unpleasant ‘dumping’ syndrome – these foods will be avoided!
- Can be reversed, but with some degree of difficulty
Disadvantages of the RYGB
- More complex surgically than the Sleeve Gastrectomy and the One Anastomosis Gastric Bypass
- Eating fatty or sugary foods will lead to dumping syndrome, symptoms of which include stomach cramps and diarrhoea.
- Requires life-long vitamin and mineral supplementation to prevent deficiencies after surgery.
- Not suitable for smokers and regular users of anti-inflammatory drugs (ie ibuprofen).
Risks and Complications of the RYGB
Risks in the Short-Term
(common to most surgical procedures)
- Bleeding during or after the operation
- Damage to organs
- Wound infections
- Chest infections
- Deep vein thrombosis (blood clots in your legs)
- Pulmonary emboli (blood clots in the lungs)
- Leakage or bleeding at the new joins between stomach-to-bowel, and between bowel-to-bowel
- Death (very rare)
- As with any other operation, there are risks associated with having an anaesthetic (please see this section detailing this).
Risks in the Long-Term
- Potential for anastomotic strictures – where new joins over-tighten during the healing process – may require stretching by gastroscopy.
- Potential for adhesions or scar tissue formation within the abdomen that sometimes may require surgery to release (can occur in any abdominal procedure).
- Potential for hernia formation at the site of the wound closure – may require surgery to repair.
- Potential for internal hernia/bowel obstruction, where loops of bowel tangle or twist – may require surgery to correct.
- Potential for development of nutritional deficiencies due to bowel involvement and malabsorptive features of the RYGB – may be avoided with good diet and vitamin/mineral supplementation
- Potential for development of ulcers if patients smoke or regularly use anti-inflammatory medications (ie ibuprofen).
- Potential for failure to lose weight, or subsequent weight regain – most frequently occurs due to poor dietary choices.