Roux En Y Gastric Bypass Surgery

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Roux En Y Gastric Bypass Surgery

 

Roux en y gastric bypass surgery is arguably the most popular bariatric surgical procedure performed in the western world. It was first performed by Swiss surgeon, Cesar Roux. It is a procedure that has both restrictive and malabsorptive function.

What do I mean by that?

Restrictive in the sense that part of the surgery is designed to reduce the size of the stomach limiting the amount of food you eat.

Malabsorptive given the fact that, the second aspect of the roux en y surgery bypasses some part of the small intestine where absorption of food takes place, thereby limiting the amount of calories absorbed.

 What is involved and how does the roux en y gastric bypass surgery work?

This weight loss surgery is one where a small stomach is fashioned out by the bariatric surgeon. Staples or a silastic band are applied to the upper part of the stomach wall to make the upper stomach smaller. This achieved by creating a pouch.

The whole idea here is to create a pouch in the upper stomach such that the volume of the usual stomach is significantly reduced. This way, you can only practically eat very little as you will fill up pretty quickly. Less food consumed means less calories available to be absorbed.

This small pouch is then attached by the surgeon to the upper part of the small intestine bypassing the lower half of the stomach and the duodenum and sometimes the jejunum depending on the doctor’s preference.

The reason for this bypass aspect is to reduce the amount calories available for absorption. Less calories absorbed means less excess calories available to be deposited as fat. How much absorption of food into our body largely depends on the total functional length of the small intestine.

Therefore the shorter the functional length of the small intestine is, the less absorption that takes place and this is what your bariatric surgeon would aim at in the second aspect of this life-saving procedure.

 How is roux en y gastric bypass surgery performed?

 The roux en y gastric bypass surgery can be performed either via the laparoscopic route (key hole) or through open surgery.

If you have to choose between the open procedure and the laparoscopic one, my advice would be to go for the laparoscopic alternative.

Why…..because the laparoscopic approach is much better. The recovery time is much less and the length of hospital stay is shorter. The only downside is that, the laparoscopic approach requires a lot more skill which some bariatric surgeons do not possess but that situation is changing....fast.

When done laparoscopically, the bariatric surgeon will make a small cut around your belly button through which a long instrument is introduced inside the belly, after introducing a body-friendly gas inside the belly to make space for manipulation of the operating instruments.

Additional long instruments are introduced to help with the manipulation of the stomach, small and large bowel.

The roux en y surgical procedure is then performed, creating a small stomach pouch which is then stitched to the upper part of the small intestine bypassing the larger lower stomach and the first part of the small intestine.

The gas is then expelled from the belly and the incisions closed up. The same procedure is done when the open approach is adopted. The only difference is that the bariatric surgeon makes a bigger incision and therefore has better access with which to perform the operation.

However as a trade-off, the recovery time from the open surgery is twice as long and you stay much longer in hospital before discharge.

 Who is the right person for the roux en y gastric bypass surgery?

You should consider this weight loss surgery if:

 

What happens after you leave hospital following roux en y gastric bypass surgery procedure?

You will be expected to leave hospital after about 2 days if you had the procedure done laparoscopically, but might take up to 5 or even 6 days after open surgery.

After a roux en y gastric bypass surgery, your bariatric surgeon will arrange follow-up care before you leave hospital. Your sutures will be removed around the 7th day after surgery and any relevant wound care will be provided.

The surgery is just one aspect of the procedure. Other aspects that are just equally important are dietary and exercise advice. These all work together to enable you achieve your target weight loss goals, and your bariatric clinic should ideally provide these.

You should be able to start your usual routine duties i.e back to normal life within 4 weeks unless there is a complication from the procedure.

 What kind of diet can I expect after roux en y gastric bypass surgery?

You will learn to adapt to a new way of eating ultimately after the surgery. Soon after the operation, your initial diet will be liquid type for the first couple of days to allow for the new pouch to small intestine connection to heal.

You will then progress to semi-solid diet which you will maintain for about 4 weeks or thereabout. You will need to learn at this point that the size of the stomach pouch is such that it cannot accommodate both food and drinks at the same time.

So you will need to drink in between meals and this is important to avoid dehydration.

Once your bariatric doctor and dietitian are happy with your progress, solid food will be introduced.

You will need to understand at this juncture that the solid food you eat would need to chewed thoroughly before swallowing to prevent indigestion and vomiting.

Your situation will be monitored closely to ensure your progress is sustained and your solid diet requirements are stabilised as this is essentially a life-long project.

Welcome to the new you!

 What are the health advantages and how much weight can you expect to lose after having the roux en y gastric bypass surgery procedure?

This is one weight loss surgery that has a better success rate compared to restrictive procedures.

There is evidence to suggest over 70% loss of excess body weight is lost over 5 years in individuals who undertake this bariatric surgical procedure. However much of the weight loss occurs in the first 18 months of having the operation.

The weight loss achieved through this procedure is sustainable in the long term especially if the patient demonstrates dietary discipline. There is good evidence to suggest too that only 10% of weight is regained following this bariatric surgery even after 12 years.

Over 90% of patients who have had this surgical procedure have had documented improvements in their health problems like diabetes, sleep apnoea, high blood pressure.

 What are the health disadvantages or risks of roux en y bypass surgery procedure?

 What you however need to decide when considering these risks, is whether the health benefits of surgically managing morbid obesity outweighs the risks associated with this procedure.

 How can the nutritional deficiencies of roux en y gastric surgery be taken care of?

As explained earlier, bypass bariatric procedures can by their very nature result in nutritional deficiencies depending on the part of the intestine that is bypassed.

In the case of the roux en procedure, iron absorption as well as vitamin B12, vitamin D and consequently calcium are affected.

The way to tackle this deficiency is to take supplements to replace them. Supplements like iron tablets, vitamins are readily available both online and offline but you may need to take them for the long term, possibly for life to prevent complications like osteoporosis.

These nutritional supplements can be taken as pills, nasal sprays or regular injections….your choice.


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