Roux-en-Y Gastric Bypass Weight-Loss Surgery
What is gastric bypass weight-loss surgery?
Roux-en-Y gastric bypass (RYGB) is a type of weight-loss surgery. Weight-loss surgery
is also called bariatric surgery. It’s often done as a laparoscopic surgery, with
small incisions in the abdomen.
This surgery reduces the size of your upper stomach to a small pouch about the size
of an egg. The surgeon does this by stapling off the upper section of the stomach.
This reduces the amount of food you can eat. The surgeon then attaches this pouch
directly to part of the small intestine called the Roux limb. This forms a “Y” shape.
The food you eat then bypasses the rest of the stomach and the upper part of your
small intestine. This reduces the amount of fat and calories you absorb from the foods
you eat. It also reduces the amount of vitamins and minerals you absorb from food.
Why might I need gastric bypass weight-loss surgery?
Gastric bypass surgery is used to treat severe obesity. It’s advised for people who
have tried other weight loss methods without long-term success. Your doctor may advise
gastric bypass surgery if you are severely obese with a body mass index (BMI) over
40. Your doctor may also advise it if you have a BMI between 35 and 40 and a health
condition such as sleep apnea, high blood pressure, heart disease, or type 2 diabetes.
Gastric bypass can help a person lose about 100 pounds of excess weight. It may also
improve, or in some cases even reverse type 2 diabetes. It can also improve or stop
heartburn and reflux. Weight-loss surgery can also lower the risk for high blood pressure
or improve it for people that already have it. A gastric bypass can also help with
sleep apnea, and certain other health problems such as high cholesterol.
What are the risks of gastric bypass weight-loss surgery?
Bleeding, infection, and blood clots in your legs are possible side effects that may
occur after any surgery. General anesthesia may also cause breathing problems or other
reactions. You may also have leaks from the stomach pouch or the Roux limb.
Possible problems over time may include:
Low levels of vitamins if you don’t take supplements daily for the rest of your life
Low levels of iron and calcium
Trouble getting enough protein
Dumping syndrome. This can cause nausea, fast heartbeat, abdominal cramping, fainting,
and diarrhea after eating.
Narrowing of the sites where intestines are joined (stenosis or stricture)
Dangerous internal hernia, in which the small intestine can be trapped and blocked
Hernia at the port sites
Poor healing of the incision sites
Need for additional surgery
Failure to lose enough weight
Weight regain, if you snack on high-calorie foods and don’t exercise
Loss of too much weight too quickly. This can cause sagging skin that may need to
be removed surgically.
Gallstones. This requires surgery to remove the gallbladder.
You may have other risks based on your health. Make sure to talk with your healthcare
team about any concerns before the surgery.
How do I get ready for Roux-en-Y gastric bypass surgery?
Your healthcare team will need to make sure that gastric bypass surgery is a good
option for you. Weight-loss surgery isn’t advised for people who abuse medicines or
alcohol, or who are not able to commit to a lifelong change in diet and exercise habits.
Before having surgery, you’ll need to enroll in a bariatric surgery education program.
This will help you prepare for surgery, and life after surgery. You’ll have nutritional
counseling. And you may have a psychological evaluation. You’ll also need physical
exams and tests. You will need blood tests. You may have imaging studies of your stomach,
or have an upper endoscopy.
If you smoke, you will need to stop several months before surgery. Your surgeon may
ask you to lose some weight before surgery. This will help make your liver smaller,
and make surgery safer. You’ll need to stop taking aspirin, ibuprofen, and other blood-thinning
medicines in the days before your surgery. You shouldn’t eat or drink anything after
midnight before surgery.
What happens during Roux-en-Y gastric bypass surgery?
The surgery usually takes several hours.
You will have general anesthesia for your surgery. This will cause you to sleep through
the surgery, and not feel pain.
Your surgeon may use laparoscopy. He or she will make several small cuts (incisions)
in your abdomen. The surgeon will then insert a laparoscope and put small surgery
tools into these incisions.
The surgeon will use a laparoscopic stapler to make a small stomach pouch with the
upper part of your stomach.
He or she then uses the stapler to divide the upper part of your small intestine into
a tube with two ends.
One end of the small intestine (the Roux limb) is brought up to the stomach pouch,
and a small connection (anastomosis) is made between them. The other end of the small
intestine is then connected to another part of the small intestine.
Then your surgeon may test for leaks with a dye study or an upper endoscopy.
What happens after Roux-en-Y gastric bypass surgery?
You may stay in the hospital for 1 to 2 days after the surgery. Talk with your doctor
about wound care, safe pain medicines, and when you can start physical activity. Your
doctor will tell you how often to change the dressing on your incision.
Tell your doctor right away if you have any of the below:
Your wound becomes painful or hot to the touch or leaks fluid
Coughing or trouble breathing
Vomiting and diarrhea
Blood in your bowel movement
Pain in the abdomen, chest, shoulder, or legs
Any other problems or symptoms
You will likely only have liquids for the first 1 to 2 weeks after surgery. Your doctor
may slowly add soft food and then regular food to your diet about a month after surgery.
You will be need to chew slowly and fully, and not to drink 30 minutes before or after
Your initial weight-loss may occur quickly, so it's important to get all of the nutrition
and vitamins you need as you recover. Your doctor will prescribe vitamin and mineral
supplements that your body may no longer absorb well from food alone.
To prevent nutritional problems after gastric bypass surgery, many doctors advise:
Daily multivitamins. You should take a daily multivitamin that contains 200% of the daily values.
Daily calcium supplements. Multivitamins with calcium may not protect bone health. You may need 1,600 to 2,000
IU vitamin D and 1,600 mg calcium daily. Take a calcium supplement at least 2 hours
after your multivitamin.
Vitamin B-12 supplements. Doctors advise vitamin B-12 supplements for all people who have had weight-loss surgery
to help prevent bone fractures. You can take this by mouth several times a week. Or
you may have B-12 injections every month.
Oral vitamin D supplements. You may need this if you have low levels. Your doctor may prescribe 50,000 IU of
vitamin D taken by mouth once a week for 8 weeks. Some people need lifelong vitamin
Iron supplements. After gastric bypass surgery, the amount of iron in a multivitamin may not be enough
to prevent anemia. You may need an additional 50 to 100 mg of elemental iron a day.
Taking vitamin C will help your body absorb iron. Ask your doctor about the recommended
dose for you.
Because nutritional deficiencies can happen after this surgery, experts recommend
that your blood be tested at least every 6 months for the rest of your life to ensure
that you are getting the right amount of vitamins and minerals.
During weight-loss, you may have body aches, dry skin, mood changes, and temporary
hair thinning, and feel tired and cold. As your weight stabilizes, these problems
should go away. Weight loss continues for about a year, and then will stop. After
a year, you may be able to eat more if the pouch stretches. You should use the first
year to develop good eating and exercise habits that will keep you from regaining
Along with follow-up appointments with your doctor and surgeon, you will likely see
a dietitian who will teach you how and what to eat with your reduced stomach size.
You may also need to see a psychologist to help you deal with the feelings and concerns
over your changed lifestyle.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure