What is Roux-en Y (RY) gastric bypass?

Roux-en Y (RY) gastric bypass or gastric bypass is an established surgical treatment for morbid obesity. This is usually performed with laparoscopy or “key-hole” surgery. It involves partitioning the stomach into a small pouch and re-arranging part of small bowel. The small stomach pouch, about the size of one's thumb, is fashioned with surgical stapler and separated from he remainder of stomach. The upper half of small bowel is sectioned and re-arranged into 2 limbs - Roux or the 'food' limb and biliopancreatic or “ digestive enzyme” limb. The “food” limb is then connected to the small stomach pouch to restore the continuity of gut and the “digestive enzyme” limb connected to the “food” limb downstream to allow digestion of food and absorption of nutrients in the “common” limb. With gastric bypass, patients feel full and satisfied with small portion of food. In addition, the re-arrangement of small bowel triggers hormonal changes that suppress hunger and improve diabetes.

Why choose gastric bypass?

The advantages of gastric bypass are:

1. Gastric bypass has a proven track record (> 30 years) with consistent results, it is the most commonly performed weight loss surgery worldwide.
2. It achieves greater weight loss than gastric sleeve and gastric band.
3. It improves or cures diabetes.
4. Despite smaller food portion, patient can still enjoy a variety of food and quality of eating.
5. Gastric bypass can cure reflux disease or ‘ heartburn’.
6. No post-operative adjustment required.
7. It can also be a ‘salvage’ procedure for other ‘failed’ or complicated bariatric surgery.

What are the disadvantages of gastric bypass?

The disadvantages of gastric bypass are:

1. Gastric bypass is a more complex and longer surgery than gastric band and sleeve, and hence its risk is slightly higher. However it can be performed safely with key-hole surgery and overall risk of potential significant complication is less than 5%.
2. Leakage from joint from gastric pouch to small bowel (2%)
3. Bleeding from staple line (1%)
4. Sometimes gastric bypass can only be done with open incision.
5. Longer operating time (2-3 hours for primary gastric bypass and up to 6 hours for revision gastric bypass) and longer hospital stay (4-5 days)
6. Not easily reversible
7. Greater nutritional surveillance required including blood tests.

When will I see results?

Patients may start to see weight loss within the first month after surgery. However, total weight loss usually happens between 12 to 18 months after the procedure. It can vary based on individual diet and exercise habits, and adherence to doctor's recommendations. Patients are encouraged to lead a healthy lifestyle for the best results.

Should I be followed up after surgery?

Yes, long-term follow up is mandatory. 6 to 12 monthly nutritional surveillance with blood test to ensure adequate nutritional health.