Roux-en-Y Gastric Bypass
The Roux-en-Y gastric bypass (RYGB) has existed for over 30 years and was originally popularised in America. For many years, the RYGB has been recognised as the ‘gold standard’ for weight loss but comes with significant operative risk and long-term complication profile which many patients and clinicians find unsatisfactory.
At Circle of Care, we only recommend this operation when the benefits outway the risks on an individual patient basis. The most common indication is chronic gastro-oesophageal reflux disease (GORD) and Barrett’s oesophagus.
What is the procedure?
Once a general anaesthetic has been administered, five key-hole ports are inserted into the patient’s abdomen. Similar to the Omega loop gastric bypass, the operation begins by dividing the lesser omentum (a strip of fat between the stomach and liver), allowing a stapler cutting device to be placed across the lesser curve of the stomach to create the new gastric pouch. The pouch is stapled and divided away from the rest of the stomach over a calibration tube to ensure that the correct size is obtained.
The remainder of the stomach is not removed in this procedure. However, it is now disconnected away from the main of passage of food.
Similar to our gastric sleeve technique at Circle of Care, we place additional sutures, imbricating or burying the top of the staple line of the pouch to prevent leakage.
At the 60cm mark, the small intestine is divided with a stapler cutting device, with the downstream end pulled up to the new small gastric pouch and connected to it using a combination of the stapler and laparoscopic sutures. This creates a join, with a double of layer of sutures placed in order to prevent a join leak. What was the upstream end of the divided small intestine is then reconnected to the gastrointestinal circuit, 100cm from the new gastric pouch-intestinal join.
In the newly-created gastrointestinal circuit, food passes from the oesophagus to the pouch, then through the join to the intestine. Unlike the Omega Loop Bypass, food then travels another 100cm before it mixes with bile and pancreatic juice. Only then is it properly digested and has a very small distance of small intestine to travel where absorption can occur before it reaches the colon.
The operation is then completed by closing the mesenteric defects with permanent suture material. These potential spaces are created when positioning the bowel in its new configuration and if not properly closed increase the risk of internal hernia in the future.
Internal hernia can present clinically as mild intermittent colicky pain right
through to the other end of the spectrum with complete bowel obstruction requiring emergency surgery.
All wounds are closed with buried dissolvable sutures and local anaesthetic injected to numb the port sites. Photo documentation is taken throughout the case in order to show our patients step by step how their procedure progressed.
How does it work?
As the stomach is now much smaller, a person’s appetite is significantly reduced and portion size greatly diminished. In addition, bypassing 100cm of small intestine means not as many calories are able to be absorbed in the short distance of remaining intestine that food travels through before reaching the colon. This leads to substantial weight loss over a 12 to 18-month period. Over this time, an average of 75 to 85 percent excess weight is lost.
A full blood panel needs is required every 6 months for the remainder of the patient’s life as early detection of nutrient deficiencies is essential with gastric bypass surgery .Rapid decline in Vitamin D, Calcium, Vitamin B12 and iron stores can lead to anaemia, osteoporosis and loss of sensation in the hands and feet.
Our allied health program will advise you in adapting your eating technique to get the most out of your RYGB and coach you towards long-term lifestyle change.