The Roux-en-Y Gastric
Bypass is generally
considered to be the best
surgical procedure for
the treatment of morbid
obesity. Weight loss is
achieved by reducing the
functional portion of the
stomach to a pouch one
ounce or less in size,
and by creating a stoma,
a small opening between
the stomach and the
intestine. The small size
of the stomach pouch
causes the patient to
have a sensation of
fullness after eating
only a small portion of
food. The small stoma
delays stomach emptying,
making the sensation of
fullness last longer.
These are called the
Restrictive components of
the procedure. The limb
of intestine coming down
from the small pouch is
called the Roux limb. The
limb of intestine coming
down from the bypassed
portion of the stomach
can be called the Biliary
or Bypassed limb. The
remaining portion of the
intestine is called the
Common Channel.
Food does not pass down
the Bypassed limb, only
the Roux limb and the
Common Channel. The
longer the Bypassed limb,
the less the length of
intestine actively
working to absorb
nutrients from the food
that is eaten. Digestive
juices that normally help
absorb nutrients from the
food enter the Bypassed
limb from the larger
portion of the stomach,
the liver, and the
pancreas, and pass down
the Bypassed limb to the
Common Channel. These
juices do not mix with
the food while it is
passing down the Roux
limb. The longer the Roux
limb, the longer the
portion of intestine
trying to absorb
nutrients without the
benefit of these
digestive juices. Both of
these changes result in
less absorption of
nutrients and contribute
to weight loss, and are
called the Malabsorptive
components of the
procedure.
Exactly how the operation
is done for an individual
patient depends on their
individual anatomy, their
general health status,
whatever changes they may
have from prior
surgeries, and what they
hope to be achieve from
the operation. The
stomach compartments can
be completely divided
from each other or simply
partitioned, the small
stomach pouch and the
intestinal limbs may be
connected to each other
with either staples or
sutures, a small band may
be placed around the
stomach pouch, and the
two intestinal limbs may
be made longer or
shorter.
Patients will be on a
clear liquid diet for the
first few days
immediately following
surgery, and then advance
to a pureed diet. These
foods will be very soft,
so as to pass through the
small, newly formed pouch
and stoma. One of the
main issues during this
period will be adequate
fluid intake, and
dehydration can be a
problem for patients
recovering from this
surgery. We will ask
patients to take in at
least 32 ounces of liquid
a day before leaving the
hospital.
Approximately one month
after surgery the
patients can expect to
advance to a transitional
diet. They begin to take
more regular table foods,
but will often still go
back to eating the pureed
foods that they have
tolerated well. They will
still be learning how to
eat right, including
chewing food carefully,
learning to drink most of
their liquids between
rather than with meals,
and learning that eating
the wrong foods, such as
sweets or fatty foods,
can make them ill.
Patients experience the
most rapid weight loss
during this period. They
are often thrilled to see
the weight coming off,
sometimes at the rate of
20 pounds a month, but it
is not an easy time.
Patients feel the loss of
calories taken in, and
are sometimes low in
energy. Their small pouch
will make them
uncomfortable when they
eat too much or too fast.
They may have diarrhea,
which can usually be
controlled by avoiding
certain foods or by
taking medication. They
may experience hair loss,
though the hair usually
begins to grow back
within a few months.
At 6 months the patients
will probably be on their
long-term maintenance
diet, which is more or
less what and how they
will eat for the rest of
their lives. The
maintenance diet for the
most part consists of
regular table foods, but
in small portions. Most
patients describe their
meals as child sized, and
they often do not finish
what they are served. The
patients generally become
comfortable eating these
small meals, and almost
always say the loss of
the ability to enjoy
large meals or certain
foods is more than
compensated for by being
able to successfully
control their weight.
Patients may expect to
lose approximately 70% of
their excessive body
weight during the first 2
years following surgery.
An approximately 10%
weight regain is
sometimes seen between
years 2 and 5, perhaps
because the small pouch
increases several ounces
in size, and perhaps
because the patients
learn how to take in
extra calories without
making themselves sick.
