The Roux en-Y gastric bypass (RYGB) is a hybrid procedure considered by many to be the mainstay gold standard bariatric operation to which all other procedures are compared with. In various forms, it has been performed for close to half a century and is the most studied in the scientific literature. The procedure is typically performed laparoscopically. It involves the creation of a small gastric pouch and the rerouting of part of the small intestine — though to a much lesser degree than with the duodenal switch (DS). Therefore, there are fewer metabolic side effects and lower complication profiles. It is similar to the DS, however, in that resolution of medical comorbidities, especially diabetes, is independent of weight loss and relates to changes in the hormonal milieu resulting from the intestinal bypass component.
There are some differences in the manner various surgeons perform a standard gastric bypass. These relate to technical nuances of pouch creation, anastomoses (hook-ups), and/or minor alterations to intestinal limb lengths. Named subtypes do exist, but these are fundamentally similar to a regular RYGB. Patients, however, should be aware of two exceptions: the mini gastric bypass and the distal gastric bypass (with or without remnant gastrectomy). The former is also known as the loop gastric bypass or the mini-sleeve bypass. It is fundamentally different from the standard RYGB due to biliary juices no longer being diverted away from the long gastric pouch. As a result, bile reflux can develop, which in the scientific literature has been implicated as potentially carcinogenic. Until more is known about the mini gastric bypass, the American Society for Metabolic and Bariatric Surgery does not condone its performance.
The distal gastric bypass has been proposed either as a primary procedure or as a rescue operation for a “failed” standard RYGB. As with the DS, significant intestinal rerouting is carried out. In contrast, however, the stomach size remains small just as with a standard gastric bypass. Significant malabsorption is, therefore, not countered by the ability to eat a larger volume of food. This can lead to major metabolic derangements, requiring hospitalizations for nutritional support and revisional surgery. Some surgeons even remove the remnant stomach, a step not performed during a standard RYGB. This complicates the management picture, as in cases of malnutrition, when the conduit for tube feedings no longer exists.
It is important to fully understand the type of procedure being offered, and to further review its parameters with your own doctor and family. At University Bariatrics, we do not believe that patients should be exposed to such unwarranted risks. Our expert team has successfully performed hundreds of laparoscopic Roux en-Y gastric bypasses with no fatalities, staple line leaks, anastomotic strictures, or conversions to open surgery. Our results reflect our constant and unwavering commitment to the three fundamental pillars of successful bariatric surgery: patient education, preparation, and operative safety.
To watch an animated video of a gastric bypass, please here.
Gastric Bypass FAQ
What is a Roux-en-Y Gastric Bypass?
Long considered as the gold standard bariatric procedure, the “Roux-en-Y Gastric Bypass” or RYGB is a hybrid operation where both the stomach size is reduced and a segment of the small intestine is bypassed.
We recommend the RYGB because it offers the following benefits:
•Average loss of 60% to 80% of excess weight
•Causes early fullness, decreased hunger, and some malabsorption
•Full remission or improvement in conditions such as type 2 diabetes, gastroesophageal reflux disease (GERD) and hypertension
•Increased life expectancy
•Positive and very early effects on insulin resistance, which are weight loss independent and related to the physical alterations to the gastrointestinal tract
At University Bariatrics, we perform the RYGB using minimally invasive techniques. To qualify for this procedure, patients must have a Body Mass Index (BMI) of 40 or greater, or a BMI of 35 or greater plus a medical condition such as type 2 diabetes, high blood pressure or sleep apnea. RYGB benefits have also been well documented in diabetics with lower BMIs.
How is Roux-en-Y Gastric Bypass Performed?
The Roux-en-Y Gastric Bypass surgery, the process begins with the surgeon creating a small-sized gastric pouch from the top of the stomach. The pouch on average is approximately one to two ounces in volume, and functions to limit the food intake levels of the patient.
The next step is dividing the small intestine into two parts known as “limbs”: the biliopancreatic limb and the Roux limb, from which the procedure gets its name. The biliopancreatic limb is located at the beginning of the small intestine. The biliopancreatic limb contains digestive juices from the stomach, bile, and pancreas.
The Roux limb on the other hand is in the middle portion of the small intestine which is known as the jejenum and is connected directly to the pouch. The food flows directly from the gastric pouch into the Roux limb, and bypasses most of the stomach and the hormonally active part of the small intestine. The remaining stomach continues to create digestive juices however these flow directly into the biliopancreatic limb which is reattached below the Roux limb. This intersection forms a “y” shape, which is where that part of the surgery gets its name.
What Preparation is Required Before Roux-en-Y?
Patient preparation before surgery is always determined on a case-by-case basis. However, there are certain general parameters which all patients must follow. One is enrollment in a pre-surgery nutrition program and meeting with a psychologist and a nutritionist. This reduces postoperative complications significantly. The University Bariatrics dietician will create a plan tailored specifically to your goals.
What Happens After the Roux-en-Y is Performed?
Here at University Bariatrics we take immense pride in the superior level of care which we provide for our patients. Our dedicated team will develop a personalized, individual postoperative program for you with monitoring, guidance and support after the procedure.
Must I follow a specific diet after having the Roux-en-Y procedure?
No! With all bariatric procedures we strongly suggest an adjustment to both the lifestyle and the diet of the patient, favoring a healthier diet and more exercise. However, there is no requisite diet after the recovery period for the procedure has passed.
Is it still possible to get pregnant after having the Roux-en-Y procedure?
Yes! In fact, many of our bariatric patients encounter greater success attempting for a pregnancy after having undergone their bariatric procedures! Oftentimes infertility is a comorbidity of obesity, and once the patients’ obesity has abated, they have been able to become pregnant!
Why University Bariatrics?
When performed properly, weight loss surgery is indeed a highly effective tool to significantly improve patients’ long-term health and quality of life. Before making the decision to undergo surgery, though, prospective bariatric patients should first be certain that they’re receiving the very best care.
Over one thousand patients have trusted the experience and expertise at University Bariatrics & its founder, Dr. Amir Mehran. As a well-known & respected member of the California bariatric surgery community, he is credited with over 200 surgical publications & invited bariatric presentations, and considered to be an early pioneer and champion for vertical sleeve gastrectomy in Southern California. He is certified by the American Board of Surgery; served as an Associate Professor of Surgery and Director of Bariatric Surgery at UCLA; and has repeatedly been peer elected to the highly selective Southern California Super Doctors (2010-2016).