What is the procedure for a Roux-en-Y (Roux-en-Y gastric bypass) gastric bypass surgery?

Roux-en-Y Gastric Bypass Procedure Summary

Laparoscopic Roux-en-Y gastric bypass is a mixed restrictive and malabsorptive bariatric procedure that creates a small gastric pouch connected to mid-jejunum, bypassing the remaining stomach, duodenum, and proximal jejunum to achieve significant weight loss and metabolic improvements. 1

Surgical Technique

• The procedure begins with the creation of a small (approximately 20 mL) proximal gastric pouch based on the lesser curve and cardia of the stomach 1
• The remaining stomach is left in place but is completely bypassed from the food stream 1
• A Roux limb is created from the mid-jejunum and anastomosed to the gastric pouch 1
• This creates two distinct pathways:
  • The alimentary channel (Roux limb) which carries food from the gastric pouch 1
  • The biliopancreatic limb which transports bile and pancreatic enzymes distally 1
• These two limbs converge at the jejunojejunostomy anastomosis, creating the "common channel" where food mixes with digestive enzymes 1
• The procedure is typically performed laparoscopically using 5-6 trocar incisions, though single-incision techniques have been developed 2, 3

Mechanism of Action

• The small gastric pouch provides restriction, limiting food intake and creating early satiety 1
• Bypassing the duodenum and proximal jejunum creates metabolic effects likely mediated by hormonal changes 1
• The combination of restriction and malabsorption leads to significant weight loss 1

Outcomes and Effectiveness

• Excess weight loss typically ranges from 50-80% (25-45% total weight loss) 1
• Weight loss outcomes are generally superior to sleeve gastrectomy 1
• Significant improvements in metabolic diseases, especially diabetes (88% of patients no longer requiring medications at 1 year) 4
• Resolution or improvement of other obesity-related comorbidities including gastroesophageal reflux disease 5, 2
• Quality of life improvements reported in 95% of patients with more than 1 year follow-up 2

Perioperative Considerations

• Operative time averages 162-234 minutes, with time decreasing significantly with surgeon experience 4
• Median hospital stay is typically 2 days, with most patients discharged within 3 days 4, 2
• Patients generally start oral diet approximately 1.5 days after surgery 2
• Return to work occurs at approximately 21 days post-procedure 2

Potential Complications

• Perioperative mortality is low (0.1-0.9%) 1, 4
• Major complications include:
  • Anastomotic leaks (1.8-5.1%), which decrease with surgeon experience 4
  • Bowel obstruction (2.8%) 4
  • Major wound infections (1.5%) 4
• Minor complications include:
  • Incisional hernias (0.7-1.8%) 4, 2
  • Wound infections requiring outpatient drainage (5%) 2
• The learning curve for this procedure is steep, with complication rates decreasing significantly with surgeon experience (100-150 cases) 6

Contraindications

• History of inflammatory bowel disease 1
• Disease states potentially affected by altered absorption (e.g., post-organ transplantation requiring immunosuppression) 1

Post-Operative Care

• Patients should follow up in a comprehensive management program 1
• General and nutritional lab tests are typically drawn at 6 months and 1 year postoperatively, then yearly 1
• Women should wait at least one year after surgery before becoming pregnant to minimize nutrition-related risks 1
• Monitoring for potential weight regain and nutritional deficiencies is essential 1