What is Roux-en-Y gastric bypass surgery?
The Roux-en-Y gastric bypass (RYGB), commonly referred to as gastric bypass surgery, is a surgical procedure performed laparoscopically (keyhole surgery) by Dr Ozmen to assist in weight loss.
Roux-en-Y gastric bypass procedures have been performed for over 20 years and account for about 40% of weight loss operations performed worldwide. Health agencies base evidence on gastric bypass surgery meaning it is now recognised as the gold standard in surgical weight loss procedures against which other methods are considered.
RYGB surgery is performed under general anaesthetic and alters the pathway that the food you eat takes from your stomach to the small bowel. During the surgery your upper stomach is stapled and reduced to the size of a small pouch. The original stomach remains in place but is completely separate to the new smaller pouch stomach. The new stomach is then surgically attached to the middle of the small intestine; the Roux limb which forms a “Y” shape thus bypassing the duodenum. Although the rest of the stomach and duodenum are not removed from the body, they are no longer a working part of the digestive tract.
How does Roux-en-Y gastric bypass surgery assist in weight loss?
Gastric bypass surgery assists in weight loss through two methods. The reduced size of the new stomach pouch limits the amount of food you are able to eat and a feeling of satiety (fullness and satisfaction) sooner together with hormonal effects due to the early passage of food into the intestine which reduces the amount of fat and calories your body absorbs. The surgery also results in taste changes with less desire to eat carbs and sweet foods.
The other noted benefits associated with gastric bypass surgery include its effectiveness on how much weight is lost combined with the length of time the weight loss lasts.
How much excess weight is generally lost with Roux-en-Y gastric bypass surgery ?
Although each individual is different and a number of factors determine how much weight you will lose, gastric bypass surgery is highly effective and creates greater weight loss than most other procedures.
Typically at 6 months you can expect to have lost about 30-40% of your excess weight. This will increase up to an average of 70% of your excess weight in year 1. Although 70% is an average – some patients will lose less and some may lose up to 80% of excess weight.
Over time your body will adjust seeing your excess weight loss reduction of approximately 50 – 60% over a ten year period.
What are the other health benefits (other than weight loss)?
Studies have shown Roux-en-Y gastric bypass surgery resulted in significant health benefits and improved well being including the following:
- Long term remission of type 2 diabetes in many instances allowing most patients to remain insulin free for a minimum of 3 years after the surgery.
- Improved heart health. A decrease in the risk of coronary heart disease and stroke.
- Return to normal blood pressure and cholesterol levels
- Improved mental health through relief of depression and isolation caused by poor self image and social stigma associated with obesity.
- Elimination of obstructive sleep apnoea
- Improved joint health and possible elimination of the requirement of joint replacement surgery due to less strain on load bearing joints.
- Improved fertility and pregnancy.
- Eliminate stress urinary incontinence.
What are the risks and potential complications?
Roux-en-Y gastric bypass surgery is considered a safe, effective procedure for weight loss for suitable candidates. As with any surgical procedure there are risks involved, however, there are generally a few associated with gastric bypass.
There are two categories of surgical risk:
General surgical risk associated with any surgical procedure.
General surgical complications include infection, post-operative bleeding, blood clots, pneumonia/chest infection, wound breakdown or haematoma (bruising). The risk of general surgical complications increases with other factors such as obesity, smoking, cardiovascular problems and diabetes.
Risks specific to gastric bypass surgery.
Dr Ozmen will discuss the risks specific to you prior to your surgery, however surgical risks and potential long-term complications specific to gastric bypass surgery include:
- Dumping syndrome. The symptoms for this include abdominal cramps, nausea or vomiting, dizziness, rapid heart rate and diarrhoea and can occur after bypass surgery when the food you eat (in particular sugar) moves into your small bowel too quickly.
- Low blood sugar
- Bowel obstruction
- Hernias (internal)
- Marginal ulcers
- Leak and bowel perforation
- vitamin and mineral deficiencies
Who qualifies for Roux-en-Y gastric bypass surgery?
Gastric bypass is most suitable for heavier patients which is why it is more commonly performed in the super morbid obese.
Ideally, a suitable candidate for gastric bypass surgery will have a body mass index (BMI) of 40 or higher or a BMI of 35 or more and have associated health problems related to your excess weight such as type 2 diabetes or high blood pressure.
People who are committed to follow up and lifestyle change.
What is the cost?
Roux-en-Y gastric bypass surgery is an elective procedure that is currently performed mainly in private hospitals. A portion of the cost is covered by some private health insurance policies. You may also be eligible to access your Superannuation funds as weight loss surgery has recognised health benefits.
Please contact Sydney GI Surgery for an accurate assessment of the cost involved.
Preparing for weight loss surgery
To ensure the best possible outcome from your surgery, a low calorie pre-operative diet is recommended. The purpose of this diet is to shrink your liver by reducing fat in your liver making the surgery easier and safer. To achieve this, Dr Ozmen will recommend a 2-3 week meal replacement program.
Dr Ozmen performs gastric bypass surgery laparoscopically (by keyhole) to minimise your recovery time. All patients recover differently and Dr Ozmen will discuss your specific risks with you prior to your surgery, however in general, recovery will usually require between 2-3 days in hospital before returning home. Normal activities can usually be resumed after 2 weeks, with full recovery anticipated in 4 weeks. After your gastric bypass surgery you will be required to adopt a strict diet in the first 2 weeks following surgery. Your diet will be clear liquids and gradually increases in consistency with the introduction of solid foods. Once you have fully recovered from your surgery, you will be able to eat most food types (although in smaller quantities) with a reduced intake of sugar and carbohydrates.
Life after Roux-en-Y gastric bypass surgery
The high success of this procedure and the improved quality of life following surgery, makes gastric bypass surgery the recognised gold standard surgical procedure for weight loss. One advantage of gastric bypass surgery over other surgical procedures for weight loss is that patients are able to eat most types of food (although in smaller portions). Additionally, Gastric bypass surgery has fewer long- term risks compared to some other weight loss procedures. You will also need to add daily supplements to your diet.
As with any surgical procedure, gastric bypass is used as tool for weight loss and its success requires your personal commitment to lifestyle change including a healthy, balanced diet and regular exercise. The regain of weight is common after any weight loss surgery where healthy lifestyle choices are not adopted.
Dr Ozmen will provide access to dieticians who specialise in weight loss surgery after care and can assist you in adopting a healthy eating plan post surgery.