Laparoscopic Roux-en-Y Gastric Bypass (RYGB)

Roux-en-Y Gastric Bypass (RYGB) is a surgical procedure typically performed to induce weight loss. The procedure is restrictive and malabsorptive in nature.

Laparoscopic RYGB involves the use of slender surgical instruments inserted into the abdomen. The instruments are inserted into the abdomen through small incisions. A small camera (laparoscope) is also inserted into one of the incisions; this allows the surgeon to view the procedure on a video monitor.

Laparoscopic RYGB is less invasive than an open RYGB. Laparoscopic RYGB is usually associated with a shorter hospital stay, a more rapid recovery, and a decrease in the incidence of wound infections.

Once the surgical instruments and camera are in place, there are two basic steps in the procedure:

1. A small "pouch" is created by surgically separating and stapling across the stomach. The bottom portion of the stomach remains intact; however, it will not function as a food storage area as it once did. The pouch is typically 30 mL, or about the size of a medium egg, therefore, it restricts the amount of food that can be consumed at a given time. The newly created "pouch" will hold food before releasing it into the small intestines.
2. Surgically dividing the small intestine and connecting a portion of it to the "pouch". This creates malabsorption as food will now travel through the pouch and into this new connection, or "Roux limb". This "bypass" of the bottom portion of the stomach and a segment of the small intestine, decreases the absorption of calories, as well as certain nutrients.

Recovery
The importance of lifelong, daily supplementation is critical to combat the decreased nutrient absorption typically experienced after RYGB.

Your surgeon may recommend the following supplements after surgery:
1. Protein supplements
2. Multivitamin and mineral supplement
3. Chewable calcium supplements (to provide 1000-1200 mg/day)
4. Sublingual vitamin B-12 supplements (1000 micrograms/week)

Attendance in the Pre-Operative Nutrition Class is important to understand the dietary changes necessary in your success following surgery. In addition to supplements, your dietary habits will change. Fatty foods and fatty meats should be avoided as you may not be able to tolerate large amounts of fat after surgery. Simple sugars should also be avoided as they can lead to the "dumping syndrome".

"Dumping" involves a group of events that collectively serve as negative reinforcers to eating high-sugar foods such as cake, candy, and cookies. "Dumping" occurs after the rapid emptying of food from the pouch into the small intestine. This portion of the small intestine is not used to this concentrated solution of foods. This rapid release of the sugar causes an immediate influx of fluid and distention of the intestine. Other symptoms may include abdominal cramping, diarrhea, nausea, lightheadedness, dizziness. Dumping syndrome may be one of the most important reasons for the greater mean weight loss following RYGB in comparison to other procedures.

Typically, the laparoscopic RYGB patient at Baylor will be discharged from the hospital the day after surgery. You will need someone to drive you home from the hospital.

It is important to follow your physician's instructions, but typically once you are home, you may return to daily activities such as showering, dressing, walking, etc. The following are also typical instructions unless directed otherwise by your physician. Do not soak in a tub, hot tub, or swimming pool. You can clean your incisions with soap and water and then keep dry. Avoid lifting anything over 15 pounds until cleared by the doctor. You may drive in 3-4 days as long as you are not taking any pain medication. Sexual activity may be resumed, as you feel able. Women of childbearing age may experience an irregular menstrual cycle and should take full measure to prevent pregnancy until 1 year after surgery.

Risks
Your surgeon will discuss the risks of RYGB surgery with you and give you the opportunity to ask questions.

Risks may include:

• Nutritional deficiencies
• Pouch irritation
• Staple line leak
• Stricture
• Vomiting (from eating more than the pouch can hold)

Other risks include: Injury to other organs, ventral hernias, wound infections, deep vein thrombosis, heart or lung problems, psychological stress, failure to loose weight, and death.