Roux-en-Y Gastric Bypass (RYGB)
The Roux-en-Y Gastric Bypass (RYGB) is one of the most commonly performed weight-loss procedures worldwide. It was considered the “gold standard” of weight-loss surgery until recently, at which point sleeve has grown rapidly in numbers and popularity.
It is a combination-type of procedure, that is, weight loss is achieved both by restricting the amount of food ingested and by absorbing less calories and nutrients.
Gastric bypass has two major components. In the first component, the stomach is divided by special staplers into a large portion and a smaller portion called the gastric pouch. The gastric pouch can hold up to a cup or so of food, thus restriction is achieved.
In the second part of the procedure, the gastric pouch is disconnected from the first part of the small intestine (duodenum) and, in turn, is connected to a part of the small intestine further down (jejunum). In this way, a large part of the small intestine is “bypassed” causing malabsorption of nutrients and calories.
Estimated weight loss in the first 1-2 years after gastric bypass is approximately 80-85% of excess body weight, results very similar to sleeve gastrectomy. Up to 50% excess weight loss has been documented 10 years and more after gastric bypass. Moreover, comorbidities associated with morbid obesity significantly improve after gastric bypass. Studies reveal ≥ 90% resolution of type II diabetes and sleep apnoea during the first year after bypass surgery.
Following gastric bypass surgery, people usually stay in hospital for 2-3 days and can resume normal everyday activities within 2-3 weeks.
However, despite the several advantages and excellent results, RYGB still remains a techniquely more demanding procedure than gastric banding and sleeve gastrectomy and carries a higher risk of complications, such as bleeding, staple-line leakage, bowel ulcers, internal bowel hernias, metabolic disturbances (dumping syndrome) etc. In addition, due to the severe malabsorption of nutrients patients need to be followed-up by their surgeon and are committed to certain dietary restrictions and modifications lifelong, such as taking vitamin and mineral supplements.