Roux–en–Y Gastric Bypass Surgery: A Restrictive and Malabsorptive Procedure

Your Plaza bariatric surgeon will do a complete assessment to see if you are in general a candidate for a bariatric procedure such as Roux–en–Y gastric bypass. Be prepared to give an account of your overall state of health and weight–loss history. Your Plaza bariatric surgeon will also conduct nutritional, psychological, and medical evaluations, look at your Body Mass Index (BMI), and discuss any obesity–related health conditions you may have.

According to the American Society for Metabolic and Bariatric Surgery and the National Institutes of Health, Roux–en–Y (pronounced ROO–en–why) gastric bypass surgery is the most popular bariatric procedure in the United States.

Your Plaza bariatric surgeon will create a small stomach pouch and then construct a “bypass” for food. The bypass allows food to skip parts of the small intestine. By skipping a large part of the small intestine, the body cannot absorb as many calories or nutrients.

The following are some of the benefits of bariatric surgery in general, and the Roux–en–Y procedure in particular:

1. A 2004 meta–analysis of more than 22,000 patients showed that those who underwent bariatric procedures such as the gastric bypass experienced complete resolution or improvement of such co–morbid conditions as diabetes, high cholesterol, hypertension, and obstructive sleep apnea.
2. 83.7 percent of type 2 diabetes cases were resolved.
3. In the studies analyzed, the control group that didn’t have bariatric surgery had a nearly fourfold higher risk for type 2 diabetes.
4. Resolution of type 2 diabetes often occurred within days of the surgery.
5. 96.9 percent of all cases of high cholesterol were resolved.
6. 75.4 percent of hypertension cases were resolved; 87.1 percent were resolved or improved.
7. Substantial weight reduction occurred; 61.6 percent of excess weight was lost.
8. In 2000, a study of 500 patients showed that 96 percent of co–morbidities such as back pain, sleep apnea, high blood pressure, type 2 diabetes, and depression were improved or resolved.
9. A great deal of excess weight was lost, and patients experienced resolution of co–morbidities, and improved appearance, social opportunities, and economic opportunities.

Risks and disadvantages of Roux–en–Y gastric bypass may include:

1. Because the duodenum and other sections of the small intestine are bypassed, poor absorption of iron and calcium can cause low total body iron and a greater chance of having iron–deficiency anemia.
2. Bypassing the duodenum can cause metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back, and fractures of the ribs and hip bones.
3. Chronic anemia may occur as a result of vitamin B12 deficiency.
4. A condition known as dumping syndrome can result from eating too much sugar or too large an amount of food at one sitting.
5. The bypassed portion of the stomach, duodenum, and parts of the small intestine cannot be easily seen using X–ray or endoscopy.
6. It is a permanent, nonreversible procedure.
7. There is a small but statistically significant risk of death associated with the procedure.

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Qualifying for Bariatric Surgery

Your Plaza bariatric surgeon will do a complete assessment to see if you are in general a candidate for a bariatric procedure such as gastric bypass surgery. Be prepared to give an account of your overall state of health and weight loss history. Your Plaza bariatric surgeon will also conduct nutritional, psychological, and medical evaluations, look at your Body Mass Index (BMI), and discuss any obesity–related health conditions you may have.

Qualifying Factors

The National Institutes of Health and the American Society for Metabolic and Bariatric Surgery have set minimum requirements for recommending any type of bariatric surgery as a treatment option:

100 pounds or more above ideal body weight or a BMI of 40 or greater, or a BMI of 35 or greater with one or more obesity–related health condition.

Other qualifying factors may include:

1. A documented history of dietary weight loss attempts.
2. A lifelong commitment to complying with dietary, exercise, and medical guidelines.
3. A psychological evaluation.

Together, you and your Plaza bariatric surgeon will take steps to determine:

1. Whether you are a good candidate for surgery.
2. Whether the gastric bypass is an appropriate procedure for you.
3. Whether you are mentally and emotionally prepared to make lifelong lifestyle changes.
4. That you have, or will have, the necessary support system around you.

Expect the prequalification process to include a series of tests. Over several sessions leading up to your surgery, you will meet with a nutritionist and several other members of your Plaza healthcare team. Each will help you prepare for the changes and challenges that lie ahead.

If you believe gastric bypass surgery would improve your health and well–being, contact Plaza Bariatric Services Coordinator Shante’ Legington, RN, CBN, at 817–347–1129 or shante.legington@hcahealthcare.com to launch the prequalification process.

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Preparing for Gastric Bypass Surgery

The presurgical program at Plaza consists of medical, nutritional, psychological, and surgical components. Your Plaza multidisciplinary team will evaluate you before surgery and provides education and treatment after surgery.

Gastric bypass surgery is like other major surgeries. The best way to prepare for it is by knowing the benefits and risks and closely following your doctor’s instructions.

Some things you can do to mentally prepare yourself are to:

1. Understand the surgical process and what to expect afterward.
2. Keep in mind that you’ll never be able to eat the way you did before, and that you’ll have to watch the way you eat for the rest of your life.
3. Talk to people who have had bariatric surgery.
4. Write a letter to yourself and your surgeon explaining your reasons for having bariatric surgery and outlining your plans to maintain your weight–loss after surgery.
5. Start a journal. Record how you feel now, the challenges you face, and the things you hope to be able to do after bariatric surgery;
6. Get a letter of support from your family. It helps to know you have people behind you, waiting to help.

To prepare yourself physically, follow the guidelines your Plaza bariatric surgeon gives you. The guidelines will be based upon your procedure, your personal profile, and other factors. You want to ensure the best possible outcome, and the guidelines will help you do that.

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The Day of Surgery

For many gastric bypass patients, the long–anticipated day of surgery is an exciting end to a long wait. Afterward, patients sometimes refer to it as their “birthday,” because of the life–altering transformation it initiates.

Preparing for the day of gastric bypass surgery is like preparing for many other types of surgery. Your Plaza bariatric surgeon will have specific instructions for you to follow, which will likely include the following:

1. Nothing to eat or drink starting the evening prior to your procedure.
2. Bring all of your medications to Plaza with you, and follow your surgeon’s instructions on how to take them.
3. If you use a C–PAP machine, bring it to the hospital with you.
4. Get to the hospital early.

When you first arrive, there will be a couple of preoperative steps for you to complete. First, you will need to change out of your clothes. Next, an IV line will be started to keep you hydrated and to administer medications such as antibiotics. Then you will be taken to the operating room.

If you are not already under anesthesia before you get to the OR, you will be once you arrive there. Then, you will be intubated and your surgeon will perform the operation. After surgery, your Plaza healthcare team will make sure your vital signs are acceptable and arrange for you to be taken to a recovery room.

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Life After Surgery

Gastric bypass surgery is not a quick fix. It’s part of an ongoing journey toward weight loss that also involves a number of permanent lifestyle changes. After surgery, the difference in your body makes it physically easier to adjust your eating and lifestyle habits.

Fortunately, you will not have to face this process alone. Your Plaza healthcare team will be there to support you. Positive changes in your body, your weight, and your health will occur, but you will need to be patient through the recovery process.

In the recovery room, you can expect to feel some discomfort. This could last for several days. You may be provided with an analgesia pump which you yourself activate to help control pain. Another option is an infusion pump that provides a local anesthetic directly to the surgical site.

All abdominal operations carry the risks of bleeding, infection in the incision, blood clots, lung problems (pneumonia or pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestines. These risks are greater in patients suffering from morbid obesity.

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Post–Surgery Diet

The changes made to your gastrointestinal tract will require a number of modifications in your eating habits that must be strictly adhered to if you are to achieve permanent weight loss. The following are some of the more routine guidelines:

1. When you start eating solid food again, it is important to chew it very thoroughly. After swallowing, you must wait two to three minutes before putting the next bite of food in your mouth.
2. Don’t drink fluids while eating. They will make you feel full before you have eaten enough food. Fluids consumed with meals can lead to vomiting, and cause you to feel hungry again more quickly than you otherwise would.
3. Don’t eat desserts and sugary snacks if the serving size is greater than 3 to 5 grams.
4. Avoid carbonated drinks, high–calorie nutritional supplements, milk shakes, foods high in fat, and foods that have no nutritional value.
5. Avoid alcohol.
6. Limit snacking between meals.

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Maintaining Excess Weight Loss

Bariatric surgery is meant to help you shed excess body weight and keep it off for the rest of your life.

However, it is not an immediate fix. It’s the first step in an ongoing process of change. After surgery, your body will give you signals to stop eating before you take in the extra calories that would cause you to gain back excess body weight. It’s how you act in response to these signals that counts.

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Frequently Asked Questions

Here are some questions patients often ask about maintaining excess weight loss and the resumption of normal activity.

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