Roux en Y Gastric Bypass Surgery - Part I

In the United States, the most common bariatric surgery procedure performed is a gastric bypass operation known as Roux-en-Y; also called RNY. Roux-en-Y combines restriction of the amount of food that can be taken in with malabsorption techniques that cause a portion of the calories and nutrition consumed to pass through the body unabsorbed. Roux-en-Y uses a bipass procedure known as gastrojejunostomy, a “digestive short cut” in which the reduced stomach pouch is surgically connected directly to the small intestine. This is the malabsorption component in this type of surgery.

Patients who have undergone RNY surgery usually lose weight very quickly. Although it is a bypass type of procedure, the most commonly used form of Roux-en-Y is a “malabsorptive” surgery but is one that is the least likely to result in malnutrition. This surgery has three distinct types: Distal, Medial, and Proximal. These terms are indicative of the length of small intestine that is bypassed. Proximal is the most common of these; in this surgery, the least amount of small intestine is bypassed. Malnutrition is unusual with Proximal RNY, because the patient has more intestine to absorb the nutrients in the food consumed. Distal and Medial RNY surgeries are not used as often, because severe complications can occur; among those are serious malnutrition and chronic diarrhea.

In people who have not had Roux-en-Y surgery, the pyloric valve, which is located at the lower end of the stomach, regulates the release of food into the bowel. When the Gastric Bypass patient eats a food that has a high sugar or carbohydrate content, he or she often experiences a syndrome that is known as “dumping”. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of the weight loss surgery patient's stomach are "dumped" into the small intestine too quickly. Common symptoms include abdominal cramps, nausea, and a lightheaded feeling. People who are the most sensitive can suffer nausea and vomiting, sweating, faintness, palpitations and hypo tension or low blood pressure. These symptoms usually occur shortly after eating the bothersome food, but can take up to three hours to show up. Some people get so weak while they are “dumping” that they must lie down until the symptoms pass. Roux-en-Y patients are aware of this characteristic of their surgery before they undergo the knife; some “sugar addicts” specifically choose this surgery in order to combat their lifelong sugar cravings.