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Laparoscopic Roux-En-Y Gastric Bypass Thousands of articles published in the medical literature address surgery for morbid obesity. Briefly, the two components to the Roux-En-Y Gastric Bypass include restriction and malabsorption. The Roux-En-Y Gastric Bypass procedure involves dividing the stomach into two compartments: a small stomach pouch and leaving the remaining 'remnant' stomach. The jejunum (part of the small intestine) is then divided a short distance from the stomach and the lower end (Roux limb) is brought up and connected to the small pouch. The larger 'remnant' stomach and duodenum are reattached further down the jejunum (Tyler et al., 2006, p.47). Diet/Nutrition Guidelines: After the Roux-En-Y gastric bypass, patients can no longer eat or drink foods containing sugar. Patients who eat or drink any foods or liquids containing sugar (e.g. cake, cookies, milk shakes, ice cream, etc.) will likely experience the dumping syndrome. Patients will have a stomach pouch holding approximately (1) one ounce of food. With a stomach pouch this size, patients are expected to eat 2-3 tablespoons of food at each meal. Patients eat three meals a day. See Post-Op diet after GASTRIC BYPASS surgery. Gastric Bypass surgery process: Patients are admitted the same day of surgery and usually discharged 2-3 days later. The If the patient is being treated for sleep apnea, it is important that the patient bring the equipment (i.e. CPAP machine) to the hospital on the day of surgery so that it can be used while in the hospital. After Gastric Bypass surgery: Refer to Gastric Bypass discharge brochure (PDF) Patients will be seen frequently in the first year of surgery and then routinely for life. Patients will have office visits with one of the Hartford Specialists Bariatric providers 2 weeks after surgery to check wounds and overall assessment and then at: 2 months, 5 months*, 8 months, and at one year from surgery. After the first year, patients are advised to return at 6 months, then yearly for visits. *At the 5-month visit, patients are advised to begin Vitamin B12 supplementation by taking a weekly nasal spray or monthly injection. Goals include: Average 2 pounds weight loss/per week for the first 12-18 months after surgery Decreased appetite Increased activity Monthly support group attendance Decrease/loss of comorbidities Risks and/or possible complications include: A blood clot can form in your legs and possibly travel to your lungs. If this happens, it can sometimes be fatal. Conversion to open: It is possible that we will not be able to complete your operation with the laparoscope. In that case, you will need a larger incision and this will result in a longer hospital stay and recovery. Death - There is a real chance that you may die as a result of this operation. The risk of dying as a result of this operation is about 1%. Excessive bleeding from any one of several places we need to cut in order to do the operation. You may require a second operation and / or a blood transfusion if this occurs. Failure of Weight Loss: You may not loose all the weight you expect, or you may gain some weight back. This often depends tremendously on your compliance. Hernias can occur at one of several locations that may require another operation to fix. This can occur even many years after the operation. Infection can occur at any number of sites after the operation. This could require a second procedure. Kidney stones can also occur after gastric bypass surgery, but can usually be prevented by drinking plenty of fluids (preferably water) each and every day. Leaking from one of the anastomoses (surgical connection) we create: either between the stomach and the intestine (gastrojejunostomy) or between a second intestinal connection (the jejunojejunostomy). Leaks almost always require a second operation and the placement of temporary drainage tubes and a feeding tube, as well as a prolonged recovery. Loose skin is quite common after the operation. Many patients will desire plastic surgery. These procedures are often not covered by insurance. Psychiatric Disorders: The stress related to undergoing such a drastic life change may worsen pre-existing depression, anxiety or other psychological problems. Sometimes patients get depression or anxiety for the first time after the procedure. Strictures are a narrowing of the connections we make. They can occur at anytime after the operation and prevent food from passing easily. Strictures can usually be treated by dilating the connection, but sometimes require another operation. Ulcers can form near the newly created junction of the stomach and the small intestine, causing burning pain and/or bleeding. These can usually be treated with anti-ulcer medications, but some patients will require another operation to treat the ulcer. Aspirin and pain-relievers like Motrin, Aleve, Celebrex, and other non-steroidal anti-inflammatory drugs (NSAIDs) cause ulcers and should never be taken after gastric bypass surgery. Alcohol and smoking can also cause ulcers and must be avoided. Vitamin and nutrient deficiencies can be serious and cause permanent damage. The operation makes it possible to become deficient in several important minerals and vitamins. It is therefore critical that you take the recommended supplements every day. Why can't I have sugar or sugar containing foods? After gastric bypass, the food you eat travels into the small bowel (small intestine) after it leaves the stomach pouch. This usually causes the dumping syndrome. Sugar that enters the small bowel directly causes severe cramping and pain. You feel sweaty and feel like your heart is racing. Later on, it can cause your blood sugar to drop to very low levels. Low blood sugar can make you extremely tired, weak, and possibly confused. Diarrhea usually follows. Even small amounts of sugar or sugar from a natural source like orange juice can cause the dumping syndrome, so it must be strictly avoided. If you do get the dumping syndrome after accidentally eating some sugar, usually lying down can help. Over the next couple of hours, the symptoms will pass.

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