RnY Surgery – Roux-en-Y Gastric Bypass

Description of RnY

* the upper portion of the stomach is freed and a row of staples is placed horizontally a few centimetres below the oesophagus – stomach junction. The surgeon will create a pouch from the existing stomach that measures about 1-2 ounces and is totally separated from the remaining stomach.
* the small bowel is divided approximately 24 inches beyond the stomach. The farthest loop is brought up and attached to the stomach pouch. This forms the food channel.
* the nearest loop contains secretions of bile and pancreas and is called the biliopancreatic channel. This channel is attached to the side of the food channel approximately 24 inches away to the attachment of the stomach and small bowel forming a Y-shaped arrangement of the bowel.
* In this procedure food intake is restricted because of the small stomach pouch and there is poor absorption of food because the bile and pancreatic secretions do not come in contact with food until about 48 inches beyond the stomach.

Advantages of RnY:

* Covered by MSP of British Columbia and most other Provincial Medical Plans (Check in your Province)
* Average weight loss is 75% of excess weight.
* Weight loss occurs rapidly with most of the excess weight being lost in the first 12 months.
* 96% of certain associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) are improved.
* Early and late complication rates are reasonably low, and operative mortality ranges from 0.2 percent to 1 percent.
* Patients return to eating a normal balanced diet but much smaller quantities.

Disadvantages of RnY:

* Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anaemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding haemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
* Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
* A chronic anaemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
* A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
* In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
* The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.