Laparoscopic Roux-en-Y Gastric Bypass

A Restrictive and Malabsorptive Procedure

How is it done?

This is a graphic of the RY Gastric bypassThe laparoscopic RY gastric bypass is performed by introducing a laparoscope, which is connected to a video camera, through small abdominal incisions, giving a magnified view of the internal organs on a television monitor. The entire operation is performed “inside” the abdomen after gas has been inserted to expand it. Special stapling instruments are used to separate about 5% of the stomach to create a new small <30 ml gastric pouch. The remaining 95% of the stomach (excluded stomach) is not removed. It continues to produce digestive juices and some essential factors. The outlet from this newly formed gastric pouch is connected to the small intestine (roux limb) so that food empties directly into the lower portion of the intestine (common channel) bypassing the stomach. Digestive juices produced by the stomach, pancreas, gall bladder and duodenum are directed by the bilio-pancreatic limb back into the common channel in a “Y” shape hookup that gives the technique its name (Roux-en-Y gastric bypass). The small gastric pouch causes patients to feel full sooner and eat less (restriction); bypassing a portion of the intestine means the patient’s body absorbs fewer calories (malabsorption). We believe that the laparoscopic gastric bypass, when performed properly, produces the best long term results. The surgical technique used by many bariatric surgeons results in large gastric pouches (new stomach) which enlarge further with the passage of time and the adaptation of the human body. This can lead to significant weight regain. To avoid this, we use a special technique that creates a very small stomach pouch, ~30-40 ml. This pouch does not enlarge and is responsible for the excellent results shown by our patients. If you want to see the technique see Our Surgical Videos. If you try to eat more than 4 ounces of food at a meal, you may feel uncomfortable and may regurgitate. This reaction is common, but often is due to inappropriate eating behaviours. You quickly will learn how to eat to avoid discomfort and regurgitation. As you eat less food, your body will stop storing excess calories and it will begin to use its fat energy stores.

What are the benefits?

Patients report an early sense of fullness and satisfaction that reduces the desire to eat. Patients who have gastric bypass generally lose more weight sooner than patients who undergo purely restrictive procedures. Our patient follow-up statistics* show that the gastric bypass, results in the loss of 60-80% of the extra weight patients carry and keep this weight from coming back if they follow our post-operative instructions. * Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years.

Disclaimer: Individual results may vary.

In addition to this weight loss, if they have any of these conditions, they will improve or resolve after the surgery:
  • Type 2 Diabetes
  • High blood pressure
  • Sleep apnea
  • Abnormal lipids/cholesterol
  • Asthma
  • Low back pain
  • Weight-bearing arthritis of the hips, knees, ankles, and feet
  • Skin fold dermatitis
  • Urinary stress incontinence
  • Acid reflux
  • Metabolic Syndrome
Finally, the health benefits gained with gastric bypass surgery can reduce your risk of premature death.

What are the risks?

The worst that can happen is that you die from the operation. Please note that the death rate while waiting to have bariatric surgery is higher than the risk of the surgery itself! The chance of dying in the first 30 days of surgery (this is how medicine defines a “surgical death”) depends on your Body Mass Index, your sex, the number and type of obesity associated health conditions that you have, and the experience of the bariatric surgeon and the bariatric team.

General Risks:

  • General risk of anesthesia as for most types of surgery
  • Because the duodenum is bypassed, poor absorption of iron can result in iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids.
  • Because the duodenum is bypassed, poor absorption of calcium has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hipbones. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
  • A chronic anemia due to Vitamin B12 deficiency may occur.
  • All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
  • 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 carbohydrate containing food (past is a good example) is consumed. The symptoms include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and are an indication that you are not following the diet recommended to you. We consider this a “safety valve” created by this surgery and will remind you that if you cheat – you pay!
  • Inability to detect the stomach, duodenum, and parts of the small intestine using X-ray or endoscopy, should problems arise after surgery such as ulcers, bleeding, or malignancy

Specific Risks based on our team’s experience with laparoscopic Roux-en-Y bypass at our private hospital.

Short Term (within 30 days of Surgery)
Death* 0%
Acute Pancreatitis 0.2%
C. difficile colitis 0.2%
Colon perforation 0.2%
Deep vein thrombosis 0.4%
Internal Bleeding 1.4%
Liver/Spleen laceration 1.4%
Suture/Staple line leak 3.2%
Port site infection 1.2%
Heart attack 0.2%
Pulmonary embolism 0.2%
Tear of the lining of the intestine 0.2%
*for selected cases with BMI<59, ASA<4 and OSMRS<4.
Long Term (months to years postop)
Stricture of the pouch-intestine hookup (GJ) 4.0%
New stomach pouch ulcers (anastomotic ulcers) 1.4%
Hernia at the port sites (small holes used for the surgery) 0.8%
Communication between the new stomach pouch and the old stomach (fistula) 1.2%
Formation of gallbladder stones (10 years) 14.4%
Communication between parts of the small intestine (fistulas) 0.2%
Blockage of the small intestine/internal hernia (bowel obstruction) 2.6%
Pregnancy in the first year after surgery 1.1%
Need for additional surgery 3%
Vitamin/mineral deficiencies 2%
Anemia 10%

What are the situations where this surgery should not be done?

  • Complex medical conditions:
    • Cardiac: severe heart failure, unstable coronary artery disease
    • Pulmonary: end stage lung disease
    • Hepatic: portal hypertension
  • Active cancer
  • Extremely limited mobility
  • Untreated psychiatric disorders, substance abuse including alcohol, or narcotic dependency
  • Genetic disorders e.g. Prader-Willi Syndrome
  • Untreated endocrine disorders e.g. Cushing’s Syndrome
  • Psychological instability
    • Inability to cope with the changes in diet and life modification after surgery
    • Refusal to be assessed by psychologist or psychiatrist