This surgery involves creating a small (less than one ounce) vertically oriented stomach pouch, as well as a bypass of most of the stomach and a varying amount of small intestine. As a result, weight loss is accomplished both by restriction of food intake and by malabsorption of nutrients. Ingestion of concentrated sugar is also essentially prohibited because doing so may result in "dumping." Dumping is a group of unpleasant symptoms that resembles food poisoning (nausea, vomiting, diarrhoea, abdominal cramps, flushing, and palpitations) that occurs when simple sugars enter the small intestine without first being properly digested by the stomach. Many people also report diminished appetite after Roux-en-Y gastric bypass, as well as a change in the taste of food. With the Roux en Y gastric bypass it may seem intuitive that the configuration interferes with the normal digestion of food. This is so because the digestive enzymes normally produced in the stomach and upper small intestine continue to be made, but do not contact the food that has been ingested until a few feet down the intestine. Hence, the digestion of the food is delayed until it is already part way down the intestine. These are additional ways the gastric bypass causes weight loss.
Since the staples at the top of the stomach completely block off the lower portion of the stomach and the upper small intestine, there is no easy way to evaluate these portions of the gastrointestinal tract should a problem -- such as ulcer, bile duct stones, or cancer -- arise at a future time. However, although this could be a very real problem, it seldom becomes as issue.
Weight loss commonly reaches 75% of a person's excess body weight. As in all weight loss surgery, however, the amount of weight loss is not guaranteed. In fact, there is no guarantee that the patient will lose any weight at all. The amount of weight a patient loses depends not only upon the surgery, but also upon what the patient does with the surgery. The surgery is not a cure for morbid obesity; it is merely a tool. Patients have been known to ingest large quantities of high caloric foods that can result in less than satisfactory weight loss. If a patient adheres to the pouch rules and takes regular exercise then satisfactory weightloss is achieved.
As in any sort of major surgery, there is a certain amount of risk. It is important to consider these risks when deciding to have weight loss surgery. Operative risks are: death (0.5%), leaks or perforation causing internal infection and need for reoperation (0.6%), wound infection (2 %), and pulmonary embolism (0.1%).
Advantages of RNY
- Average weight loss is 75% of excess weight.
- Weightloss 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
- Anastomotic leaks and strictures,
- Severe dumping syndrome symptoms in some patients
- Some patients experience problems eating certain foods after surgery like bread, meat and pasta.
- Distension of the excluded stomach and internal hernias.
- Roux-en-Y gastric bypass is technically more challenging to perform than the restrictive procedures, particularly when using the laparascopic approach. In experienced hands, the conversion rate of laparascopic Roux-en-Y gastric bypass to open is 5 percent
- A commitment to take life long vitamin supplements
- Blood tests on a regular basis for life
- Some patients experience constipation, diarrhoea and increased flatulence.
- Patients are at risk for developing anaemia because of poor absorption of iron and vitamin B12.
- Poor absorption of calcium may also occur.
- A percentage of patients regain up to 10% of their weight loss over time and some may need a revision.
Living with the RNY
I had my RNY at St Richards's hospital in Chichester in June 2006. At the time of my surgery I weighed 23 stone and 10lb, suffered with high blood pressure and type 1 diabetes that was getting harder and harder to control with my increased weight. I was very fortunate my surgery was done laparascopically and was a textbook procedure with no complications. I had a 6-day stay in hospital and was back to work in less than 4 weeks. I found immediately after surgery I no longer required my blood pressure medication and my insulin requirements dropped significantly. Initially post op I was unable to eat much, half a yoghurt, half a slice of bread half a tin of soup but gradually as the months progressed and I moved onto more solid foods I found my pouch stretching and I was able to eat much more. Today I can go to a restaurant and order a two-course meal with no problems eating.
As someone with an extremely sweet tooth I was disappointed to find that I was able to eat chocolate and cake and never experienced "dumping syndrome". I have also found that I am unable to eat any kind of meat now despite chewing and adding lots of sauce or gravy. At 6 months post op I experienced quite heavy hair loss, this only lasted about 8 weeks and I have found my hair has grown back thicker and curly now. I do have problems with increased flatulence and it is impossible to control, some days when I have eaten more carbs it is really bad and smells really foul. I also have problems with bowl movements, I find that they are very large and most days I am unable to flush them away, which can be very embarrassing. I still find I am being sick when I try to eat more than my pouch will hold. It is very difficult to stop when you are enjoying a meal but your pouch soon tells you it's had enough.
I take my multi vitamin daily and always ensure I have at least 2 litres of fluid. Not being able to eat meat has made my protein intake a challenge, I always make sure that I eat my protein first before anything else on the plate and try to avoid too many carbs. I had hoped to be able to loose another 2 stone but when I was 9 months post op I fell pregnant which was a huge surprise for my husband and I as we had been trying for 10 years unsuccessfully. My pregnancy went really well with no real complications as a result of my RNY. A dietician did have to see me more regularly, and my own Obs and Gynae Consultant, but the outcome was completely successful and I gave birth to a beautiful baby girl on the 1st September 2007.
My RNY has changed my life completely and If I had to make a choice again I would not hesitate to have the surgery.
Read Nikki's story - A RNY patient.