Roux-en-Y Gastric Bypass

Roux-en-Y Gastric Bypass (RNY) is a gastric bypass surgery performed laparoscopically. It restricts the absorption of nutrients and appetite-stimulating hormones.

How it works 

The RNY is reversible, but is designed to be permanent. The surgeon divides the stomach, making a smaller upper portion by stitching shut a larger remainder of the stomach. 

During the normal process of digestion, food empties from the stomach to the upper portion of the small intestine. During the Roux-en-Y Gastric Bypass this system is changed after the surgeon attaches the small stomach pouch lower down on the small intestine, 'bypassing' the majority of the stomach, the duodenum (upper portion of the small intestine) and part of the jejunum (middle portion of the small intestine).

The Long-Limb Roux-en-Y Gastric Bypass procedure bypasses even more of your intestine; in this case, the surgeon attaches a newly formed small stomach pouch to a place even lower on the small intestine. The long-limbed RNY procedure can lead to faster weight loss because of greater nutrient malabsorption (fewer nutrients absorbed). 

The procedure is called 'Roux-en-Y' because the gastric pouch is called the 'roux limb' and the Y shape is formed by the three arms coming together at a junction. 

Is it right for me? 

An advantage of the Roux-en-Y Gastric Bypass is there are no foreign objects left your body, such as bands, balloons and staples. It is the most common form of weight loss surgery which means there has been more research into the safety and effectiveness of the procedure than for newer weight loss surgery types. 

You can expect rapid weight loss to happen in first 6 to 12 months, achieving around 65 to 70 per cent of excess weight loss (EWL) within 2 years. People who have received RNY tend to regain around 20 or more pounds after the first two years of weight loss. 

With the RNY, more weight loss occurs in the first year than with the gastric sleeve and gastric band; leading to quicker health improvements (improving blood sugar control with better insulin resistance, lower blood sugar levels and possible reversal of Type 2 diabetes). The RNY procedure might be a good option for individuals with a sweet tooth as the newly designed digestive system is intolerant to high-sugar foods. High-sugar and high-fat foods can cause dumping syndrome, with symptoms of shakiness, nausea, vomiting and diarrhoea. 

The RNY procedure entails a higher risk of nutritional deficiencies due to malabsorption than does the gastric band and gastric sleeve. Weight regain can occur after a couple of years if appetite levels increase and the stomach pouch becomes stretched. Overeating causes the stomach pouch to stretch, leading to less restriction and making the procedure less effective over time. 

What is the recovery like?

You can experience some stomach pain and may need pain relief for the first week or two after surgery. The surgical incision may be tender and sore to touch. 

Depending on how the surgery was performed (open or laparoscopic) recovery will be a period of 4 to 6 weeks. Patients who have laparoscopic surgery will recover faster. For patients having open surgery it is especially important to avoid heavy lifting and strenuous exercise during the recovery period. 

With laparoscopic gastric bypass surgery you will likely stay in hospital for 2 to 3 days. If you have open surgery then your stay in hospital and recovery period will be longer.

It is important to take up gentle exercise as soon as possible to stimulate blood flow and aid healing. 

What are the risks and complications? 

All surgery comes with risks. Possible complications associated with the Roux-en-Y Gastric Bypass can include:

  • New food intolerances  
  • Gastroesophageal reflux disease (GERD) with heartburn 
  • Nutritional deficiencies due to low food intake and malabsorption of nutrients
  • Dumping syndrome 
  • Staple line leaks 
  • Vomiting/nausea/diarrhoea 
  • Strictures 
  • Bowel obstruction 
  • Blood clotting

Please seek and follow the specific guidelines from your bariatric team. Guidelines vary for individual patient needs and surgeries.