Background RYGB

The Roux-en-Y gastric bypass is a commonly performed bariatric procedure. It is often referred to as the 'gold standard' of weight loss surgery. This procedure reduces both stomach capacity and absorptive length of the small bowel. The restrictive and malabsorptive effects have proven to be a promising solution for morbid obesity. However, recent evidence suggests significant metabolic effect due to changes in patients' gut hormone profiles. This results in resolution of obesity related comorbidity as well as weight loss.

Postoperative weight loss is significant, allowing the improvement or resolution of obesity-related comorbidities (e.g. hypertension, type 2 diabetes, obstructive sleep apnea, non alcoholic fatty liver disease and gastroesophageal reflux).

Indications RYGB

• Previous non-surgical attempts at weight loss for a minimum of 1 year.
• Willingness to adopt both pre- and postoperative weight-loss behaviours.
• Body Mass Index (BMI) ≥ 40 kg/m².
• BMI of 35-45 kg/m² with a major comorbidity (e.g. hypertension).

Contraindications RYGB

• High anesthetic risk.
• A short mesentary or jejunal length which would produce tension on the gastrojejunal anastomosis.
• Adhesions in the retrogastric space due to previous surgical intervention or pathology e.g. pancreatitis.
• An enlarged fatty liver limiting surgical field of view.

Relative contraindications RYGB

• Diabetes type 1
• Crohn’s disease
• Liver cirrhosis
• Laparotomy

Possible complications

Immediate

• Staple line bleeding.
• Suture line failure.
• Trauma and thermal injury to local viscera, including the pancreas and vagus nerves.

Early

• Staple line leak.
• Port site hernia.
• Postoperative bowel obstruction.
• Marginal ulceration due to staple line infection
• Chest infection.
• Wound infection.
• Deep vein thrombosis.
• Pulmonary embolism.

Chronic/Late

• Gallstones.
• Dumping syndrome/Hypoglycemia.
• Excess skin and subcutaneous tissue formation.
• Protein, iron and calcium deficiencies.