Laparoscopic Roux-en Y Gastric Bypass (RYGB)

“The body achieves what the mind believes!”

Laparoscopic Roux-en y gastric bypass surgery is one of the oldest and time-tested bariatric procedures with great weight loss results. It also leads to a significant improvement in all obesity related co-morbidities like type 2 diabetes, high blood pressure, high cholesterol etc.

Laparoscopic Roux-en y gastric bypass surgery is a weight loss procedure in which a small pouch of the stomach is created and the small intestine is re-routed to attach to this pouch. Rest of the stomach remains inside and is bypassed along-with the duodenum and first part of jejunum. A non-adjustable band can be applied over the stomach pouch to prevent it from dilating in future.

Laparoscopic Roux-en y gastric bypass surgery leads to about 65 to 75% excess weight loss over 12 to 18 months. Of course this can be made better if the patient puts in more effort in the form of diet and exercise. Roux-en y gastric bypass surgery also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc.

Laparoscopic Roux-en y gastric bypass surgery is the most popular weight loss procedure performed all over the world.

Eligibility for laparoscopic Roux-en y gastric bypass surgery

The IFSO- APC (International Federation for Surgery for Obesity and Metabolic Disorders – Asia Pacific Chapter) guidelines for weight loss surgery are as under:

• Bariatric surgery/obesity surgery/weight loss surgery must be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 Kg/m² with or without any associated diseases.
• Bariatric surgery/metabolic surgery must be considered for the treatment of type 2 diabetes or metabolic syndrome for patients who are inadequately controlled by lifestyle alterations and medical treatment for acceptable Asian candidates with BMI ≥ 30 Kg/m².
• Bariatric surgery/metabolic surgery may also be considered as a non-primary alternative to treat inadequately controlled type 2 diabetes or metabolic syndrome for suitable Asian candidates with BMI ≥ 27.5 Kg/m².

Roux-en y gastric bypass surgery has shown good weight loss outcomes and co-morbidity remission. This surgery can be safely performed in most patients. Roux-en y gastric bypass surgery is one of the best procedures for obese diabetics and a lot of times patients do not need to take any anti-diabetic medications after this surgery. Remission of type 2 diabetes and other co-morbidities varies from patient to patient and depends on a lot of factors, which the doctor and the team will explain to you during consultation. Roux-en y gastric bypass surgery is also the procedure of choice for obese patients who suffer from hiatus hernia and acid reflux disease. This surgery improves the symptoms of acid reflux to a very large extent.

Preparation before the procedure

• First step is a consultation with the doctor and the team to decide on your eligibility for Roux-en y gastric bypass weight loss surgery. A detailed medical history, diet recall and a complete physical and psychological assessment will be performed at this time.
• Once we have decided to go ahead with Roux-en y gastric bypass weight loss surgery, you will need to undergo a battery of tests. You may also need to see a diabetologist, endocrinologist, nephrologist, chest physician etc based on your clinical profile and associated co-morbidities.
• A pre-operative upper GI endoscopy is a must before all bariatric procedures.
• You will also need to be on a high protein liquid diet for a period of 5 to 7 days prior to the procedure. Most obese patients have fatty and enlarged livers. Swelling on the liver makes the surgery difficult for the surgeon. Pre-operative high protein liquid diet helps to shrink the liver and makes the surgery easier for the surgeon and safer for the patient. It has been seen that patients who sincerely follow the pre-operative liquid diet, tend to achieve better weight loss results post bariatric surgery.

In the hospital

• Once all the tests have been done and you are medically fit to undergo Roux-en y gastric bypass surgery, you will need to get admitted to the hospital one evening before your scheduled surgery.
• All pre-operative medications including prophylaxis for venous thrombo-embolism will be taken care off at the hospital.
• You will be fasting for 6 to 8 hours prior to the surgery.
• Roux-en y gastric bypass surgery typically takes about 75 to 120 minutes to perform and is done under general anaesthesia.
• You will be encouraged to walk around on the same day and can go to the washroom yourself.
• You will be started on liquids on the next day after the surgery. If all is well, you will be discharged to go home on the day after surgery.

Mechanism of action of laparoscopic Roux-en y gastric bypass surgery

• Roux-en y gastric bypass weight loss surgery functions on the basis of a combination of restriction and mal-absorption. The small stomach pouch leads to early satiety and patients tend to feel full even after consuming small quantities of food.
• As the stomach and first part of intestine are bypassed, this surgery also leads to some degree of mal-absorption. This basically means that the patient will not absorb everything that he/she consumes.
• Since the food reaches the distal part of intestine much faster, there is an early release of certain gastro-intestinal hormones like GLP 1, PYY etc. This has a favourable effect on improvement of type 2 diabetes.
• The hunger inducing hormone “ghrelin” also decreases considerably after Roux-en y gastric bypass weight loss surgery. This leads to a reduced sensation of hunger after the surgery and patients are comfortable despite consuming small quantities of food.
• In addition to the above there are additional mechanisms like the role of gut flora and bile acids etc that aid in weight loss as well as improvement of associated diseases.
• All of the above mechanisms lead to a gradual mobilization of fat stores from the body and result into weight loss.

What to expect after laparoscopic Roux-en y gastric bypass surgery

• You will be started on a clear liquid diet on the day after your surgery.
• If you are able to tolerate liquids and do not have any other clinical problems you will be discharged on the day after your surgery.
• All medications including prophylaxis for venous thrombo-embolism will be explained to you before discharge.
• After Roux-en y gastric bypass surgery, you will be on a liquid diet for about 15 days followed by soft and mashed diet for the next 15 days. You will be able to consume normal home cooked food after one month of surgery, but it will be restricted in quantity.
• You will also need to take nutritional supplements and other medications as advised by the team. We will guide you at every step.
• It takes a few months to adjust to new eating habits. Please do not worry. We are available at all times to answer your queries.

Expected weight loss after Roux-en y gastric bypass surgery

• Patients may lose up to 65 to 75% of their excess weight after Roux-en y gastric bypass weight loss surgery. Weight loss is dependent on many associated factors such as initial weight of the patient, age, gender, associated co-morbidities, behavioural modification made by the patient etc.
• Patients who embrace the lifestyle change and comply with behavioural modification guidelines as suggested by the team, tend to do better after any weight loss procedure including Roux-en y gastric bypass weight loss surgery.
• Please note that weight loss procedures must not be perceived as a short cut. High level of commitment is needed from both, the doctor as well as the patient. It is mandatory to follow the diet prescribed by the team and to put in atleast 30 to 45 minutes of exercise every day to achieve best results.

Improvement in co-morbidities

• Roux-en y gastric bypass weight loss surgery also leads to a significant improvement in associated co-morbidities such as type 2 diabetes, high blood pressure, high cholesterol, obstructive sleep apnoea, gout, PCOD etc.
• Improvement in the above components of metabolic syndrome eventually leads to a considerable decrease in the risk of developing heart disease.
• Roux-en y gastric bypass weight loss surgery is the procedure of choice for obese patients suffering from hiatus hernia and acid reflux disease.
• Overall weight loss secondary to bariatric surgery leads to a significant improvement in quality of life and confidence levels of the patients.

Upsides

• One of the oldest and time-tested bariatric procedures practiced across the world.
• Roux-en y gastric bypass weight loss surgery is the number one bariatric procedure being performed all over the world.
• Roux-en y gastric bypass weight loss surgery has shown very good results in morbidly obese patients suffering from type 2 diabetes and other components of metabolic syndrome.
• Roux-en y gastric bypass weight loss surgery is also the procedure of choice for patients suffering from hiatus hernia and acid reflux disease.
• Long term weight maintenance has been seen to be better after Roux-en y gastric bypass weight loss surgery as compared to other procedures like sleeve gastrectomy.

Downsides

• Long term weight maintenance is much better after a Roux-en y gastric bypass surgery. Yet, the importance of embracing lifestyle change and behavioural modification is paramount after any bariatric procedure. Surgery is just a tool that leads to massive weight loss but for long term weight maintenance, effort has to be put in by the patient and the team.
• In terms of complications, this surgery is as safe as any other surgery. In this age of internet and Google doctors, you will come across a lot of unnecessary information on the internet. We sincerely urge you not to get influenced by half-baked information on the internet. Doctor and the team will honestly discuss the complication rates of all procedures with you during your consultation.
• If you are a smoker, please stop smoking atleast 3 weeks before your surgery. Smoking can lead to life-threatening complications after bariatric surgery. It is advisable not to undergo any bariatric procedure if you will continue to smoke after the surgery.

Long term follow up

• Bariatric surgery leads to best results in patients who follow up regularly. Follow up schedule will be given to you at the time of discharge from the hospital and we urge you to follow this schedule strictly.
• You will need to see the doctor and the team on a regular basis in the first year and once every year there-after for life.
• Please get your tests done as advised by the team. This goes a long way in preventing nutritional deficiencies.
• It is mandatory to get an upper GI endoscopy done once every year after any bariatric procedure.

Cost of laparoscopic Roux-en y gastric bypass

Dr. Aparna Govil Bhasker has one of the highest experiences in performing this surgery in the country. Laparoscopic Roux-en y gastric bypass surgery  cost depends on many factors. Roux-en y gastric bypass surgery cost depends on the disposable equipment used during the surgery. Roux-en y bypass weight loss surgery cost also depends on the type of room category selected by the patient and duration of hospital stay. Cost of laparoscopic Roux-en y gastric bypass surgery is not routinely covered by insurance companies. Off late there has been some movement on this front and some of the insurance companies have started covering the cost of Roux-en y gastric bypass surgery. Cost of Roux-en y gastric bypass weight loss surgery is covered for central government employees in India under the CGHS health scheme. Nowadays there are some companies that have started giving interest free loans and cover the cost of surgery in affordable EMIs. The doctor and the team will guide you about the cost after assessing and evaluating all the above details.

Last but not the least

We understand that by taking the decision to undergo this surgery, you have taken a major life decision. The objective of the above information is not to overwhelm you but give you a detailed and honest account of how your life will change. This decision will propel you into a better and healthier life. We are your equal partners in this journey and having a positive frame of mind is extremely important before taking this step. We are here to take care of you and solve your tiniest query. We urge you to stay positive, because at the end of the day, your body hears everything that your mind says.

“Take care of your body. It is the only place you have to live.”