Laparoscopic Roux-En-Y Gastric Bypass – drfuadahmed

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What is Laparoscopic Mini Gastric Bypass (MGB)?

RYGB is a form of obesity management surgery (bariatric surgery) that is typically performed over 2 steps. The first step is making the stomach smaller through stapling, turning the original sac shape into a small, egg-sized pouch. The second step involves bypassing a large part of the small intestine, where a distal part known as the “Roux climb” is connected directly to the newly formed pouch, while the part that was originally connected to the stomach is rerouted to also be connected to that part, forming a Y-shaped union, which is where this surgery gets its name. The end result is a smaller stomach which restricts solid food, and a shorter digestive tract which absorbs fewer fats and calories, and so you would start to lose weight.

What Does “Laparoscopic” mean?

A laparoscopic approach to surgery means using 3 tiny incisions to do the surgery (two 5 mm in length, and one 12 mm in length), as opposed to the regular approach where a large incision is made in your abdomen. The surgeon would use a specialized thin long telescope to which a camera is connected known as the Laparoscope together with some very small surgical instruments to reach the surgical area without opening up your belly too much. This means less scarring as most of these incisions are hidden, less pain during the post-operative recovery period, and fewer surgical complications. It is the approach of choice for most bariatric surgeries.

Do I Need RYGB surgery?

Bariatric surgeries are indicated for people with extreme obesity who have failed to lose weight using a diet and regular exercise. Obesity is identified by using a metric known as the body mass index (BMI) which is the ratio of your weight to your height. A BMI of over 30 is considered obese, 35 to 39 is considered severe obesity, while over 40 is considered morbid obesity, where your weight would start to affect your health. RYGB is indicated for people whose BMI is over 35, and who may also suffer from some metabolic disorders that originated from being overweight such as diabetes, high blood pressure, and sleep apnea. A BMI of over 40 means you are a direct candidate for RYGB even if your general health isn’t affected.

How is RYGB Done?

Once you’re anesthetized, the surgeon will use the laparoscope with the small surgical instruments to first staple the larger part of the stomach excluding it from the digestive pathway, and leave only a small part as the usable stomach about the size of an egg. Next, he would bring a distal part of the small intestine known as the “Roux climb” up to attach to that newly formed egg-sized pouch. Finally, to make use of the bypassed part of the stomach and intestine, it is rerouted and sewn to this newly brought up part, where the stomach and intestinal juices can flow to add in digestion. You’ll probably remain in the hospital for a day or 2.

Life After RYGB

RYGB effects work very rapidly. In fact, most people who undergo this surgery end up losing 50% of the excess weight in the first year, and reach their optimum weight at the 2-year mark. While that sounds great, it also comes with a few restrictions to your lifestyle afterward. Therefore, we recommend you follow the following steps to minimize risks and gain the most out of your procedure:
· The rapid drop in body weight can sometimes cause a few unwanted but completely expected side effects during the first 6 months of surgery. These include body aches, hair loss, mood changes, dry skin, and constantly feeling tired. All you need to do is support yourself both physically and mentally, and know this is a temporary phase that will pass very soon.
· Dumping syndrome – where the food rich in sugar is rapidly “dumped” from the stomach to the small intestine – is very common with RYGB, which could lead to cramps, diarrhea, nausea, and vomiting, so make sure you avoid high sugar-containing foods.
· For 2 weeks after the surgery, you would be limited to a liquid diet, and would gradually transition to pureed food, soft food, and then regular food in about 1 month. Do not rush the process of returning to hard foods so as not to risk nausea and vomiting.
· Eat very slowly and chew your food very well, since your smaller stomach does not have the same capacity for digestion as it used to.
· A smaller stomach and shorter intestine means consuming less food and therefore less intake of nutrients. This means 2 things:
o You’ll have to take multivitamins to meet your daily requirements as prescribed by your doctor.
o You would need to do blood tests every 3 months to make sure you don’t suffer from anemia or vitamin deficiency.
· Make sure you follow a proper diet designed specifically for your case and keep exercising regularly to maintain the effects of the surgery.
· To avoid muscle wasting (which means weakening of your muscles due to loss of muscle fibers), you would need to not only take protein supplements, but specialized exercise to make sure you keep your muscle mass and strength.

Some Other Life Changes to Consider

RYGB and other bariatric surgeries affect every aspect of your life, so you would need to change some of your lifestyle choices to cope with the effects of the procedure. These include smoking, drinking alcohol, and some medications such as ibuprofen, Voltaren and Aspirin which will all need to be used with moderation.
In addition, not only will you change physically, but it can be hard for some people to cope mentally with the changes of the procedure, especially with the visible signs such as hair loss and dry skin as we mentioned before. Should you feel overwhelmed at any point, there is absolutely no shame in seeking help whether professional or through support groups, family, and friends.

Is RYGB the Only Option for Weight Loss?

As we mentioned, RYGB is indicated mainly for people with BMI over 40. However, there are other bariatric surgeries to choose from which can be better for your case. Make sure to ask your surgeon about laparoscopic gastric banding, laparoscopic sleeve gastrectomy, mini gastric bypass, or laparoscopic transit bipartition.

If you need any more information about the procedure or the follow-up aftercare period,
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