A few words on RNY & Malabsorption . . .
Surgery via "Roux-en-Y" Gastric Bypass
Gastric Bypass Surgery via the Roux-en-Y is generally considered to
be the best surgical procedure for the treatment of morbid obesity.
Weight loss is achieved by reducing the functional portion of the
stomach to a pouch one ounce or less in size, and by creating a
stoma, a small opening between the stomach and the intestine.
The small size of the stomach pouch causes the patient to have a
sensation of fullness after eating only a small portion of food. The
small stoma delays stomach emptying, making the sensation of
fullness last longer. These are called the Restrictive components of
the procedure.
The limb of intestine coming down from the small pouch is called the
Roux limb. The limb of intestine coming down from the bypassed
portion of the stomach can be called the Biliary or Bypassed limb.
The remaining portion of the intestine is called the Common Channel.
Illustration of Gastric Bypass Surgery Procedure
Food does not pass down the Bypassed limb, only the Roux limb and
the Common Channel. The longer the Bypassed limb, the less the
length of intestine actively working to absorb nutrients from the
food that is eaten. Digestive juices that normally help absorb
nutrients from the food enter the Bypassed limb from the larger
portion of the stomach, the liver, and the pancreas, and pass down
the Bypassed limb to the Common Channel. These juices do not mix
with the food while it is passing down the Roux limb. The longer the
Roux limb, the longer the portion of intestine trying to absorb
nutrients without the benefit of these digestive juices. Both of
these changes result in less absorption of nutrients and contribute
to weight loss, and are called the Malabsorptive components of the
procedure.
Exactly how the operation is done for an individual patient depends
on their individual anatomy, their general health status, whatever
changes they may have from prior surgeries, and what they hope to be
achieve from the operation. The stomach compartments can be
completely divided from each other or simply partitioned, the small
stomach pouch and the intestinal limbs may be connected to each
other with either staples or sutures, a small band may be placed
around the stomach pouch, and the two intestinal limbs may be made
longer or shorter.
Patients may expect to lose approximately 70% of their excess body
weight during the first 2 years following surgery. Sometimes a
weight regain of about 10% is seen between years 2 and 5, perhaps
because the small pouch increases several ounces in size, and
perhaps because the patients learn how to take in extra calories
without making themselves sick.
The surgical community involved in gastric bypass surgery is very
concerned about this late 10% or any other weight regain. There is a
national effort underway to keep patients involved in support groups
and in follow-up with their doctors to reinforce what they had been
taught after surgery, and what had worked for them the first 2
years. Long term success with this operation requires a team effort
of both the patients and their doctors.
Gastric Bypass Surgery patients take in less food and absorb less of
what they take in, making them at risk for developing nutritional
deficiencies. They must also make a life long commitment to taking
vitamin, mineral, and possibly protein supplements, and may become
very ill if they don’t. These supplements will cost about $30.00 a
month and can be purchased almost anywhere.
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