Extended (distal) Roux-en-Y Gastric Bypass Overview

There are two Roux-en-Y variants: Roux-en-Y gastric bypass (RYGBP) and Extended (distal) Roux-en-Y gastric bypass (RYGBP-E). RYGBP involves creation of a small pouch to restrict food intake whereas RYGBP-E creates a comparatively larger pouch but reduces the functional part of the small intestine even further. This minimizes absorption of calories and nutrients further.

The patient has to go through prescreening where his or her weight is assessed in order for them to qualify for the surgery, and thereafter they are also given psychological assistance to mentally prepare them for the operation.

In the operating room, the patient is put on an IV drip. The anesthesiologist then puts the patient under general anesthesia. The patient is put on a respirator and a nasogastric tube is attached to the nasal passage to drain out secretions. A urinary catheter is attached to the bladder to check hydration.

Depending on the procedure, the bariatric surgeon either cuts open the abdominal skin or makes a laparoscopic incision. He or she proceeds towards the stomach which is divided to form a pouch. The larger part of the stomach is still intact. Either staples or sutures or both are used to achieve this. The small intestine is divided into an upper longer part and a lower shorter part. The shorter part is brought up and connected to the pouch.

Now the longer part which carries bile and pancreatic enzymes is connected to the newly formed limb giving it a Y shape. The Y connection is made at a lower (distal) level as compared to the traditional RYGBP, in which the same may be done at the proximal end. This is done to bring the food in contact with only a very small part of the intestine, decreasing absorption or causing malabsorption. The food that enters the pouch moves directly into the last part of the intestine, gets poorly absorbed and moves out of the body, effecting weight loss.

Since RYGBP-E is a major weight loss surgery, the patient will experience postoperative pain and this can be managed with medications. The dressing on the surgical incision may be kept on for about 48 hours. Blood clots pose a risk in any operation, and therefore Venodyne boots are fitted to the patient’s legs in order to massage them. The patient is also encouraged to walk from the third day onwards, depending on his or her physical condition. Walking also reduces the risk of pneumonia. If all goes well, the patient can resume normal physical activity within three to four weeks. Pain and stiffness under the diaphragm discourages deep breathing, and therefore the patient has to be taught how to use a spirometer to increase the depth of breathing. Painkillers are initially given intravenously, but oral medications are started from the third day onwards. The transition from clear liquid diet to milk-based diet and from pureed diet to solid food has to be done under the guidance of a dietitian. Postoperative care is the key.

If there are no complications, the patient may be discharged within three days. If there is fever, vomiting or infection the person has to stay in hospital for a longer time. For more information about different types of weight loss surgery, contact our Dallas bariatric surgery center.