Laparoscopic Roux en-y gastric bypass is a type of weight-loss/bariatric surgery. As the name suggests it can be performed through key-hole method (laparoscopy). In this technique 4 to 5 tiny cuts of half to one cm are made on the abdomen and the whole surgery is performed through these. In a Laparoscopic Roux en-y gastric bypass surgery, a small 30 to 50 cc stomach pouch is created using surgical staplers. Small intestine is divided at about 50 to 100 cm from the duodeno-jejunal junction and attached to the stomach pouch in a “y” shaped fashion. The food comes into the stomach pouch and flows directly into the small intestine. It bypasses the remaining stomach and the first part of small intestine.
Most common question asked by patients is about the risks associated with laparoscopic Roux en-y gastric bypass. Laparoscopic Roux en-y gastric bypass is as safe as any other surgery like laparoscopic cholecystectomy or a knee replacement surgery. The overall risk of complications is less than 1%. What we need to understand is that the risk increases or decreases based on the patient’s clinical profile. Risk stratification of the patients based on the weight, BMI and associated disease status must be done prior to the surgery. Patients with higher BMI or those with multiple associated co-morbidities have a higher risk as compared to those with lower BMI and lesser co-morbidities. However, it is also important to keep in mind that inability to lose weight will eventually lead to more life-threatening issues. The risks and repercussions of not losing weight are much higher than that of being operated.
One of the immediate risks associated with a laparoscopic Roux en-y gastric bypass is that of a staple line leak. If the staple lines were to open up due to some reason, there can be leakage of gastric contents into the abdomen. This can lead to pus formation and septicaemia. In such cases re-surgery may be needed at times. Venous thrombo-embolism or blood clotting is another complication associated with severe obesity. Narrowing of anastomosis and ulcer formation can happen in rare cases. There are some other complications as well but the overall risk of complications is less than 1%.
In the long term the main issues observed with a laparoscopic Roux en-y gastric bypass are internal herniation and weight regain. Patients with a Roux en-y gastric bypass must undertake all tests at regular intervals. As most of the stomach and first part of intestines is bypassed, there is a potential for vitamin, calcium and iron deficiencies and these may need supplementation. Obesity is a chronic progressive disease and as with any weight loss procedure, regular follow up with the bariatric surgeon team is the key to success after a laparoscopic Roux en-y gastric bypass.
While we must be aware of complications, we must always weight the pros and cons of having surgery against those of not losing weight. Obesity has life threatening consequences and is the real emperor of all maladies. Fear of complications must not come in the way of taking an informed decision regarding your health.
Dr. Aparna Govil Bhasker is a Bariatric and Advanced Laparoscopic Surgeon.
Affiliations: Global Hospital, Parel; Apollo Hospitals, CBD Belapur, Tradeo and Chembur; Currae Hospital, Thane; Suchak hospital, Malad and Namaha Hospital, Kandivali