Roux-en-Y gastric bypass is considered by many to be the gold standard in weight loss surgery.  In this article we’ll answer questions about how it’s done, expected results, recovery time, and how to qualify, and other things you need to know about the procedure.

There are several different bariatric surgery methods, but Roux-en-Y gastric bypass (RYGB) is widely considered to be the most effective.

The laparoscopic procedure has a high success rate, and though it is an invasive surgery, recovery is generally easy, and there are few complications.

In this article, we’ll dive deep into the process and answer questions about how it’s done.  We’ll give you details on the surgery, discuss common results, what to expect, and how to determine if you are a candidate.  You’ll walk away with everything you need to know about RYGB.

How is Roux-en-Y Gastric Bypass Done?

The reason that this bariatric surgery is so effective at producing significant, rapid weight loss is because it restricts both the size of your stomach and how many calories you absorb from your food.  This means not only will you eat less, but your body will also store less fat from what you eat.

It’s done by a licensed surgeon who will divide your stomach into two parts, one of them will be approximately the size of an egg.  This smaller section is then attached to a Y-shaped section of your small intestine that’s medically known as the Roux limb.

By doing this, the food you eat will now bypass both your lower stomach and the second segment of your small intestine which means that you’ll absorb fewer calories, fat, and nutrients.

Why Would Gastric Bypass Be Needed?

Gastric bypass surgery is one treatment option for people who are severely obese.  This is defined as someone who has a body mass index over 40.

It’s also a possible option for someone with a BMI between 35 and 40 who has a health condition that could be dramatically improved with significant weight loss like high blood pressure, sleep apnea, type 2 diabetes, or heart disease.

Typically, your doctor will only discuss the procedure if you’ve been unsuccessful with other weight loss methods and need to lose half of your body weight or more to improve your health.

Expected Weight Loss Results

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Although every patient has a different experience, it’s typical for people to lose between one half and two-thirds of their body weight within two years after the procedure.

The weight loss usually lasts for 12 to 18-months before stabilizing and settling by the two-year mark.

Pros And Cons Of Roux-en-Y Gastric Bypass

stomach diagram

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As with any invasive surgical procedure, there are many significant advantages and disadvantages to consider.

On the plus side, patients who have Roux-en-Y gastric bypass surgery experience significant weight loss that lasts for the long-term.   Thanks to their smaller stomach, they eat less and develop healthier mealtime habits.

Studies show that they will also see favorable changes in their hormones over time and will start to feel more stated and have a reduced appetite which helps to maintain the long-term weight loss.

However, there are a few drawbacks.  As with any malabsorptive surgery, your body doesn’t absorb vitamins and minerals, and you could develop deficiencies of key nutrients like calcium, B12, iron and folate.

Also, this type of weight loss surgery requires a lifetime lifestyle change to be effective.  You’ll need to closely follow your doctor's orders regarding your diet and supplementation to stay healthy and keep the weight off.

Roux-en-Y Gastric Bypass Surgery Risks

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In addition to the potential drawbacks, there are also several risks associated with surgery.  The most common include:
  • Infec​​​​tion
  • Bleeding
  • Blood clots
  • Adverse reactions to anesthesia
  • Stomach pouch leaks
  • Leaks at the Roux limb

Patients who undergo the procedure are also at higher risk for conditions that may develop over time.  Vitamin deficiencies, including iron and calcium, and trouble eating enough protein are two of the most common occurrences.

Dumping syndrome, which happens when high-sugar foods move from your stomach to your intestine too quickly, is another problematic side effect.  If can cause abdominal cramping, diarrhea, nausea, an elevated heart rate, or fainting after meals, but can be managed by making changes to your diet.

There is also a risk of developing a hernia in your small intestine or a narrowing where your stomach is joined to your intestine.  Both of these conditions are dangerous and would require additional surgery to fix the issue.

Finally, despite the efficacy of the procedure, it’s also possible to either not lose enough weight or to gain back weight lost if you don’t also make lifestyle changes.  This is the reason why following the diet and exercise program your doctor prescribes is critical to achieving and maintaining long-term success.

If you have other health issues, there may be additional risk factors that are specific to your situation.  Talk with your doctor to understand all of the potential side effects.

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What To Expect Before Roux-en-Y Gastric Bypass Surgery

Before you undergo the procedure, you’ll first need to meet with your doctor to determine if you are a good candidate for the surgery.  Even if you meet the BMI requirements, your doctor will want to ensure that you don’t have any drug or alcohol problems and are ready to commit to the lifestyle changes that accompany the treatment.

If your physician feels this is an option for you, then you’ll enroll in a pre-bariatric surgery education program.  The course will provide you with things like nutritional and psychological counseling that will help you to prepare for the procedure and plan for what life will be like afterward.

You’ll also undergo a series of tests and physical exams like blood work, imaging, or endoscopy.

Many programs also require you to lose weight before the surgery.  This shrinks the size of your liver which lowers some of the risks associated with Roux-en-y Gastric Bypass.

Smokers will be required to quit several months before the scheduled procedure, and anyone who takes any blood thinners, aspirin, or ibuprofen will need to stop for several days ahead of time.

Finally, the night before the surgery you’ll need to fast and won’t be able to eat or drink anything for 12 hours prior.

What to Expect During Roux-en-Y Gastric Bypass Surgery

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Your surgeon will meet with you before your surgery to give you a detailed list of what to expect before, during, and after.  This is a general overview of what is involved with the procedure itself.

First, you will be put under general anesthesia and will sleep for several hours while the team completes the surgery.  You won’t feel any pain and won’t remember any of the steps.

Once you’re under, your surgeon will make the incisions in your abdomen and insert the laparoscope and tools in them.  Next, they will use a laparoscopic stapler to section off a portion of your upper stomach into a small pouch.

Then the surgeon will use the stapler to split the upper section of your small intestine into two portions.  One end, the Roux limb, is then joined with the stomach pouch and the other is connected back to a different portion of the small intestine.

Before closing you up, your doctor will likely test for any leaks between the connections by conducting a dye study.


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What To Expect After Roux-en-Y Gastric Bypass Surgery

Following your surgery, expect to stay in the hospital for one to two days while you recover and receive post-op care.  Your doctor will give you detailed instructions on medications, how to care for your dressings and wound sites, and when and how to begin physical activity.

After you’re released, it’s important that you watch for any symptoms that are not normal and could indicate complications.  These include:
  • Fever
  • Incision site becomes hot, painful to touch, or begins leaking
  • Upset stomach
  • Difficulty breathing or coughing
  • Pain that isn’t general soreness in your stomach, legs, chest, or shoulders

For the first few weeks following the procedure, you will likely be on a liquid diet.  Your doctor will give you suggestions on when you can introduce soft food and then regular foods into the program, and tips on how to eat them.

It’s critical that you eat slowly, chew your food thoroughly, and space out your fluids and meals.  You don’t want to drink anything for 30 minutes before or after you’re scheduled to eat.

You’ll also need to begin your supplementation program, and your doctor will tell you what to take to avoid developing any nutritional deficiencies.  To ensure that you’re healthy, you’ll have to take a blood test every six months to check your vitamin and mineral levels.

Regarding weight loss, you will see results very quickly.  Most patients start dropping pounds immediately and see significant reductions in the weeks and months following surgery.

During this time, you may also experience moodiness, body aches, hair loss or thinning, body aches, and feel cold and tired.  These are typical side effects and will go away once your weight stabilizes.

Finally, you’ll be required to go to regular follow-up appointments with your surgeon and doctor.  They may also suggest that you work with a dietitian to hone in your new eating and lifestyle habits, and a psychologist to help you adapt to, process, and manage your new way of life.

What’s Next?

If you feel that you’re a candidate for gastric bypass surgery, start by talking with your physician.  They will help evaluate your needs and can recommend resources to begin the process if you’re a good fit.

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