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Scot Currie, DO
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Roux-en-Y Gastric Bypass Surgery: a Restrictive and Malabsorptive Procedure
According to two organizations, the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y (pronounced ROO-en-why) gastric bypass surgery is the most popular bariatric surgery in the United States.
In this procedure, the surgeon creates a small stomach pouch and then constructs a “bypass” for food. The bypass allows food to skip parts of the small intestine. By skipping a large part of the small intestine, the body cannot absorb as many calories or nutrients.
Advantages
- A 2004 meta-analysis of more than 22,000 patients showed that those who underwent a bariatric surgical procedure experienced complete resolution or improvement of their co-morbid conditions including diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea.16
- 83.7 percent of type 2 diabetes cases were resolved.3
- In the studies analyzed, the control group that didn’t have bariatric surgery was at a higher risk for type 2 diabetes: 3.7 times higher.3
- Resolution of type 2 diabetes often occurred within days of the surgery.3
- 96.9 percent of hyperlipidemia cases were resolved.3
- 75.4 percent of hypertension cases were resolved; 87.1 percent were resolved or improved.3
- Substantial weight reduction occurred; 61.6 percent of excess weight was lost.3
- In 2000, a study of 500 patients showed that 96 percent of co-morbidities (the study looked specifically at back pain, sleep apnea, high blood pressure, type 2 diabetes, and depression) were improved or resolved.8
- A great deal of excess weight was lost, and patients experienced resolution of co-morbidities, and improved appearance, social opportunities, and economic opportunities.3
Risks and Disadvantages
- Because the duodenum and other sections of the small intestine are bypassed, poor absorption of iron and calcium can cause low total body iron and a greater chance of having iron-deficiency anemia. Patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids should be aware of the chance of iron-deficiency anemia. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the possibility of increased bone calcium loss. By taking a multivitamin and calcium supplements, patients can maintain a healthy level of minerals and vitamins.
- Bypassing the duodenum can cause metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back, and fractures of the ribs and hipbones. Eating foods rich in nutrients and taking vitamins can help patients avoid this.
- Chronic anemia due to vitamin B12 deficiency may occur. The problem usually can be managed with vitamin B12 pills or injections.
- A condition known as dumping syndrome can occur from eating too much sugar or large amounts of food. While it isn’t considered a serious health risk, the results can be very unpleasant. Symptoms can include vomiting, nausea, weakness, sweating, faintness, and, on occasion, diarrhea. Some patients are unable to eat sugary foods after surgery.
- The bypassed portion of the stomach, duodenum, and parts of the small intestine cannot be seen easily using X-ray or endoscopy if there are problems such as ulcers, bleeding, or malignancy.
- It is a permanent, nonreversible procedure.
- The procedure could result in death.
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