What is roux-en-y gastric bypass (RYGB) surgery?

The operation is done under general anaesthesia. This means you will be asleep during the procedure. Gastric bypass is usually done using keyhole (laparoscopic) surgery. The operation usually takes two hours. You will usually be able to go home two to three days after your operation but it usually takes between four and six weeks to make a full recovery from a gastric bypass operation.

What all tests you undergo before surgery?

There is a battery of tests you must undergo before RYGB. This is to ensure that your operation is carried out with the least risk and also prevent all avoidable post op complications. To assess your fitness to undergo surgery, we will do routine blood tests, an echocardiography (for your heart), pulmonary function tests (for your lungs), a sleep study (regarding snoring and episodes of breathlessness in your sleep), and Thyroid function tests. You will need to undergo an ultrasound of your abdomen and a Doppler study (a type of Ultrasound) of your lower limb veins.

An Upper GI endoscopy is done in which a gastroenterologist passes a telescope through your mouth into your stomach so that he can see the inside of your stomach on a screen connected to the telescope. This is to see any ulcers in your stomach if present as then the operation will have to be postponed. This is a short procedure that may cause you slight discomfort. Your endocrinologist will also conduct a few blood tests to assess your diabetic status.You may need to undergo additional tests if indicated by the results of the above mentioned investigations.

You will also have sessions with your dietician who will assess your ideal weight and BMI. Your dietician will give you a diet chart for you to follow. It is necessary that the diet restrictions must begin prior to the surgery. You are advised to lose 4-5 kg prior to your operation which not only makes your operation safer but is also a proof of your motivation to lose weight.

How are you prepared for surgery?

– Preoperative preparation

• After your surgeon reviews the potential risks and benefits of the operation with you and your relatives, you will need to provide a written consent for surgery. If your drink alcohol or smoke Cigarettes please inform you doctor.
• You will be put on liquid diet 14 days prior to the operation. On the night before operation, you will have nothing to eat and drink after 12 midnight.
• You will be assessed by your anaesthetist the day before the surgery and you will be advised regarding the medicines that have to be taken on the day of surgery.
• It is mandatory that your blood pressure and blood sugars are controlled prior to surgery. If you are a diabetic on oral hypoglycaemic medicines, you may be advised to stop them and start on Insulin injections. This is to have better control over your sugars preoperatively and intraoperatively.

What happens during surgery?

• The operation is done under General Anaesthesia. So you wouldn’t know anything that is happening to you and you will know no pain during the surgery.
• A cannula (small tube), is inserted into your hand veins through which you will be given fluids and other medicines required during operation
• Small openings of size are made to your abdomen. First gas is passed into your abdominal cavity so that enough space is created to carry out the operation effectively.
• A laparoscope connected to a TV screen is passed through the opening in the midline. Other openings are used to insert the required instruments into your abdomen. Five to six such holes (5mm to 12 mm) are created.
• A bougie (tube) of a definite size (36F) is passed into your stomach though the mouth. This is to have an idea about the size of your stomach to be removed and to check patency and rule out leak of stomach to intestine anastamosis.
• A portion of your stomach is then cut using a special laparoscopic stapler-cutter which places three rows of staples on each side and cuts in between. The Surgeon cuts across the top of your stomach, sealing it off from the rest of your stomach. The resulting pouch is about the size of a large egg and can hold only about 30-50ml of food. Normally, your stomach can hold about 1500ml of food.
• Then the surgeon cuts the small intestine and sews part of it directly onto the pouch.Food then goes into this small pouch of stomach and then directly into the small intestine sewn to it. Food bypasses most of your stomach and the first section of your small intestine, and instead enters directly into the middle part of your small intestine. Intra-abdominal defects created are closed with non absorbable sutures.
• You will be shifted to recovery room or ICU depending on your condition after surgery

How will be your post operative period ?

• When you wake up from the anaesthesia, you will find that a tube may be placed in your abdominal cavity to drain any fluid that may get collected inside during or after operation. This drain is usually removed on the second or third day after operation depending on the amount of fluid getting collected.
• After the surgery, you will not be allowed to eat or drink anything that day. On the morning of the day after operation, you maybe star tedon liquids as recommended by the dietician, if no complication is suspected by your treating doctor. You may need to undergo gastrograffin test (x-rays will be taken after you are made to drink a dye)This is to confirm that there is no leak from the repaired part of your stomach.
• A complication that can take place in the post operative period due to your obesity and surgery is clotting of blood in your leg vessels (Deep Vein Thrombosis-DVT) which can be dangerous. To prevent this we apply pumps on your legs throughout surgery much your hospital stay. These pumps compress your legs alternatively thus preventing DVT. We also give injections that will thin out your blood and prevent clotting. These injections will have to be taken for about 10 days after surgery.
• After the surgery while you are in the hospital, you should do breathing exercises, be active and follow your dietician’s advice.

Benefits and Risks of surgery benefits?

• Significant and durable weight loss
• Improvement /Resolution of Type II Diabetes Mellitus
• Improvement/Resolution of several problems including Sleep Apnea, High Blood Pressure, Joint Pains, GERD, PCOD.
• Improved Quality of Life and improved self-esteem Risks
• Roux-en-Y gastric bypass (RYGB) surgery is a major surgical procedure. Like any other major surgery it can lead to complications though the overall risk of complications is low.
• Conversion to open Surgery. Although majority of the procedures can be completed laparoscopically, we may need to give a big cut in case of a difficulty during surgery
• Leak from Staple Line is a serious complication and may prolong the hospital stay by many weeks. The management of this complication may require another surgery or endoscopic intervention
• Bleeding can occur either during surgery or after surgery. This may require blood transfusions or additional surgery
• Injury to organs including spleen, intestine, oesophageal injury.
• DVT or blood clots in the legs can occur despite all the precautions. Sometimes the clot can travel to lungs and prove fatal
• Chest Infection which may require antibiotics, admission to ICU and ventilator support.
• Vomitings in the early postoperative period may be troublesome. This usually settles within few days but may require endoscopy and dilatation of the narrow passage
• Marginalulcer can occur, might need an endoscopy
• Internal hernia can occur leading to obstruction and might need reoperation.
• Wound Infections are usually minor but some of them may take long time to resolve
• Anaemia, micro and macronutrient deficiency can occur post surgery, so you need to regularly followup with your doctor, regularly at 3,6,12,months, then yearly with investigations and take life long multivitamin suppliments.
• Incase of Fever, Pain abdomen, vomiting Urgently report to your doctor on given Emergency numbers

This brochure is not intended to replace your discussions with your surgeon and dietician. Your decision to undergo the procedure should be made after your consultation with your surgeon. if you have any questions regarding the procedure, you must ask your doctor.

This brochure intends to give you a basic understanding regarding Laproscopic Roux-en-Y gastric bypass (RYGB) Surgery which is an effective surgical procedure for treatment of morbid obesity.