Table of Content
- What is a Roux-en-Y Gastric Bypass (RYGB)?
- What are the benefits of a Roux-en-Y Gastric Bypass (RYGB)?
- How much weight can you expect to lose?
- What are the risks of a Roux-en-Y Gastric Bypass (RYGB)?
- What should you expect after the procedure?
- Complications that can occur after surgery
- Possible long term complications after surgery
What is a Roux-en-Y Gastric Bypass (RYGB)?
A Roux-en-Y Gastric Bypass (RYGB) involves dividing the stomach to create a small pouch at the top. A segment of the small intestine is then connected to this pouch. There is a connection between the 2 limbs of the small bowel further down (called the jejuno-jejunal anastomosis) to allow mixing of gastric juice and food to allow digestion. Food is hence bypassed from the larger portion of the stomach and the first part of the small intestine (call the duodenum). It is used to help people to lose weight and improve their health.
Losing weight lowers the risk of developing medical problems associated with obesity, such as heart attack, high blood pressure, diabetes mellitus, arthritis, obstructive sleep apnea, fatty liver, back pain, knee pain and ankle pain. This is a very effective operation to help improve Type 2 Diabetes Mellitus. The diabetic control can be improved and the need for medications reduced.
What are the benefits of a Roux-en-Y Gastric Bypass?
After the surgery, food will enter the small stomach pouch from the oesophagus and then directly into the small intestine (Roux limb), hence bypassing the larger portion of the stomach. It will mix with the gastric juice to allow digestion after the jejuno-jejunal anastomosis.
A patient after Roux-en-Y Gastric Bypass (RYGB) will feel less hungry and fuller sooner and for longer after a meal. The need for blood pressure or diabetes medication may be reduced, but still able to achieve a better control compared to before the operation. Risk of heartburn is lower in gastric bypass patients compared to those who underwent sleeve gastrectomy.
The surgery is done laparoscopically, commonly known as “keyhole” surgery. This means that you will be up and about soon after surgery and should make a speedy recovery.
How much weight can you expect to lose?
You can lose up to 50% – 80% of your excess weight (EWL) or 25-35% of your total weight (TWL) in the first 12–18 months following surgery. However, an excess weight loss of 100% or more is not uncommon in patients who do intensive exercising.
The amount of weight you are able to lose and keep off after surgery will depend also on the lifestyle changes that you make, such as increasing the amount of exercise you take and eating a healthy diet.
What are the risks of a Roux-en-Y Gastric Bypass?
Recovery
What should you expect after the procedure?
Hospital Stay
The first few hours after the operation
You will wake up in a recovery room where nursing staff will monitor you for any complications. You will have a drip and also be wearing stockings and have a pumping device on your legs to prevent blood clots.
As soon as you are fully awake and comfortable, you will be transferred to either the surgical ward, high dependency or the intensive care unit or where your relatives can visit you. You will be able to have sips of water and some painkillers to control any pain.
You are encouraged to get out of bed as soon as possible after surgery. This helps to reduce the chance of post-operative complications such as blood clots in the legs or chest infections.
The day after the operation
You may be scheduled for a swallow test by Dr Tan. After which you will be able to have some fluids. Your drip will be removed when you are drinking enough to keep you hydrated.
The following few days after the operation
You should start to feel better very quickly after the operation and will be able to move around on your own. You will need to drink an average of 1.5L to 2.5L of fluids daily. We will have a dietician to guide your post-operative diet. 2-3 days after surgery you will be able to go home.
At Discharge
Pain and Medications
You will be given oral pain medications to go home. You will also be given anti-acid medications. If you have been taking medication to control your blood pressure or diabetes, these will be reviewed before your discharge. In most cases, these can be reduced or sometimes stopped altogether. Please make sure you are clear about this before you leave the hospital.
Wounds
The small incisions made for your surgery may be covered with small plasters upon discharge. Dr Tan will review the wounds when you see him in the clinic.
Eating and Drinking after the operation
You will be given a diet information sheet. Our dietician will help guide you along for your post-operative diet.
Activities
You will be able to walk straight after surgery. Try to go for a walk every day, gradually increasing the distance as you feel able. You will be given hospitalization leave. It is advisable to avoid heavy lifting for at least 1 month after abdominal surgery.
Women of childbearing age must not become pregnant for at least one year following bariatric surgery.
After one year: if you are planning a pregnancy, please inform Dr Tan and he will guide you accordingly.
Follow up schedule
You will be given an appointment to see Dr Tan in his clinic for follow up. Initially after the surgery, there will be closer follow up, after which the periods for follow up will then be further spaced out.
Complications that can occur after surgery
- Wound infection: this can usually be treated with a course of antibiotics and does not require hospital admission.
- Bleeding: You will be monitored carefully for signs of bleeding. If occurs, it can be often managed conservatively and occasionally it may require transfusions. Exceptionally the Dr Tan will need to perform surgery to stop the bleeding.
- Blood clots in the legs or the lungs (DVT/PE): To prevent blood clots from forming you will be given an injection just before the operation to thin the blood. During and immediately after your operation, you will wear special stockings to prevent clots from occurring. You will be asked to ambulate early to minimize the risk of such clots.
- Smoking significantly increases the risk of clotting. If you are a smoker, you will be advised to stop smoking before surgery.
- Leaks from staple lines: This postoperative problem is rare but serious and may require emergency surgery. A leak is usually caused by a failure of the natural healing process as all staple lines are checked at the end of the operation. If this happens, your hospital stay will be longer. Sometimes this will heal without further surgery. In the worst-case scenario, Dr Tan may decide to take you back to operating theatre to control the leak and perform additional measure to help with your recovery.
Possible long term complications after surgery
- The risk of additional surgeries after Roux-en-Y gastric bypass is generally higher than sleeve gastrectomy
- “Dumping” of food may occur, especially after eating foods with high content of sugar or fat. There are early and late dumping syndromes. Dr Tan and his dietician will help you along should you experience these symptoms.
- Hair loss or thinning in the first six months. This is a temporary side effect of the rapid weight loss and it will improve with time.
- Gallstones. Gallstone formation can be found in up to 30% of post bariatric surgery patients. Discuss your options with Dr Tan.
- Nutritional deficiencies. It is highly encouraged that you take multi-vitamin supplements after Roux-en-Y gastric bypass, due to lesser absorption of nutrients after surgery. Dr Tan and dietician in the multi-disciplinary team will guide you in your vitamin supplementation during your follow up visits in Dr Tan’s clinic.
- Port site hernias of the abdominal wall.
- Internal hernias. Risk of internal hernia happening is low, but one needs to be aware of it. Symptoms to look out for include severe abdominal pain, vomiting. Such symptoms can happen many years after the bypass surgery. Severe cases can lead to obstruction of small bowel, sometimes even small bowel compromise requiring resection. Please head to the A&E immediately in the event of emergency and get the A&E doctor to contact Dr Tan.
Keyhole Surgery Expertise
A Roux-en-Y Gastric Bypass (RYGB) is carried out through a minimally invasive way known as laparoscopic, or keyhole, surgery. Whereas an open surgery requires long incisions made in the abdomen, laparoscopic surgery only requires small incisions and is carried out with the use of specialised keyhole instruments.
Because the procedure is less invasive, keyhole surgery offers the advantage of promoting less post-operative pain, shorter hospital stay and a quicker recovery period. At Surgicare, Dr Tan specialises in providing keyhole surgery when surgical repair is needed and where applicable.
Dr Tan Chun Hai (陈俊海医生)
Upper Gastrointestinal, Bariatric & General Surgeon
Endoscopy & Minimally-Invasive Surgery Specialist
Dr. Tan Chun Hai is a dual fellowship-trained specialist in laparoscopic (keyhole) stomach cancer surgery and Bariatric & Metabolic surgery. His clinical expertise includes the use of minimally invasive surgical techniques for stomach-related disorders, Gallstones, Appendicitis and Gastroesophageal Reflux Disease.
Dr. Tan also specialises in performing endoscopies/gastroscopies and colonoscopies. When applicable, Dr. Tan provides same-day treatment within a few hours of diagnosis. Dr. Tan subscribes to a less invasive practice, promoting less postoperative pain and shorter hospital stays.
Have a concern?
Send us your enquiry or give us a call at 6250 5610
For emergencies after hours, send us a text via WhatsApp > head to Gleneagles Urgent Care Centre and request for Dr. Tan Chun Hai
Our Clinic: 6A Napier Road, Gleneagles Hospital Annexe Block, #05-36A, Singapore 258500
