BODY MASS INDEX
RNY Gastric Bypass
Roux-N-Y Gastric Bypass is one of the most frequently used obesity surgery operations in the world. It was found and practiced by Dr. Mason in 1966. The use of Roux-N-Y Gastric Bypass surgery has decreased with the development of techniques that cause less absorption defects while it was the most common procedure in the 2000’s. It keeps the most commonly used method in Europe. Roux-en-Y Gastric Bypass is an operation which both minimizes stomach capacity and restricts absorption. It reduces the amount of foods you eat, and at the same time it ensures some of the nutrients’ disposing without absorbing.
Like all obesity surgeries, Roux-en-Y Gastric Bypass surgery is applied to obese patients who can not lose weight with diet and exercise. Roux-en-Y Gastric Bypass provides you to lose your over weight which you can not lose with diets and heavy exercises. In this surgical method, it should not be forgotten that if the person does not pay attention to his diet she/he will gain weight again in the long term.
It is performed by the closed method, in other words by the laparoscopic method. First of all, a small stomach is formed at the entrance of the stomach and this is called a stomach pouch. The capacity of the newly created gastric pouch is approximately 35-50 cc. If your normal stomach volume is approximately 800-1000 cc, it means that your stomach capacity will be reduced by more than 95%. This is called a restrictive effect.
For this newly created stomach pouch, it is necessary to make a new way to ensure the passage of food to the intestines. For this, your small intestines are cut in the middle. The edge that continues downwards is pulled up and connected to the new stomach pouch. So, the taken foods come to the new stomach pouch. The old stomach remains passive and does not meet food at all. Food coming into the new stomach pouch passes directly to the small intestine which was connected directly. Thus, with the remaining stomach, some small intestine is separated from the food passage and it does not contact with food at all. This process prevents the absorption of all nutrients and increases the strength of weight loss.
At a point further from the newly created small gastrointestinal junction, the remaining intestine from the stomach is reconnected to the main line. So, the remaining enzymes and fluids produced by the stomach combine with the food and continue on their normal passage.
The neurohormonal effect of RNY Gastric Bypass has been commented differently in different studies. Ghrelin which is known as the appetite-effective hormone is produced in the fundus part of the stomach. In this type of bypass, the stomach remains closed. While some studies claim that the level of ghrelin does not decrease significantly, some studies defend that the level of ghrelin decreases significantly with the disconnection of the network. In this type of bypass, it is known that the level of satiety hormones (GLP-1, PYY, CCK) increases and these patients are saturated with much smaller amounts. After meals the increase in GLP-1 is observed in early period and this is the main role in the control of diabetes.
The restrictive effect of the left stomach pouch is usually short-term and this does not have a restrictive effect as much as a tubed stomach. This transition between the intestine will expand by time. The additional intestinal part is not as resistant to expansion as the stomach and this intestine can expand and take the shape of a new stomach. Considering that all foods will bypass the stomach and the initial small intestine, it should be kept in mind that some vitamins will be continuously taken as supplements after this surgical method.
The patients who prefer this method should not forget that the stomach will remain closed and can not be reached into the stomach with techniques such as endoscopy. It’s important that it may cause late diagnosis of a possible stomach cancer in races and societies where gastric cancer is common. This type of bypass should be preferred especially for patients with gullet wounds due to reflux which is related to large gastrocoele.
The length of the bypassed small intestine junction is related to the patient’s weight loss, in other words it is related to the severity of the absorption defect. If the more intestinal connections are bypassed, the more vitamin deficits the patient will face, but the more weight will be lost and the risk of weight gain will decrease. This is the same for all bypass processes including metabolic surgery.
Dumping syndrome is an important problem encountered in this type of bypass. Dumping syndrome is a syndrome that occurs when dense stomach contents (foods) suddenly pass into the small intestine. This structure which acts as a valve at the exit of the stomach and regulates the intestinal passage has been deactivated and it has been bypassed in these surgeries. In addition, in this surgical method, due to the cutting of the stomach nerves, the expansion capacity of the stomach decreases and causes the rapid discharge of fluids. Dumping syndrome has two stages or types; early and late dumping syndrome.
Early Dumping Syndrome: Occurs 15-30 minutes after eating. Symptoms include sweating, weakness, palpitations, cramping stomachache and dizziness. The patient feels unwell and may have a dying sensation. This is just a feeling.
Late Dumping Syndrome: Occurs 2-3 hours after eating. The patient may have low glucose after meals. It improves when sugar is given to the patient.