According to the American Academy of Family Physicians, 67 percent of Americans are overweight, resulting in over $100 billion in medical costs per year. Diseases related to obesity include diabetes, heart disease, sleep apnea, osteoarthritis, depression and some types of cancer. Roux-en-Y gastric bypass, or RYGB, is a surgical procedure performed to cause weight loss in severely obese patients. It can have complications as well as benefits.
Procedure
According to the AAFP, Roux-en-Y gastric bypass is a major abdominal surgery, the most commonly performed weight loss surgery in the U.S. RYGB reduces the size of the stomach to a 1-oz. pouch and alters the digestive tract so that food bypasses most of the stomach, duodenum and upper intestine.These surgical alterations assist with weight loss by limiting the amount of food that can be eaten and limiting the absorption of nutrients and calories, explains the National Institute of Diabetes and Digestive and Kidney Diseases.
Indications
According to the National Institutes of Health, to qualify for RYGB a patient must have a body mass index of at least 40, or 35 if one or more obesity-related conditions exist. Patients must have a history of failed attempts at weight loss in a program that included changes in diet, exercise and behavioral modification. Motivation, the ability to understand the risks and benefits of surgery and a firm commitment to postoperative lifestyle changes and medical care are necessary. Good candidates meet all of these criteria.
Contraindications
Contraindications to Roux-en-Y gastric bypass surgery include binge eating disorders, depression, psychosis, current abuse of alcohol or drugs, blood clotting disorders and inability to follow ongoing requirements related to diet and supplements, explains the Merck Manual Online Medical Library. RYGB is contraindicated in those under 18 unless they are extremely obese, have serious weight-related medical or emotional disorders and have reached their maximum height.
Short-Term Complications
Common short-term complications include infections of the incision, constipation and stomal stenosis, which is a narrowing of the surgically created connection of the stomach and intestines, according to the AAFP. Stomal stenosis occurs in approximately 9 to 20 percent of patients and results in persistent vomiting. A stomach ulcer occurs in 1 to 16 percent of patients and can result in bleeding. Constipation commonly results from pain medication and dehydration.
Long-Term Complications
Long-term complications following RYGB surgery include gallstones, ongoing vomiting, nutritional deficiencies and dumping syndrome, explains the AAFP. Dumping syndrome is characterized by nausea, vomiting, diarrhea, rapid heart beat, increased salivation and dizziness after eating sweet foods and simple carbohydrates. A high-protein diet and high-potency vitamins are required to prevent nutritional deficiencies. Anemia can develop in menstruating women. Malnutrition can develop in patients who experienced prolonged nausea and vomiting and repeated hospitalizations, due to the development of food phobias. Excess abdominal skin resulting from weight loss may require surgical removal if infections, called panniculitis, are a problem.
Life-Threatening Complications
According to Merck, the most common cause of death following RYGB surgery is a pulmonary embolism, a blood clot that travels to the lungs. Other serious complications include respiratory failure and the leaking of gastric fluid into the abdominal cavity, called an anastomotic leak, which requires surgical correction and can be fatal.
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