UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Laparoscopic Roux-en-Y gastric bypass

Author
Robert B Lim, MD, FACS, COL, MC, USA
Section Editor
Daniel Jones, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Laparoscopic Roux-en-Y gastric bypass (LRYGB), as a bariatric procedure, was first described by Alan Wittgrove in 1994 [1]. Over the ensuing decades, the technique of LRYGB as well as perioperative care of patients have been gradually improved and refined [2]. Consequently, the mortality rate associated with the RYGB has decreased from 2.6 percent at the turn of the century [3] to 0.12 percent in contemporary practices [4].

LRYGB has been established as the gold standard against which other bariatric procedures are measured. LRYGB induces more weight loss than adjustable gastric banding [5] and more durable weight loss than sleeve gastrectomy [6], causes lower morbidity and mortality than biliopancreatic diversion/duodenal switch [7], and has proven efficacy that is unparalleled by newer procedures such as mini-gastric bypass, single-anastomosis duodenal switch, intragastric balloon, and vagal stimulation [8-10].

The indications, preoperative workup, techniques, postoperative care, and outcomes of LRYGB are discussed here. Other bariatric procedures and perioperative management of bariatric patients in general are discussed in other topics, including:

(See "Bariatric operations for management of obesity: Indications and preoperative preparation".)

(See "Bariatric procedures for the management of severe obesity: Descriptions".)

                                              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2017. | This topic last updated: Apr 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic Gastric Bypass, Roux-en-Y: Preliminary Report of Five Cases. Obes Surg 1994; 4:353.
  2. Lehman Center Weight Loss Surgery Expert Panel. Commonwealth of Massachusetts Betsy Lehman Center for Patient Safety andMedical Error Reduction Expert Panel on Weight Loss Surgery: executive report. Obes Res 2005; 13:205.
  3. Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg 2007; 246:1002.
  4. DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2010; 6:347.
  5. American Society of Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers. http://asmbs.org/resources/estimate-of-bariatric-surgery-numbers (Accessed on February 03, 2017).
  6. Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric Surgery and Long-term Durability of Weight Loss. JAMA Surg 2016; 151:1046.
  7. Nelson DW, Blair KS, Martin MJ. Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. Arch Surg 2012; 147:847.
  8. Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis 2015; 11:321.
  9. Alfredo G, Roberta M, Massimiliano C, et al. Long-term multiple intragastric balloon treatment--a new strategy to treat morbid obese patients refusing surgery: prospective 6-year follow-up study. Surg Obes Relat Dis 2014; 10:307.
  10. Sarr MG, Billington CJ, Brancatisano R, et al. The EMPOWER study: randomized, prospective, double-blind, multicenter trial of vagal blockade to induce weight loss in morbid obesity. Obes Surg 2012; 22:1771.
  11. le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg 2007; 246:780.
  12. American Society for Metabolic & Bariatric Surgery. Low BMI. https://asmbs.org/resources/bariatric-surgery-in-class-i-obesity (Accessed on February 02, 2017).
  13. Aminian A, Brethauer SA, Andalib A, et al. Can Sleeve Gastrectomy "Cure" Diabetes? Long-term Metabolic Effects of Sleeve Gastrectomy in Patients With Type 2 Diabetes. Ann Surg 2016; 264:674.
  14. Aminian A, Andalib A, Ver MR, et al. Outcomes of Bariatric Surgery in Patients with Inflammatory Bowel Disease. Obes Surg 2016; 26:1186.
  15. Schigt A, Coblijn U, Lagarde S, et al. Is esophagogastroduodenoscopy before Roux-en-Y gastric bypass or sleeve gastrectomy mandatory? Surg Obes Relat Dis 2014; 10:411.
  16. Edholm D, Kullberg J, Karlsson FA, et al. Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass. Surg Obes Relat Dis 2015; 11:602.
  17. Birkmeyer NJ, Finks JF, Carlin AM, et al. Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery. Arch Surg 2012; 147:994.
  18. Nielsen HK. Pathophysiology of venous thromboembolism. Semin Thromb Hemost 1991; 17 Suppl 3:250.
  19. Birkmeyer NJ, Finks JF, English WJ, et al. Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery. J Hosp Med 2013; 8:173.
  20. Yoong W, Saxena S, Mittal M, et al. The pressure profile test is more sensitive and specific than Palmer's test in predicting correct placement of the Veress needle. Eur J Obstet Gynecol Reprod Biol 2010; 152:210.
  21. van Wezenbeek MR, van Oudheusden TR, Smulders JF, et al. Transection versus preservation of the neurovascular bundle of the lesser omentum in primary Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2016; 12:283.
  22. Al-Mansour MR, Mundy R, Canoy JM, et al. Internal Hernia After Laparoscopic Antecolic Roux-en-Y Gastric Bypass. Obes Surg 2015; 25:2106.
  23. Owens M, Barry M, Janjua AZ, Winter DC. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011; 9:218.
  24. Al Harakeh AB, Kallies KJ, Borgert AJ, Kothari SN. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis. Surg Obes Relat Dis 2016; 12:194.
  25. Ahmed AR, Rickards G, Husain S, et al. Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2007; 17:1563.
  26. Escalona A, Devaud N, Pérez G, et al. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis 2007; 3:423.
  27. Steele KE, Prokopowicz GP, Magnuson T, et al. Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc 2008; 22:2056.
  28. Dogan K, Homan J, Aarts EO, et al. A short or a long Roux limb in gastric bypass surgery: does it matter? Surg Endosc 2017; 31:1882.
  29. Mahawar KK, Kumar P, Parmar C, et al. Small Bowel Limb Lengths and Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2016; 26:660.
  30. Risstad H, Svanevik M, Kristinsson JA, et al. Standard vs Distal Roux-en-Y Gastric Bypass in Patients With Body Mass Index 50 to 60: A Double-blind, Randomized Clinical Trial. JAMA Surg 2016; 151:1146.
  31. Giordano S, Salminen P, Biancari F, Victorzon M. Linear stapler technique may be safer than circular in gastrojejunal anastomosis for laparoscopic Roux-en-Y gastric bypass: a meta-analysis of comparative studies. Obes Surg 2011; 21:1958.
  32. Lee S, Davies AR, Bahal S, et al. Comparison of gastrojejunal anastomosis techniques in laparoscopic Roux-en-Y gastric bypass: gastrojejunal stricture rate and effect on subsequent weight loss. Obes Surg 2014; 24:1425.
  33. Suggs WJ, Kouli W, Lupovici M, et al. Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. Surg Obes Relat Dis 2007; 3:508.
  34. Lemmens L. Banded Gastric Bypass: Better Long-Term Results? A Cohort Study with Minimum 5-Year Follow-Up. Obes Surg 2017; 27:864.
  35. Heneghan HM, Annaberdyev S, Eldar S, et al. Banded Roux-en-Y gastric bypass for the treatment of morbid obesity. Surg Obes Relat Dis 2014; 10:210.
  36. Madan AK, Stoecklein HH, Ternovits CA, et al. Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass. Surg Endosc 2007; 21:194.
  37. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med 2014; 370:2002.
  38. Jamal M, Wegner R, Heitshusen D, et al. Resolution of hyperlipidemia follows surgical weight loss in patients undergoing Roux-en-Y gastric bypass surgery: a 6-year analysis of data. Surg Obes Relat Dis 2011; 7:473.
  39. Ashrafian H, le Roux CW, Rowland SP, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax 2012; 67:442.
  40. Fredheim JM, Rollheim J, Sandbu R, et al. Obstructive sleep apnea after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention. J Clin Sleep Med 2013; 9:427.
  41. Madalosso CA, Gurski RR, Callegari-Jacques SM, et al. The Impact of Gastric Bypass on Gastroesophageal Reflux Disease in Morbidly Obese Patients. Ann Surg 2016; 263:110.
  42. Pallati PK, Shaligram A, Shostrom VK, et al. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2014; 10:502.
  43. Choudhry AJ, Haddad NN, Martin M, et al. Medical Malpractice in Bariatric Surgery: a Review of 140 Medicolegal Claims. J Gastrointest Surg 2017; 21:146.
  44. Elms L, Moon RC, Varnadore S, et al. Causes of small bowel obstruction after Roux-en-Y gastric bypass: a review of 2,395 cases at a single institution. Surg Endosc 2014; 28:1624.