RNY GASTRIC BYPASS SURGERY

SURGICAL METHOD

•  Inflate the abdomen with CO2 gas to create sufficient space around the stomach and intestines. The abdomen will be deflated at the end of surgery, however some gas residue will remain and cause pain and discomfort (on the left side and left shoulder in particular). Walking as much as you can after surgery will help to reduce pain and remove gas much faster. Learn more at Pain. Left side stabbing pain or left shoulder pain, early recovery stage.
• Perform an endoscopy to check on the stomach condition. Learn more about the pre-op and post-op endoscopy here >>
• If the liver is large, a special instrument called liver separator will be inserted to keep the liver in an uplifted position throughout surgery to allow access to the stomach.
• Hiatus (an opening in the diaphragm where the esophagus connects to the stomach) will be examined to check if hiatal hernia is present. If a hiatal hernia is diagnosed and it is large, it will be repaired during surgery by suturing the opening in the diaphragm. The stomach will be pulled into its correct natural position and if need be anchored by a so-called anchor stitch (it is important to stress that there is no guarantee a hiatal hernia will not develop again in the future).
• With the help of a laparoscopic stapler, the surgeon separates a tube-shaped chamber from the stomach at the base of the esophagus, it will be connected to the small intestine, this will form the first anastomosis (connection between the stomach pouch and the small intestine). The remaining part of the stomach is no longer attached to the esophagus and will no longer receive food. It does remain in your body in its original position and continues producing stomach acid that flows into the small intestine and helps to digest food.  The volume of your new stomach pouch is much smaller, about 1 to 2 oz which results in restrictive feeling and smaller food portions. The pouch has the shape of a small tube.
• The surgeon will create a Y-shaped anatomy of the digestive tract formed by the stomach pouch and two parts of the small intestine: the biliary limb and the Roux limb (this is where the name of Roux-en-Y comes from). The doctor will measure out about 100 to 150 cm (3 to 5 feet) of the small intestine called duodenum (also known as biliary limb) that follows the larger part of the stomach that has been separated (see the image above). Food will no longer pass through the duodenum (biliary limb) where most of the calories and nutrients are absorbed, this produces a malabsorptive effect and results in more drastic weight loss. But the stomach juices and liver enzymes (bile fluids) that help to digest food will pass through and reach food further down. The surgeon will also measure out another 70 to 120 cm (2 to 4 feets) of the small intestine called jejunum (or Roux limb) that will follow the new small stomach pouch. Food will be passing through this portion of the small intestine. Finally, the biliary limb and the Roux limb will be stapled together creating a second intestinal connection – duodenojejunal anastomosis. At this point food passes through a so-called common channel, meaning that digestive enzymes from duodenum and food from jejunum will be united in the remaining portion of the small intestine, this is called a common channel.
• Since quite a lot of intestinal movement is involved to perform a bypass, the small intestine must be separated from the visceral fat tissue that surrounds our internal organs. This is why a good pre-op diet is so important for any type of bypass surgery: the better the diet, the less internal fat tissue (visceral fat) surrounds the intestines, the less cutting is needed, which results in less blood loss, less risks and faster recovery.
• In certain cases the surgeon removes the Fundus portion of the stomach that is located in the upper part of the stomach. This may be necessary in case of a higher complication risk, if stomach polyps are diagnosed in the Fundus, or due to the scar tissue after previous abdominal surgeries that complicate access to the stomach, due to a very large liver and other factors. Removing the fundal portion of the stomach has its pros and cons: it makes a bypass surgery slightly easier for the surgeon and reduces the risk of post-op stomach ulcers (the larger the stomach pouch, the more possibilities for ulcers to develop); some research shows that it also decreases hunger during the first months post-op by reducing production of the hormone Ghrelin that is mainly produced in the Fundus; it does however increase the risk of the post-op bleeding (the more cutting is done, the more blood vessels may bleed).
• A second endoscopy is performed to check for potential staple or suturing line disruptions, bleedings, etc.
• Drain tube will be placed (it is removed on the day of the hospital discharge).
• All the incisions are closed with 100% dissolvable stitches except for one incision that is sutured internally with non dissolvable material and externally with dissolvable suturing. This particular incision that is normally located toward the right side of the abdomen above the belly button is closed in this special way in order to prevent incisional hernia, since this incision is used more than others during surgery and thus is more traumatized. More surgical instruments are inserted and removed through this incision, if a portion of the stomach is removed, it is pulled through this incision also. Pain in this incision is expected to be a little stronger and longer-lasting compared to others. Fibrous tissue that feels like a ball or a lump when pressing on the area around that incision is normal during the first few months post-op and will reduce with time.

WEIGHT LOSS IS RAPID:

HOSPITAL AND HOTEL STAY

Short Term Disability or FMLA paperwork:

Our medical team will gladly complete the required forms for your employer. If you need a simple doctor`s note to take time off or a return to the work release note, please request one with your patient coordinator.

Send the forms (STD or FMLA) to your patient coordinator via email or fax them to 855-457-1400. Please be sure to complete the portion of the form that is non-medical related. Our medical team will complete only the portion of the form that is required to be completed by the attending physician. Usually, the top portion of any form asks for the patient to enter their personal and job-related information.

When you send us the form, please answer the following questions along with it:

1. The first day off work;
2. The day you plan on returning to work;
3. Will you need any work restrictions for a certain period of time after you return to work, such as no heavy lifting, light duty, frequent breaks, etc.? If yes, for how long, or will you need a release to full duty?

Our medical team takes 7 business days to process the forms; please send them, taking into consideration the processing times.

WHAT TO EXPECT AFTER RNY BYPASS SURGERY IN MEXICO 

• Recovery, pain, and complications are very similar to any other type of bariatric weight loss surgery.
• Pain is usually caused by the gas residue in the abdominal cave and walking helps to get rid of it faster. By the 3rd day post-op when the patient is discharged from the hospital, pain is easily manageable by non-opioid painkillers.
• In order to prevent blood clots, blood clot symptoms, and to promote healing, our medical team will have you up and moving as soon as possible following surgery. Special compression stockings will be used on your legs to help with blood clot prevention. Extra blood thinners may be prescribed upon hospital discharge, this is determined by our internal medicine doctors for each patient individually. Learn more about factors that increase blood clot risks here.
• Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly and lead to dumping syndrome. This can cause diarrhea and make you feel faint, shaky, and nauseous. It also can make it hard for your body to get enough nutrition. The same post-op diet is recommended for all surgery types. It is important to follow it without skipping any stages and without rushing, this will allow for a smooth recovery.
• During the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. Bit by bit, you will be able to add solid foods back into your diet. And after approximately one to two months you will come back to normal solid food intake. However, you will be asked to follow a new diet that will include more protein, vegetables and fruit for the rest of your life. Your stomach is much smaller and there is no room for junk food (you need to maximize nutrients from every bite you eat).
• It is important to keep sipping water throughout the day to avoid dehydration. Learn more about post-op dehydration (IV hydration)
• You may notice that your bowel movements are not regular right after your surgery. This is common, and if the condition lasts for more than 4 or 5 days you may need to use a light laxative, however, do consult your doctor before taking any additional medication. Learn more about post-op constipation.
• You must chew food very thoroughly and learn to stop eating when you feel full. This can take some time to get used to. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit.
• If you drink a lot of high-calorie liquids such as soda, fruit juice, milk, frappuccinos, etc., weight loss will slow down, stop and eventually you will start regaining the weight. The importance of food texture (solid foods vs liquids) in any type of bypass surgeries is explained in Restriction after gastric sleeve vs restriction after Mini or RNY bypass.
• If you continually overeat, the new stomach pouch and pouch opening (stoma) will stretch. If the stoma stretches, you will not benefit from your surgery and its restrictive effect will be lost.
• In RNY bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, our nutritionists will work with you on your vitamin intake and analyse your post-op lab work results. Taking vitamins post-op is highly recommended after RNY bypass for the rest of your life.
• Post-op lab work is recommended for all surgery types at 3-, 6-, 12, and 24-months post-op. Learn more at Blood work post-op.
• It is important to avoid heavy lifting: no more than 15-20 lb for the first 2-3 weeks, then no more than 35 lb for another 2-3 weeks. After 6 weeks it is safe to resume regular weight lifting but gradually.
• Light exercising is recommended after surgery as soon as you gain enough energy: walking, walking up the hill, elliptical, very light weights. Strenuous exercising is not recommended until 2 months post-op. Once your diet progresses to the stage where you can tolerate a greater variety of foods and your caloric intake increases, it is beneficial to add regular exercising to boost further weight loss.

LOWER YOUR RNY GASTRIC BYPASS SURGERY RISKS 

Before having any type of weight loss surgery, you can limit post-op side effects and complications by following these steps:

• Be completely honest in your medical questionnaire and when speaking to the medical team before surgery, do not hide any health conditions.
• Lower your BMI and shrink the fatty liver by strictly following the pre-op protein diet.
• Quit smoking cigarettes and marijuana, drinking alcohol, coffee and sugary/carbonated beverages, any type of street drugs.
• Exercise regularly (even if it is only walking)
• Stop (or continue) certain medications before surgery according to our medical team`s instructions (antacids, NSAIDs, hormonal medications, etc.)
• Start taking vitamins pre-op