RNY Gastic Bypass Surgery

Obesity is considered one of the health and social problems in recent years. Human beings get weight regain day by day due to the static system of city life and as a result, it is possible for this to cause other serious health problems. RYN Gastric Bypass (also known as gastric bypass surgery) it is defined as a type of surgical operation in the form of a new connection between the stomach and the small intestine. These surgeries are generally accepted bariatric surgery and are effective in the definitive treatment of obesity. These surgeries, which are mostly performed laparoscopically, are performed by specialist in laparoscopic surgeons in a fully equipped operating room environment. 

Obesity; it is the main cause of many health problems, especially endocrine system diseases. In genaral it can be said; complications that may be resulted by surgery for treating obesity no more dangerous than the obesity itself.

Therefore; the overweight condition of individuals, that is their conditions of obesity is a disease and its treatment is a requirement. This problem, whose struggle continues as a health problem in all countries of the world, has become a serious problem, especially in the United States, and measures have started to be taken publicly.

However, surgeries are not practices that people can decide for by themselves. Physicians and health institutions decide whether this practice is necessary with clinical monitoring, i.e. examinations, for people with obesity problems. RYN Gastric Bypass, like sleeve gastrectomy, obesity surgeries are listed among the solutions against obesity. These surgeries are also popularly called as gastric banding, stomach reduction or slimming surgery.

What is RNY Gastric Bypass Surgery?

With the planned obesity surgery, your stomach is divided into two main sections, one of which is quite small, using special surgical tools (laparoscopic insturment). The system is regulated by anastomosing the small stomach section to be formed from the starting part of the small intestine to an area of approximately 50-70 cm in length, after this level, the system is organized by re-combining two intestines that will allow your bile and pancreas secretions to reach the ongoing area of 100-150 cm.

With this surgery, it is aimed to reduce the volume of food intake due to small gastric pouch (30-50 cc) that were first created by surgery. Secondly, as a result of the later encounter with pancreas and bile fluids of the small amount of food that is eaten, it provides weight control by reducing all calories absorbtion in it. Unlike the sleeve gastrectomy, RNY Gastric Bypass reduces both food intake and prevents the intake of all calories from food.

 

Of course, which of these applications will be performed will be decided according to the analysis of the physician, not according to the possible common complication situations.

With postoperative diet program, physical activity regulation and sports, the person gets his ideal weight and long-term weight control is provided as long as he follows the rules.

After the surgery, the first 6-8 weeks under the supervision of a registered dietician begin with liquid and then mashed foods, and over time they are transferred to normal food. In the following 3-6 months (while the new stomach gains health) you adapt to your appropriate and new eating habits over time. Patients also begin to receive recommended additions of vitamins and minerals (usually iron supplements and calcium supplement) and may need to repeat in some patients after surgery.

When it comes to nutrition after RNY Gastric Bypass surgery, you must follow the surgeon’s recommendations and the nutrition protocol announced to you to the letter. Otherwise you may experience serious problems. The difference between RNY Gastric Bypass and Sleeve gastrectomy and details of the two applications will be explained to you by your physician. In your decision-making process, you should not take into account situations such as the price of RNY Gastric Bypass surgery first, you should choose what your physician envisions for you.

Possible Complications of Surgery

Risks of RNY Gastric Bypass surgery; includes the physical risks associated with surgical procedure of obestity surgery  itself and the risks of stress associated with any major surgery placed on your vital organs and body. One or more of the negative conditions described below may occur in any patient.

Your surgeon may recommend removing the gallbladder in the same surgery if there is a stone in the gallbladder during pre-surgical checks. Because a patient may not be able to keep up with a gallbladder during regular weight reduction, it can create problems that lead to clinical problems. On the other hand, if there are no stones in your gallbladder, there is no need to take the galbladder. If you still have your gallbladder after surgery, it is required to check by ultrasound at regular intervals to see if stones have formed in the slimming process.

Do not give credit to informations regarding the damages of RNY Gastric Bypass or the disadvantages of RNY Gastric Bypass. Be sure to ask your doctor about this and only respect the information provided by the health institutions.

History of RNY Gastric Bypass

Jejunoileostomy, which was applied by Kremen in 1954; recorded as an observation of weight loss with these methods for the first time. In the early 60s, Mason and Ito officially developed RYN Gastric Bypass surgery and started to perform from then onwards. In 1982, The Vertical Band Gastroplasty was developed by Mason, but not enough efficiency was obtained from it.. Then, adjustable Gastric Band applications began to be used between 1982 and 1993.

How RNY Gastrik Bypass Surgery done?

Many methods can be mentioned when it comes to surgical treatment of obesity. The operation group, which is termed as RNY Gastric Bypass, has different applications, and the method to be selected may vary depending on the person’s condition. Bariatric surgical methods or other obesity surgeries; they are not a priority choice. The diet to be applied to ensure that the person can lose weight naturally and additional treatments that the doctor will prescribe are the priority preference.

However, in some cases these methods are used to lose weight. And the fact that the person needs this surgery after the diagnostic evaluation to be performed; in other words, that he is fit for the surgery is approved by the physician and the application is performed.

  • Laparascopic Roux-en-Y (RNY) Gastric Bypass (LRYGB)
  • Sleeve Gastrectomy (Vertical Gastrectomy)
  • Laparoscopic Adjustable Gastric Band (LAGB)
  • Biliopancreatic Diversion (Duodenal Switch (BPD-DS))

are the basic methods used.

In all of these applications, in the detail of the application, it is the case to reduce the volume of part of the stomach by disabling it. The surgical details of the applications depend on the type, but are considered advanced surgical applications. These practices, which are defined as slimming surgery as prescribed by the Ministry of Health, Medical Chamber and international medical authorities, can be performed laparoscopically with or without cuts.

Which of these applications will be used will be announced to the patient by the physician after the evaluation to be made.

How long does bypass surgery take?

First of all, bypass surgery requires extra process as being different from the gastric sleeve surgery, thefore RNY Gastric bypass surgery does take much time. This surgery, which lasts between 1 and 2 hours on average, can be further extended if different complications develop. In the surgery performed via 6 small incision and under general anesthesia is applied and the duration of anesthesia is not included in the duration of the surgery. The recovery time after the RNY Gastric Bypass, which must be done by specialist doctors in the field, will start quickly if the given list is followed. Patients can lose 10 or 15 kilos from the first month thanks to this surgery, which makes it lose weight faster than sleeve gastrectomy with direct intervention to the intestines. 

For whom can this be applied?

RYN Gastric Bypass; is considered suitable in any case of morbid obesity and in case the person has different diseases due to obesity or has a risk of getting it. In other words, surgical methods can be used to treat obesity in case of life risk.

In general, without distinction between men and women. Suitable for any individual, provided they are adults. Of course, this conformity should be evaluated by physician/s after clinical analysis. People can’t make the decision on their own to have surgery for weight loss. Physicians will be the only authority in this regard.   The answer to the question who can have RNY Gastric Bypass surgery; can be understood more clearly in the subheading.

For whom is this inapplicable?

This operation is not suitable for anyone who has general obstacles to surgery or people with a condition that prevents them from having surgery with under general anesthesia. Due to the fact that this is a gastric surgery, it will also be required to pay attention to some details in case of gastric diseases.

During the Pre-operative Evaluation of Bariatric Surgery Patients, it will be analyzed whether the person is suitable for this operation. Bariatric surgery, in the treatment of obesity; in other words, as it is an operation used in the treatment of diseases such as endocrine system disorders, there is no obstacle for diabetics in general. However, in the analysis to be carried out, it is decided by the physician whether additional complications occur for these patients.

When respiratory system disorders are generally risky in all operations where anesthesia is used, this assessment should be done in detail.

Those with heart, blood pressure and circulatory system disorders should have their medications set ready and/or brought to the appropriate form before they have these surgeries.

Gastric and intestinal diseases are the most critical applications for this operation. Those with such diseases may even need to be kept waiting for treatment purposes for a while. In this case, the way to be appointed by the physician is followed.

RNY Gastric Bypass surgery does not performed in case of pregnancy.

This surgery cannot be done for non-adults.

This practice is not suitable for those with geriatric problems at an advanced age.

What are the advantages

As of 2020, clinical data of bariatric surgery applications with a history of more than 20 years are interpreted as being suitable for the evaluation of advantages. In RNY Gastric Bypass operations, post-surgical complications are decreased by 30%. In addition, it has been observed that the biggest benefit of the operation is obesity-related diseases, with a 92% decrease in the related deaths of diabetic patients and a 56% decrease in coronary patients. The total decrease in deaths due to obesity-related diseases is recorded as 40%.

In terms of complications of the surgery, it was seen that patients experienced much less difficulty and the quality of their lives was recorded to be better than other applications.

The risk and complications RNY Gastric Bypass Surgery;

Conditions defined as risks and complications in RYN Gastric Bypass surgery;

Early Period (within the first 30 days)

  • Bleeding

  • Leakage

  • Embolus (intravenous clot)

  • Pneumothorax

  • Wound Infection

     

  • Hernia at the site of the cut

Late Period ( after 30 days of surgery)

  • Intestinal Obstruction (ileus)

  • Marginal  Ulcer (Peptic Ulcer)

  • Trocar site hernia

  • Gallbstone disease

However, there is no clinical data that these situations will occur surely. It is interpreted that some or all of these complications may occur in any patient within the possibility of a different rate. However, since bariatric surgeries are generally low complications, people who have surgery to lose weight have a low incidence of very large complications.

Recovery process after RNY Gastric Bypass Surgery 

The healing process after RNY Gastric Bypass surgery is not a process that progresses very quickly, but it is a process that can be easily circumvented provided that it follows the advice of the physician. In addition, there are different recovery periods according to the condition of open surgery or laparoscopic surgery. The 6-month period after surgery is as follows:

  • First Month After Surgery

After RNY Gastric Bypass surgery, all possible complications in general occur in this process. Clinical monitoring of the patient and continuous analysis of the condition is required. While there is a significant decrease in the feeling of discomfort between 7-14 days, the person can gradually return to his daily life in the process that follows.

  • 3 Months after surgery

After the first month after RNY Gastric Bypass surgery, the person returns to his normal daily life. In this process, clinical monitoring is carried out in certain periods. The condition is evaluated with laboratory data by following the general condition of the patient. It is necessary to pay attention to the diet condition in this process.

  • 6 Months after surgery

The patient is generally considered to have recovered during the 6-month period after RNY Gastric Bypass surgery. In the process of 6-12 months, all complication risks are eliminated and the patient returns to normal life. After this process, the patient must pay attention to his diet and do appropriate exercises. This procedure, which is a method used for the treatment of obesity; is not a one-on-one solution. If the patient breaks his diet, weight gain may occur in the long term; application would lose its effectiveness.

What to do before and after Gastric Bypass Surgery?

One of the techniques used to against obesity and obesity-related diseases is RNY Gastric Bypass surgery. Patients who seek for surgery for this purpose should remember that they may have high success rates with the surgical step, but this does not mean that they can continue their old eating habits. Not all stages that take time without regulating eating habits and turning to a healthy food consumption can ensure the permanence of RNY Gastric Bypass surgery. Therefore, all kinds of right for healthy – balanced nutrition and healthy life should be followed.

What to Do Before RNY Gastric Bypass Surgery

All your pre-surgery examinations will be carried out. Obesity rate, general health status will be checked from A to Z. If you are not a suitable candidate for RNY Gastric Bypass surgery, your doctor will inform you that you need to loose weight before you have surgery. In addition, you should know that the approval of a doctor working in at least five different specialties, including endocrinology and cardiology, is required. You should not take any solid – liquid food, starting 8 – 12 hours before the day of surgery. Tests for respiratory functions performed before the operation and the stomach and intestinal system are controlled from all angles. Detailed health history information such as the patient’s musculature, muscle ratio, fat ratio, diseases, medications used regularly is obtained. At this stage you need to give your doctor all the necessary data without hiding anything. Otherwise, you can increase the risk of surgery.

What to Do After RNY Gastric Bypass Surgery

Nutrition is the most important issue after RNY Gastric Bypass surgery. Increase your number of meals during your diet, but also reduce your portions. For the first 24 hours, you should definitely only feed on fluids. Then you can gradually and at small rates move on to solid food. You need to swallow your solid foods by chewing them thoroughly. You may feel mild pains after the surgery. Your doctor will give you painkillers for this. You should continue your routine checks regularly after your pain is completely over.

As soon as you decide to eat; you should not consume any liquid drinks, including water, 30 minutes before average meals. At the same time, you should not consume liquid drinks, including water, before half an hour after eating. It is inconvenient to consume solid and liquid foods together during meals. You should go only solid – only liquid form and should proceed in small proportions. A person should drink at least 2 liters of water per day. However, you may not be able to pass 1 liter of water in the first days after surgery. In addition, you should sip during your water consumption and the straw should never be used. In this way, you should do consumption little by little.

After the surgery, the nutrition program you need will be organized through your doctor and dietician. You should choose a protein-intensive diet. You should revise your eating habits; and should minimize junk food, frying, overly fatty, salty – sugary foods. Once you’ve gone through the first days, it’s okay to increase your water consumption to two liters and more. You should keep your morsels as small as possible, and should chew a lot. This process is recommended to be continued for life, starting immediately after the surgery. Do not rush to work. 7 days after the surgery, you can return to your working life, depending on the type of work. However, in the first steps, avoid heavy work conditions, lifting loads, intensive work. If the patient who will go through the operation is a woman, it is required not to have a pregnancy for at least one year. Therefore, you can start using birth-control pills with support from your gynecologist. There is no problem for you to experience pregnancy with dietician control.

Nutrition After RNY Gastric Bypass Surgery

RNY Gastric Bypass surgery are surgeries in which the physical structure of the stomach changes. For those who have gastric bypass surgery, some changes in eating habits after surgeries are mandatory at least in the healing process. The most important thing to note here is; restriction of the intake of acidic, carbonated and fatty foods.

For the stomach not to have difficulties , hard-to-digest foods (proteins) that should be consumed daily should not be taken at once, but should be spread over as much time as possible. In fact, this diet is similar to the methods used to treat gastritis or ulcers. It is more convenient for the patient to take small amounts of nutrients and generally consume fibrous foods without fat.

Patients undergoing RNY Gastric Bypass surgery should also consume fluids slowly. It is mandatory to avoid consumption of nutrients and fluids that will cause swelling in the stomach.

Exercise Recommendations After RNY Gastric Bypass Surgery

Six months after RNY Gastric Bypass surgery, especially the first three months; exercise and even behavior is a process that needs to be changed. Exercises in which abdominal muscles are used less during this process are recommended. However, it is not true to say that there is only one type of exercise that is valid for each patient. Depending on the type of application and the condition of the patient, the exercises to be selected may vary. In addition, you should pay attention to the comment of your doctor in this regard, as there may be a necessity not to exercise due to complications. Especially in case of sports activities, serious side effects may occur, so you should not take action without approval from the physician in such cases.

RNY Gastric Bypass or Sleeve Gastrectomy? 

Your doctor will decide which method to apply after looking at blood levels and endoscopic examination results. 

Sources:

TÜRKİYE ENDOKRİNOLOJİ ve METABOLİZMA DERNEĞİ Bariatrik Cerraji Kılavuzu http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180618095001-2018tbl_gruplar1b2cd981a1.pdf

 Okmeydanı Tıp Dergisi 30(Ek sayı 1):60-65, 2014 https://www.journalagent.com/eamr/pdfs/OTD_30_SUP_1_60_65.pdf

Obezitenin Tedavisinde Geçmiş ve Güncel Bariatrik Cerrahi Uygulamaları Şeyda GÜNGÖR – Beslenme ve Diyetetik Bölümü, Sağlık Bilimleri Fakültesi, Muş Alparslan Üniversitesi, Muş, Türkiye https://dergipark.org.tr/tr/download/article-file/899853

Bariyatrik Cerrahi Prof.Dr. Ahmet Çorakcı – http://www.diabetcemiyeti.org/var/cdn/c/e/ahmet-corakci.pdf

Obezitenin Cerrahi Tedavisi Okmeydanı Tıp Dergisi 30(Ek sayı 1):60-65, 2014 doi:10.5222/otd.supp1.2014.060 https://www.journalagent.com/eamr/pdfs/OTD_30_SUP_1_60_65.pdf

TÜRKİYE ENDOKRİNOLOJİ ve METABOLİZMA DERNEĞİ Bariatrik Cerraji Kılavuzu http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180618095001-2018tbl_gruplar1b2cd981a1.pdf 67 – 84

TÜRKİYE ENDOKRİNOLOJİ ve METABOLİZMA DERNEĞİ Bariatrik Cerraji Kılavuzu http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180618095001-2018tbl_gruplar1b2cd981a1.pdf S79 – 90

Obezitenin Tedavisinde Geçmiş ve Güncel Bariatrik Cerrahi Uygulamaları Şeyda GÜNGÖR – Beslenme ve Diyetetik Bölümü, Sağlık Bilimleri Fakültesi, Muş Alparslan Üniversitesi, Muş, Türkiye https://dergipark.org.tr/tr/download/article-file/899853

Obezitenin Cerrahi Tedavisi Okmeydanı Tıp Dergisi 30(Ek sayı 1):60-65, 2014 doi:10.5222/otd.supp1.2014.060 https://www.journalagent.com/eamr/pdfs/OTD_30_SUP_1_60_65.pdf

Obezitenin Tedavisinde Geçmiş ve Güncel Bariatrik Cerrahi Uygulamaları Şeyda GÜNGÖR – Beslenme ve Diyetetik Bölümü, Sağlık Bilimleri Fakültesi, Muş Alparslan Üniversitesi, Muş, Türkiye https://dergipark.org.tr/tr/download/article-file/899853

TÜRKİYE ENDOKRİNOLOJİ ve METABOLİZMA DERNEĞİ Bariatrik Cerraji Kılavuzu http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180618095001-2018tbl_gruplar1b2cd981a1.pdf

Obezitenin Tedavisinde Geçmiş ve Güncel Bariatrik Cerrahi Uygulamaları Şeyda GÜNGÖR – Beslenme ve Diyetetik Bölümü, Sağlık Bilimleri Fakültesi, Muş Alparslan Üniversitesi, Muş, Türkiye https://dergipark.org.tr/tr/download/article-file/899853

TÜRKİYE ENDOKRİNOLOJİ ve METABOLİZMA DERNEĞİ Bariatrik Cerraji Kılavuzu http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180618095001-2018tbl_gruplar1b2cd981a1.pdf

Obezitenin Tedavisinde Geçmiş ve Güncel Bariatrik Cerrahi Uygulamaları Şeyda GÜNGÖR – Beslenme ve Diyetetik Bölümü, Sağlık Bilimleri Fakültesi, Muş Alparslan Üniversitesi, Muş, Türkiye https://dergipark.org.tr/tr/download/article-file/899853

Bariyatrik Cerrahi Prof.Dr. Ahmet Çorakcı Ufuk Tıp Fak. End.ve Met.BD http://www.diabetcemiyeti.org/var/cdn/c/e/ahmet-corakci.pdf

16 TÜRKİYE ENDOKRİNOLOJİ ve METABOLİZMA DERNEĞİ Bariatrik Cerraji Kılavuzu http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180618095001-2018tbl_gruplar1b2cd981a1.pdf