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RNY Gastric Bypass (Proximal or Distal)

RNY Gastric Bypass (Proximal or Distal)

RNY Gastric Bypass (Proximal)

RNY Gastric Bypass has been around for over 30 years and has stood the test of time. It is reliable and is also performed laparoscopically.


First 6 small incisions are made and the top part of the stomach is separated to about the size of a small egg (the pouch), then the surgeon attaches a Y-shaped section directly connected to the small intestine. Food is diverted to the small intestine bypassing the main part of the stomach where acid is formed.

This connection (the Y-shaped section) is made small, about the size of a dime. It drains the food through. This provides the restriction for portion and calories control. One can only eat ½ to one cup of food at a time. The pouch is made of flesh and will stretch in time, allowing patients to eat more when their goal weight is met. At that time the weight loss will slow down.

Eating healthy is vital to prevent weight regain.

Advantages & Disadvantages:

This is a combination restrictive and malabsorptive operation.. Weight loss is about 10% better than the Lap-Band, and works best for patients with diabetes, high cholesterol, or reflux problems.
The main disadvantage of the gastric bypass is the fear of its complications.

Early complications include Leak of the new connections made. We do place extra suture to re-enforce the connections. During surgery we also check for leaks. This can occur but rare.
Obstruction of the outlet can occur from swelling of the tissue and can occur in the immediate post operative period. A non-surgical procedure using the endoscope going through the mouth to dilate the narrowing is the procedure of choice. Ulcers at that area is also a concern. Bleeding and Infection are rare, and ntestinal obstruction can also occur, but are rare as well.

Blood clots to the lungs can occur. For high risk patients, placing of a removable filter in the main vein in the abdomen is an option. This is performed under X-ray while under general anesthesia and just before the gastric bypass is performed. Heart attack and death are extremely rare.

Late complications such as “Stricture” (narrowing of the outlet) can also occur from the healing process of the tissues. If it becomes problematic, an endoscopic procedure through the mouth is also recommended by using a catheter guided balloon to stretch the opening. Usually this single outpatient procedure will correct the problem. However, repeated dilations to a bigger opening may be necessary. Malabsorption of nutrients and vitamins can also occur. Patients will be required to take Multivitamins, B12, Calcium and iron on a regular basis. Dilatation of the pouch or the outlet can occur with the passage of time resulting in weight gain. This problem can be initially treated with endoscopic injection of scar forming medications to the outlet to shrink the opening. This may require repeated injections. However if it is not effective, a redo surgery may be necessary

Potential Concerns:

“Dumping syndrome” may occur when patients consume quantities of sweets or fats, like ice cream or chocolate.


Dumping symptom is similar to the effects of hypoglycemia (low blood sugar). It include light headedness; cold sweats; hot flashes; palpitations; nausea; stomach cramps and diarrhea. This reaction acts as a “deterrence” for patients who love sweets. However not everyone who has a gastric bypass will experience this syndrome.

Gastric Bypass is more complicated than the bands or the Sleeve Gastrectomy. But is most effective way of weight loss. Gastric Bypass patient typically lost 61.6% of their excess weight.

RNY Gastric Bypass (Distal)

This is usually performed for patients who are in the super obese group (BMI over 50).

Depending on their obesity, more small intestines are bypassed when the obesity is more severe to help them lose more weight. When more intestines are bypassed, there will be less intestinal surface for absorption of calories, especially fat. This results in more frequent bowel movements per day. If fat is consumed in the diet, fat will be digested less, and will be eliminated undigested. This may create foul smelling, loose stools.

Indication for this procedure is reserved for bigger patients, or for those patients who have failed their original gastric bypass.

Patients with the distal gastric bypass may need other fat soluble vitamin supplements, such as Vitamin a,D, E, and K, depends on how long their small intestine is bypassed. Patient follow up is very important to make sure they are metabolically and nutritionally healthy.