The most common weight loss surgical procedure performed in the U.S. is the Roux-en-Y gastric bypass (RYGB). There are two surgical approaches possible for this procedure.


Open or Laparoscopic Options

In a traditional or "open" RYGB, a large incision is made into the abdomen in order to perform the surgery. When the laparoscopic technique is utilized, several small incisions are made in the abdomen. A laparoscope connected to a video camera is inserted through the incisions. The physician is then able to perform the procedure assisted by viewing the internal organs on a television monitor.

How RNY Gastric Bypass Works

In both open and laparoscopic Roux-en-Y bypass surgery, the stomach is divided, creating a small pouch, which is closed by several rows of staples. The remaining portion of the stomach is not removed but is "bypassed" and plays a diminished role in the digestive process. A Y-shaped portion of the small intestine is then attached to the pouch. The volume the pouch is capable of holding is approximately one ounce. Weight loss occurs as a result of reduction of calories, alteration in gut appetite hormones, and decreased nutrient absorption.

Diagram illustrating before and after Roux-en-Y gastric bypass surgery

Benefits of RNY Gastric Bypass

The Roux-en-Y gastric bypass is considered the "gold standard" for weight loss surgery. Proven benefits identified with both the open or laparoscopic technique include:

  • Significant weight loss
  • Improvement in obesity-related health problems (including cardiovascular disease, hypertension and type 2 diabetes)
  • Reduction in patient mortality

Compared to an open procedure, when the laparoscopic approach is utilized, the post-operative recovery is shorter and the patient is less likely to develop certain complications (such as hernia). However, laparoscopic surgery is technically more complex, and it is extremely important that highly trained, qualified laparoscopic weight loss surgeons perform the procedure.

Potential Risks

As with all surgical procedures, there are some risks associated with bariatric surgery. Complications, which may occur with the Roux-en-Y gastric bypass, include:

  • Stomal obstruction (5 - 15 percent of patients)
  • Postoperative bleeding (1 - 5 percent of patients)
  • Small bowel obstruction (1 - 3 percent of patients)
  • Gastrointestinal leak (1 - 3 percent of patients)
  • Deep vein thrombosis (1 - 2 percent of patients)
  • Splenectomy (1 percent of patients)
  • Pulmonary embolus (0.5 percent of patients)
  • Death within 30 days (0.5 - 1 percent of patients)
  • Protein-calorie malnutrition (< 1 percent of patients)

Information provided by the Massachusetts Expert Panel on Weight Loss Surgery Summary from the Betsy Lehman Center for Patient Safety and Medical Error Reduction within the Department of Public Health.