All you could ever want to know about the RNY (Roux En Y).

The RNY is the most commonly performed surgery in the United States. It is considered the “gold standard.” It can be done through an open or laparoscopic approach. Through some studies, the lap approach has been shown safer with better results. On average, a compliant patient can lose 80% of their EBW (excess body weight) in the first year. Studies have shown that after 10-14 years, patients have only gained back 10-13% of weight lost.

How they do it!

If it is open, the surgeons make a 5-10 inch incision to examine your digestive track. If they are doing it laparoscopically, they make 5-6 small incisions and insert tubes (trocars). They fill the abdominal cavity with a harmless gas for better visualization. Through the trocars, several instruments are introduced, the first being a camera so they can see. From here, both surgeries (open and lap) are performed pretty much the same way.

The stomach is transected and separated, and a small pouch formed. The average size of the pouch is 15 cc (one half ounce) to 30 cc (one ounce). This makes the surgery restrictive. Then a portion of the intestines, including the duodenum, is bypassed. This makes the procedure malabsorptive. The small intestine (which is now the roux limb or the Alimentary Limb) is brought up and connected with the newly formed pouch.  This connection is called the gastro-enterostomal anastomosis. This is the right side of the “Y” and is where the food travels. The left side of the limb, or the Bileopancreatic Limb, is still connected to the divided stomach. The end of that is attached lower on the roux limb. This carried the digestive juices from the stomach, and where it meets the roux limb is where actual digestion occurs. Once they come together, it is called the common channel.

Distal or Proximal?

Distal, in medical terms, means something that is located far from the point of reference. Proximal is a location that is nearer to the point of reference.

The amount of small intestine bypassed produces different results. The more distal, the less absorption, the more weight loss. However, it is necessary to take in more protein and vitamins if you are distal. Some surgeons have a set amount they bypass. Others decide how much to bypass based on the individual’s weight.  Some measure the bypassed portion, and others measure the non-bypassed portion. It varies greatly.

The average data is this: <100 cm of intestines bypassed is proximal (closer to the stomach). >150 is considered distal (farther from the stomach). In the middle is considered medial. Again, this differs with each surgeon.

Benefits.

There is a high probability of co-morbidities being resolved. These include Type 2 diabetes, sleep apnea, high cholesterol, high blood pressure, gerd, incontinence, and weight related joint pain. You can expect to lose and maintain an average of 70-80% excess weight loss if you are compliant. Self-esteem generally improves, as does some social phobias.

Risks.

As with ANY major surgery, there are always risks, including death. Keep in mind, the higher your BMI, and the more co-morbidities, the higher your complication risks. Here are the risks most associated with the RNY, and the percentages.

Short Term Risks: Death (o.5-2%) pulmonary embolism, DVT, bleeding, temporary hair loss, strictures, nausea and vomiting, leakage, lactose intolerance.

Long Term Risks: staple line disruption, Ulcers, malnourishment, stretched stoma, sagging skin which can lead to infection, vitamin deficiency, dumping syndrome, hernias, nausea and vomiting, gall stones, lactose intolerance, and bowel obstructions.

Always be sure to ask what your surgeon’s complication rate is. Ensure that they are at least as good as, preferably better than, the national average.