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Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery

Nature Reviews Gastroenterology & Hepatology volume 7, pages 320–334 (2010)Cite this article

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Abstract

The National Longitudinal Study of Adolescent Health and the National Health and Nutrition Examination Survey reported that over 40% of the US population is overweight. The average weight loss attained by medical management programs is neither sufficient nor durable enough to treat medically complicated obesity. An estimated 220,000 bariatric procedures are performed yearly in the USA and Canada. The divided Roux-en-Y gastric bypass (RYGB) is performed most commonly in these countries and is considered the gold standard bariatric surgical procedure. The complexity of RYGB means that serious and potentially preventable perioperative complications can occur. RYGB alters the normal anatomy and physiology of the upper gut, which has predictable adverse effects and potential complications. Patients seek advice and care for symptoms that develop or persist after RYGB; although some symptoms are expected and predictable, others are complications that may or may not require active medical or surgical intervention. Physicians should be able to predict and manage most postoperative medical and nutritional disorders related to RYGB and should be prepared to assess patients for potential referral for surgical intervention or revision.

Key Points

  • Roux-en-Y gastric bypass (RYGB) is currently the most commonly performed procedure in the USA and Canada for the surgical treatment of medically complicated or morbid obesity

  • RYGB is associated with various symptoms, complications, nutritional deficiencies and medical disorders with which physicians who care for morbidly obese patients should be familiar

  • Symptoms that can develop after RYGB include peritonitis, tachycardia, hypotension, vomiting, bleeding, fever, dyspnea, oliguria and diarrhea

  • Complications that can occur in patients after RYGB are anastomotic leak, intestinal obstruction, wound problems and postoperative emergencies, as well as other unusual complications

  • Too rapid a weight loss induced by RYGB can cause macronutrient and micronutrient deficiencies; physicians should, therefore, be familiar with screening for nutritional deficiencies after RYGB and recommended nutritional supplements

  • Abdominal pain, abdominal gas and bloating, neurologic syndromes, malnutrition and inadequate weight loss and weight regain are common medical disorders that can develop in patients after RYGB

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Figure 1: Roux-en-Y gastric bypass.
Figure 2: Dilated loop of small intestine (biliopancreatic limb).
Figure 3: Stricture of the gastro-jejunal anastomosis.
Figure 4
Figure 5: Widely patent gastro-jejunal anastomosis visualized by upper gastrointestinal tract endoscopy in a patient seen for postoperative weight regain.

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Acknowledgements

This manuscript is based in part upon Michael G. Sarr's invited presentation at the national meeting of the American College of Gastroenterology, Orlando, FL, USA, in October 2008.

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Section of Gastroenterology, Washington Hospital Center and Georgetown University School of Medicine, Washington, 20010, DC, USA

    Bikram Bal

  2. Department of Surgery, Washington Hospital Center and Georgetown University School of Medicine, Washington, 20010, DC, USA

    Timothy R. Koch & Frederick C. Finelli

  3. Department of Surgery, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, 55905, MN, USA

    Michael G. Sarr

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M. G. Sarr declares an association with the following company: Enteromedics Inc. The other authors declare no competing interests.

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Bal, B., Koch, T., Finelli, F. et al. Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery. Nat Rev Gastroenterol Hepatol 7, 320–334 (2010). https://doi.org/10.1038/nrgastro.2010.60

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