Prof. Dr. Toygar Toydemir
He received the title of Professor of General Surgery in 2020. Dr. Toydemir, who has extensive experience in reflux and obesity surgery, continues his work in these fields. You can read the rest of our article about Roux-N-Y Gastric Bypass prices, treatment process, and post-treatment precautions.
Read More Make an AppointmentRoux-en-Y gastric bypass (RYGB) is an effective bariatric surgical method for obesity treatment. By combining both restrictive (reducing stomach size) and malabsorptive features, it supports weight loss and has positive effects on metabolic health. In this procedure, the stomach is reduced to create a pouch of approximately 15–30 mL in volume, which is then connected to the middle part of the small intestine. Thus, most of the stomach and the duodenum are bypassed. While this limits food intake and reduces absorption, it also contributes to appetite control through hormonal changes. However, due to risks such as nutrient deficiencies, regular medical follow-up and lifelong appropriate nutritional support are required after surgery.
Roux-en-Y gastric bypass (RYGB) is a major milestone in the development of surgery and is recognized for its effectiveness in treating obesity. Its history dates back to the late 19th century, when Swiss surgeon César Roux developed the “Roux-en-Y” method. Roux’s technique involved rearranging the small intestine into a Y shape to treat gastrointestinal diseases such as obstructions and peptic ulcers. Although this approach did not initially form the basis of obesity surgery, it is considered the starting point of modern bariatric surgery.
In the mid-20th century, the idea of treating obesity using surgical methods gained importance. In 1954, Dr. A.J. Kremen performed an early bowel bypass procedure that bypassed much of the small intestine to achieve weight loss, but it led to serious nutritional deficiencies and had limited success. These experiences paved the way for the development of more effective and safer methods.
In 1967, Dr. Edward Mason laid the foundation for today’s RYGB procedure. Mason created a small stomach pouch and connected it directly to the jejunum portion of the small intestine. Thus, the majority of the stomach and the duodenum were largely bypassed, both restricting food intake and reducing absorption. Initially, Mason’s method was performed through open surgery, which prolonged the recovery period.
During the 1970s and 1980s, the procedure was refined to increase efficacy. Adjustments made in the Roux-en-Y connection to prevent bile reflux improved patient comfort. Additionally, the development of surgical stapling devices made tissue connections safer. The emergence of laparoscopic surgery in the 1990s revolutionized the procedure. In 1994, Dr. Alan Wittgrove performed the first laparoscopic RYGB, introducing the advantages of minimally invasive surgery into the bariatric field.
Today, RYGB is not only effective in weight loss but also in the treatment of type 2 diabetes and other obesity-related diseases. By contributing to metabolic improvements through hormonal changes, it enhances the quality of life for many patients.
Roux-en-Y gastric bypass (RYGB) is an effective treatment option, particularly for individuals with obesity and serious obesity-related health problems. Candidacy for this surgical procedure is typically determined based on Body Mass Index (BMI) criteria. Those with a BMI of 40 kg/m² or higher (morbid obesity) are suitable candidates for RYGB. In addition, individuals with a BMI of 35 kg/m² and above who have serious comorbidities such as type 2 diabetes, hypertension, obstructive sleep apnea (OSA), and non-alcoholic fatty liver disease (NAFLD) can also benefit from this procedure.
RYGB does not solely evaluate physical health conditions; it also considers the psychological state of the candidate. In order for the surgery to be successful, candidates must be able to adopt lifestyle changes and maintain healthy weight management in the long term. Therefore, a psychological evaluation is an important step. Additionally, individuals who have been unsuccessful in losing weight through non-surgical methods may be appropriate candidates for RYGB.
Adolescents and older individuals are evaluated among special populations. Surgery may be considered for adolescents if they have severe comorbidities, while in older individuals, the risk-benefit ratio should be carefully analyzed. The absence of contraindications is another crucial criterion for suitability for surgery.
Roux-En-Y Gastric Bypass (RYGB) is an effective surgical method for managing obesity and related health conditions. However, this procedure is not suitable for every patient, and certain medical conditions can contraindicate surgery. Absolute contraindications completely rule out the procedure. For instance, severe cardiovascular diseases, such as advanced heart failure or serious coronary artery disease, can increase perioperative risks. Additionally, uncontrolled psychiatric disorders and substance abuse make RYGB inappropriate because they impede a patient’s ability to adhere to postoperative care. Coagulation disorders can make surgery dangerous due to the risk of bleeding.
There are also relative contraindications, in which the decision to proceed with surgery should involve a detailed evaluation of patient-specific risks. For example, advanced age may increase the risk of surgical complications. Previous abdominal surgeries can complicate the operation due to adhesions. In individuals planning pregnancy after surgery, potential nutritional deficiencies should be considered, and the procedure may need to be postponed.
Roux-en-Y gastric bypass (RYGB) is an advanced surgical method used to treat obesity and related metabolic disorders. The procedure is generally performed laparoscopically, which is minimally invasive and therefore involves less pain, faster recovery, and a shorter hospital stay. The operation consists of two main phases: creating a gastric pouch and performing the Roux-en-Y reconstruction.
Creating the Gastric Pouch:
The surgeon creates a small pouch in the upper part of the stomach with a volume of about 15–30 mL. This pouch restricts food intake, providing early satiety and reducing the patient’s total caloric intake. Since it significantly reduces stomach volume, it constitutes the restrictive component of the surgical procedure.
Roux-en-Y Reconstruction:
In this phase, the small intestine is cut approximately 70–80 cm below the stomach. One segment of the divided intestine is attached to the newly created stomach pouch (the Roux limb). This arrangement allows food to bypass much of the stomach and the duodenum, decreasing nutrient absorption and providing the malabsorptive component of the procedure. The segment carrying digestive enzymes is attached further down on the Roux limb, forming a “Y” shape.
Roux-en-Y gastric bypass (RYGB) is an effective surgical method for obesity treatment, but it carries risks of various side effects and complications in both the early and late postoperative periods. Therefore, it is crucial for patients to be thoroughly informed and closely monitored before and after the procedure.
Early Side Effects:
One of the primary early complications is an anastomotic (stomach–small intestine junction) leak. This leak can cause infection or abscess in the abdominal cavity and often necessitates urgent surgical intervention. Bleeding may originate from the surgical incision or the anastomosis site, requiring blood transfusion or reoperation in severe cases. Additionally, wound infections, intra-abdominal abscesses, and sepsis are possible. Venous thromboembolism (VTE) risk increases with postoperative inactivity, but prophylactic anticoagulant therapy and early mobilization can reduce this risk. Bowel obstruction may occur due to adhesions or hernias and usually requires surgical intervention.
Late Side Effects:
Later on, anastomotic strictures caused by scar tissue can lead to difficulty eating and vomiting; these are treatable with endoscopic dilation. Nutritional deficiencies, including iron, calcium, and vitamin B12, can cause problems like anemia and osteoporosis. Dumping syndrome, characterized by nausea, diarrhea, and hypoglycemia due to rapid gastric emptying, can typically be managed through dietary changes. Marginal ulcers (ulcers where the stomach and intestine join) can develop because of stomach acid and lifestyle factors; proton pump inhibitors (acid reducers) are effective in treatment. Gallstones can form due to rapid weight loss and may cause pain or inflammation of the gallbladder. Kidney stones are related to changes in absorption and diet. Some patients also experience psychological challenges.
Roux-en-Y gastric bypass (RYGB) is considered highly effective among bariatric surgeries for long-term weight loss and improvement of obesity-related comorbidities. Various studies indicate that patients can achieve 65–80% excess weight loss (EWL) within the first two years following RYGB. Long-term follow-ups show that much of this weight loss can be maintained, with 50–70% EWL preserved at 10 years.
The success of RYGB is not limited to weight loss; its impact on metabolic health is also noteworthy. In particular, it plays a significant role in the remission of type 2 diabetes (T2DM). Research reveals that approximately 80% of T2DM patients experience remission after RYGB. A comprehensive analysis published in The Lancet reported that RYGB reduces all-cause mortality by 59% among individuals with T2DM. Moreover, it significantly improves obesity-related diseases such as hypertension, obstructive sleep apnea, and dyslipidemia.
One of the most crucial factors influencing the success of RYGB is the patient’s adherence to post-surgical lifestyle changes. Regular medical check-ups and psychological support are critical for maintaining weight loss. Significant improvements in quality of life and reductions in overall mortality are also among the positive outcomes of this procedure.
A comprehensive medical evaluation before surgery is essential. Laboratory tests such as complete blood count, metabolic panel, thyroid function, as well as iron and vitamin D levels, are performed to identify and manage accompanying conditions. Patients at risk of heart disease may require an electrocardiogram or stress tests. Additionally, screening for obstructive sleep apnea is done through questionnaires or polysomnography. If diagnosed, CPAP therapy is initiated before surgery. Routine upper endoscopy is performed for patients with gastroesophageal reflux symptoms or a history of previous stomach surgery.
Nutritional evaluation is critical before and after surgery. Addressing deficiencies and following high-protein, low-calorie liquid diets can improve surgical outcomes. This diet can shrink the liver, simplifying laparoscopic procedures.
Psychological preparation is essential for ensuring that patients adapt to lifestyle changes after surgery. Conditions like eating disorders, depression, or unrealistic expectations are identified, and therapy is provided if needed.
Regular exercise and quitting smoking can improve health outcomes before and after surgery. Smoking cessation aids healing, while exercise strengthens cardiovascular health.
Patients receive detailed information about the risks and benefits of RYGB, as well as the lifestyle changes required after surgery. This information fosters active participation and increases the likelihood of long-term success.
Patients should adhere to fasting guidelines and consult their doctor about any necessary changes to medications before surgery. These precautions ensure surgical safety and minimize complications.
Adopting a healthy, sustainable lifestyle after Roux-en-Y gastric bypass (RYGB) surgery is critical for its success. The first step is following a compatible diet program to support the recovery process. Patients typically start with a liquid diet, then progress to puréed foods, soft solids, and finally a balanced solid diet in gradual stages. This diet focuses on high protein, low fat, and low sugar, with small, frequent meals. Irritants such as carbonated beverages and caffeine are generally to be avoided.
To prevent vitamin and mineral deficiencies after surgery, lifelong supplementation is necessary. Particular attention should be paid to multivitamins, calcium, vitamin D, vitamin B12, and iron. Regular blood tests and physician follow-ups are essential for adjusting supplements based on individual needs. If nutritional deficiencies are not identified early, they can lead to serious health issues.
Regular follow-up appointments are vital to minimize the risk of complications. For instance, complications such as dumping syndrome can be prevented by carefully adjusting the diet. In the long term, maintaining weight loss and supporting overall health require regular exercise, stress management, and healthy behavioral habits. Additionally, providing psychosocial support after surgery increases patients’ quality of life and helps them adapt to their new lifestyle.
How does the Roux-en-Y method differ from other types of gastric bypass?
Roux-en-Y Gastric Bypass (RYGB) is a bariatric surgical method in which a small stomach pouch is created and part of the small intestine is redirected in a Y shape, thereby both restricting food intake and reducing nutrient absorption. In contrast, the mini gastric bypass (MGB) procedure creates a long, narrow stomach pouch connected to the small intestine with a single anastomosis, simplifying the operation but potentially increasing the risk of bile reflux. Another variant, the distal Roux-en-Y gastric bypass, places the Y connection further down the small intestine, which can lead to greater malabsorption and nutrient deficiencies. Additionally, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) aims to maintain effectiveness while reducing complications by combining sleeve gastrectomy with a single bowel bypass. Each method offers different advantages and risks by balancing efficacy and safety, but RYGB remains the most commonly preferred method.
How are intestinal connections arranged during this surgery?
In Roux-en-Y gastric bypass surgery, the small intestine is restructured into a Y shape. First, a portion of the upper stomach is sectioned off to create a small stomach pouch. Then, the small intestine is cut about 80 cm below the stomach. The lower part, called the “Roux limb,” is connected to the new stomach pouch, allowing the majority of the stomach and the upper portion of the small intestine to be bypassed. The bypassed segment, known as the “biliopancreatic limb,” carries digestive enzymes and is reattached further down the small intestine. This arrangement reduces calorie absorption and alters gut hormones, supporting weight loss and improving metabolic health.
Does reflux risk decrease after Roux-en-Y gastric bypass?
Roux-en-Y gastric bypass (RYGB) significantly reduces the risk of gastroesophageal reflux disease (GERD) in obese patients. Prior to surgery, the prevalence of GERD ranges between 40.8% and 62.4%, while after RYGB, it can drop to around 23.8%. Studies have shown that GERD symptoms and medication use decrease following RYGB. For example, of those who switch from sleeve gastrectomy to RYGB, 80% experience relief from symptoms, and 19% are able to stop proton pump inhibitors. However, some patients may continue to experience GERD symptoms, especially due to weight regain or gastrointestinal dysfunctions. Overall, RYGB is an effective procedure for controlling GERD in obese patients, but long-term monitoring is important.
How is metabolism affected after surgery?
Roux-en-Y gastric bypass (RYGB) surgery significantly alters metabolism. After the procedure, levels of the hunger hormone ghrelin decrease by about 60%, leading to reduced appetite and less food intake. At the same time, levels of GLP-1 and PYY, which increase satiety, rise significantly. These hormonal changes help lower blood sugar and insulin resistance within a few months. RYGB also leads to decreases in total cholesterol and triglyceride levels, resulting in long-term positive effects. As a result, these metabolic changes often improve obesity-related diseases, such as type 2 diabetes.
What are the complications of this procedure?
Roux-en-Y gastric bypass surgery carries risks of early and late complications. Early complications include anastomotic leaks (up to 2%), bleeding, deep vein thrombosis, and pulmonary embolism. Late complications include bowel obstructions, dumping syndrome (diarrhea, nausea, vomiting), gallstones, hernias, hypoglycemia, malnutrition, gastric perforation, ulcers, and vomiting. Nutrient deficiencies are common, particularly iron, vitamin B12, vitamin D, and calcium, requiring lifelong supplementation. The 30-day postoperative mortality rate is about 0.3%. Therefore, it is important for patients to follow dietary guidelines and have regular check-ups to manage any complications that arise.
References
Prof. Dr. Toygar Toydemir - Uncategorized - Stomach Botox Cost : With and without insuranceGastric [...]
Prof. Dr. Toygar Toydemir - Uncategorized - Gastric Balloon Cost : With and without insuranceThe [...]
Prof. Dr. Toygar Toydemir - Uncategorized - Gastric Bypass Surgery Cost : With and without [...]
Prof. Dr. Toygar Toydemir - Uncategorized - Gastric Sleeve Surgery Cost : With and without [...]
Prof. Dr. Toygar Toydemir - Uncategorized - Reflux Surgery Cost: With and without insuranceReflux surgery [...]
Prof. Dr. Toygar Toydemir - Uncategorized - Cost of gallbladder surgery: With and without insuranceGallbladder [...]
Prof. Dr. Toygar Toydemir - Uncategorized - Postoperative PeriodYour new life starts here… The postoperative [...]
Prof. Dr. Toygar Toydemir - Uncategorized - Preoperative PeriodObesity is a condition that physically and [...]
Deutsch
Türkçe
Български