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Roux-en-y (RNY)

Since the first steps in bariatric surgery were taken some fifty years ago, great strides have been taken to further the precision and accuracy for doctors while maximizing the outcomes for patients.

The Roux-en-y (or RNY) falls under the area of bariatric bypass surgery and is the most common gastric bypass procedure. With this procedure a portion of the stomach is sectioned off, creating a small pouch for reduced food intake. The pouch will usually hold about one ounce of food or less, which causes the feeling of fullness after just a few bites. In short, the RNY procedure reduces the size of your stomach and reroutes the digestive system.

Three major steps are involved in the RNY procedure: first, the stomach is stapled just below the esophagus, forming a 1 ounce stomach pouch above the staples, severely restricting the amount and kind of food or liquid that can be consumed at one time.

The second step includes the division of the small bowel about one foot below the stomach. Then a new 1.5 centimeter opening (stoma) is created in the stomach pouch.

Finally, the open end of the small bowel is attached to the new opening. Food and fluids can now pass from the stomach pouch into the small bowel. The remaining end of the small bowel forms a "Y-shaped" intestinal junction at the base of the stomach. An opening is made to allow digestive juices from the bypassed part of the stomach to flow into the small bowel.

Additionally, the Roux-enY gastric bypass can be performed using both the ”open” and laparoscopic techniques. The laparoscopic method is preferred by doctors and patients alike. Laparoscopic Roux-en-Y gastric bypass is identical to the traditional gastric bypass except that instead of being performed through an incision extending from the lowest aspect of the breastbone to the navel, it is performed through several smaller incisions each measuring about an inch or less in length. Most hospitals’ physicians generally use five small incisions.

A laparoscope connected to a video camera is inserted into the abdominal cavity and the surgical field is visualized on high resolution video monitors in the operating room. Long thin surgical instruments are inserted through the other small incisions and the surgeon performs the surgery by watching the video monitor. As in the open procedure a skilled assistant surgeon is also required.

According to the vast majority of health experts and officials, the Roux-en-Y gastric bypass continues to set the standard for bariatric surgery and is the current gold standard procedure for weight loss surgery. It is also one of the most frequently performed weight loss procedures in the United States.

Weight loss commonly reaches 75% of a person’s excess body weight. As in all weight loss surgery, however, the amount of weight loss is not guaranteed. In fact, there is no guarantee that the patient will lose any weight at all. The amount of weight a patient loses depends not only upon the surgery, but also upon what the patient does with the surgery.

The Roux-en-Y procedure is not a cure for morbid obesity; it is merely a tool. Patients have been known to ingest large quantities of high caloric foods that can result in less than satisfactory weight loss. If a patient adheres to the proper dietary guidelines, and if exercise becomes a part of the patient’s regular routine, a substantial weight loss usually results.