Disadvantages: Roux-en-Y

Even though Roux-en-Y is the most widely accepted and practiced bariatric surgery performed in the United States, it still has its own disadvantages. One major downfall is that a patient my not be eligible for the renowned procedure. This is largely due to the patient’s own medical record, along with the needs of the specific patient. Remember, bariatric surgery is a complicated procedure and neither the patient nor the bariatric physician can afford to risk the health of the patient in any instances.

The complications of the roux-en-y gastric bypass are much less severe than other bypass surgeries, and most large series report complications in two phases, those which occur shortly after surgery, and those which take a longer time to develop.

The most serious acute complications include leaks at the junction of stomach and small intestine. This dangerous complication usually requires that the patient be returned to surgery on an urgent basis, as does the rare acute gastric dilatation, which may arise spontaneously or secondary to a blockage occurring at the base of the stomach.

Then there are the complications to which any obese patient having surgery is prone, these including degrees of lung collapse (which occur because it is hard for the patient to breathe deeply when in pain). In consequence a great deal of attention is paid in the postoperative period to encouraging deep breathing and patient activity to try to minimize the problem.

Blood clots affecting the legs are more common in overweight patients and carry the risk of breaking off and being carried to the lungs as a pulmonary embolus. This is the reason obese patients are usually anticoagulated before surgery with a low dose of Heparin or other anticoagulant. Wound infections and fluid collections are quite common in morbidly obese patients, hardly surprising when you realize there may be five or six inches of fatty tissue outside the muscle layers of the abdomen.

Complications which occur later on after the incisions are healed, which results from scar tissue development. Vomiting which comes on between the 4th and 12th week may well be due to this cause. Wound hernias occur in 5-10% and intestinal obstruction in 2% of patients an incidence similar to that following any general surgical abdominal procedure.

Another late problem which is fairly common, especially in menstruating women, after gastric bypass, is various kinds of malnutrition like deficiencies in iron and Vitamin B12. These vitamins may not be absorbed adequately following bypass. As a result anemia may develop: the patient feels tired and lethargic. The condition can be prevented and treated, if necessary, by taking extra iron and B12.

The possibility of calcium deficiency also exists, and all patients should take supplemental calcium to forestall this.

Surgery for severe obesity is a major operation in which complications can arise whether performed by a laparoscopic or open technique. Overall nearly 10% of patients have a risk of a complication related to the surgery, and less than 1% risk death.

Other than the known risk of anesthesia and any major abdominal surgery, the specific problems which have been reported include: infection secondary to leakage from the stomach or intestine, bleeding or injury to the spleen GI tract obstruction secondary to adhesions scarring, or strictures, malnutrition or anemia, ulcers,chronic vomiting or diarrhea.

There have been major advancements in the research for bariatric surgery in general. The advancements also bring about major strides in the roux-en-y procedure which is already praised as the leading bariatric procedure today.