Laparoscopic Gastric Bypass Surgery (“Roux-en-Y Gastric Bypass")
Laparoscopic gastric bypass surgery, also called “Roux-en-Y”, is the most commonly performed type of bariatric surgery. The question for you is whether the rewards outweigh the risks when compared to less invasive bariatric procedures.
- Is gastric bypass surgery right for you?
- What’s the difference between it and other bariatric surgery procedures?
- Results of surgery – including average weight lost and impact to obesity-related health problems
- Complications & Risks
- The Procedure - explanation and videos
- Recovery
- Life after gastric bypass surgery
- Cost of gastric bypass surgery, costs after Surgery & gastric bypass financing
- Bariatric doctors specializing in gastric bypass
Could Laparoscopic Gastric Bypass Surgery Be Right for You?
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This page and the pages we’ll guide you to below assume that you are a candidate for bariatric surgery. If you’re still not sure if surgery is right for you, see our bariatric treatment page first. There we’ll take you through specific questions and answers to help you make the most educated and responsible decision.
Assuming surgery is the route you have decided to take, Roux-en-Y laparoscopic gastric bypass surgery is a safe, effective and well-researched option. It carries a slightly higher risk than less invasive procedures such as lap band surgery but also yields consistently positive results.
Let’s move on to direct comparisons between laparoscopic
gastric bypass surgery and other bariatric procedures…
The Difference between Laparoscopic Gastric Bypass Surgery and Other Bariatric Surgery Procedures
Bariatric surgery is an evolving science. New techniques are constantly being developed that pull from the experience with previous procedures.
Of the surgeries that have been around and tested for at least 10 years, gastric bypass is the most effective.
"Gastric bypass should remain the primary bariatric procedure used to treat obesity in the United States. "
By “effective”, we are referring to the amount of weight lost both short and long term, the improvement or elimination of obesity health problems and a relatively low rate of complications.
Following are the other procedures backed by long-term
research and how
they compare to gastric bypass:
- Lap Band Surgery has a lower risk of serious complications but a higher rate of minor and annoying complications. Weight loss is extremely variable from patient to patient, but on average weight loss is much lower than with gastric bypass. Lap band surgery also has a higher rate of reoperations and long-term complications. Finally, lap band surgery is reversible while gastric bypass (usually) is not.
- Duodenal Switch leads to more weight loss than gastric bypass, but comes with a higher risk of serious complications. It is also has a much larger malabsorptive component, so it requires patients to take more vitamins and to keep a closer eye on nutritional requirements.
- Vertical
Banded Gastroplasty may be recommended for some patients,
but
gastric bypass has been shown to be less risky and to have better
outcomes (the majority of surgeons who used to perform the VBG now perform the gastric bypass almost exclusively).
It’s worth noting that both mini
gastric bypass surgery and gastric
sleeve surgery look
promising, but more long-term research is needed before any conclusions
can be drawn.
Following is a list of studies that compare gastric bypass to other surgeries along with their findings and the year they were published (click here to jump past the list)…
| Summary of Findings When Comparing Gastric Bypass to Other Procedures | Year of Study | |||
|---|---|---|---|---|
| References: A, B, C, D, E, F, G, H, I, J, K, L, M, N, O *For simplicity, all acronyms and procedure names have been changed to a common name (i.e. LAGB and Laparoscopic Adjustable Gastric Banding were changed to Lap Band Surgery). |
||||
| Lap
Band Surgery vs Gastric Bypass |
||||
| Roux-en-Y gastric bypass is associated with better weight loss, resulting in a better correction of some comorbidities than gastric banding, at the price of a higher early complication rate. This difference, however, is largely compensated by the much higher long-term complication and reoperation rates seen after gastric banding.O | 2012 | |||
| Weight loss outcomes strongly favored gastric bypass over lap band surgery. Patients treated with lap band had lower short-term morbidity than those treated with gastric bypass, but reoperation rates were higher among patients who received lap band surgery. Gastric bypass should remain the primary bariatric procedure used to treat obesity in the United States.A | 2008 | |||
| Collectively, data clearly point to distinct changes in dietary habits after bariatric operations which markedly differ between gastric bypass and lap band patients. Overall, it is tempting to conclude that gastric bypass operations lead to a healthier and a more balanced diet than lap band implantations.B | 2008 | |||
| Gastric bypass seems to provide a stronger suppression of ghrelin in comparison with gastric lap band procedure. These findings are consistent with the hypothesis that suppression of ghrelin is one mechanism by which gastric bypass can reduce body weight long term, more than lap band.C | 2003 | |||
| Mini
Gastric Bypass Surgery vs Gastric Bypass |
||||
| Pending long-term evaluation, mini gastric bypass surgery seems a good alternative to gastric bypass, giving the same results with a more simple and reproducible technique.D | 2008 | |||
| Previous studies have demonstrated that hospitalization after gastric bypass increases remarkably (20% per year). The present study shows that hospitalization following mini gastric bypass surgery instead of rising, as reported with gastric bypass, decreases by a third. The mini gastric bypass has been shown to be a short, safe successful weight loss surgery in previous work. The present study supports the mini gastric bypass as a low risk procedure that decreases the need for hospitalization.E | 2006 | |||
| Both gastric bypass and mini gastric bypass surgery are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. Mini gastric bypass surgery is a simpler and safer procedure that has no disadvantage compared with gastric bypass at 2 years of follow-up.F | 2005 | |||
| Vertical
Banded Gastroplasty (VBG) vs Gastric Bypass |
||||
| The patient's eating habits before surgery play an important role in the choice of the operative technique used. The two operative techniques had the same efficacy in weight reduction. Data were available 2 years after surgery for 101 of the 110 patients (91%). Most comorbid conditions resolved by 1 year after surgery regardless of the type of operation used.G | 2007 | |||
| Preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient. Although gastric bypass is associated with better mean weight loss outcomes, the percentage of patients who achieved and maintained ≥50% excess weight loss after VBG in this pre-selected patient population was not significantly different. Each type of operation has advantages and disadvantages, and, if properly chosen, a purely restrictive procedure can be successful for some patients. Therefore, it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients' own preferences and outcome expectations.H | 2006 | |||
| Gastric
Sleeve Surgery vs Gastric Bypass |
||||
| PYY levels increased similarly after either procedure.
The markedly
reduced ghrelin levels in addition to increased PYY levels after
gastric sleeve surgery,
are associated with greater appetite suppression and excess weight loss
compared with gastric bypass.I (Editors’s note: both ghrelin and peptide YY effect appetite. See our obesity and genetics page for more details) |
2008 | |||
| The gastric sleeve operation is able to achieve significant weight loss comparable to the gastric bypass and duodenal switch operations but with the low morbidity profile similar to that of lap band placement.J | 2007 | |||
| Duodenal
Switch (DS) vs Gastric Bypass |
||||
| Compared with gastric bypass, duodenal switch may be associated with a greater risk of vitamin A and D deficiencies in the first year after surgery and of thiamine deficiency in the initial months after surgery.K (Editors’s note: See our Bariatric Vitamins page for more.) | 2009 | |||
| Although duodenal switch is associated with more bowel episodes than gastric bypass, the difference is not statistically significant. Bowel habits are similar in patients who achieve 50% estimated body weight loss with duodenal switch surgery or gastric bypass.L | 2008 | |||
| Direct comparison of Duodenal Switch to Gastric Bypass demonstrates superior weight loss outcomes for DS. Importantly, the likelihood of successful weight loss (excess weight loss >50%) was significantly greater in patients following DS (12 months, 83.9% vs. 70.4%; 18 months, 90.3% vs. 75.9%; 36 months, 84.2% vs. 59.3%).M | 2006 | |||
| No patients reported dumping syndrome (after DS surgery), and marginal ulcers were not seen.N | 2003 | |||
See our Lap
Band vs Gastric Bypass page for a in-depth comparison of the
two
most commonly performed bariatric procedures.
For a high level overview of all major bariatric procedures and how
they compare to gastric bypass, go to our Types
of Bariatric Surgery page.
Results of Laparoscopic Gastric Bypass Surgery
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- Why is gastric bypass successful?
- How does it impact health problems?
- How much weight can you expect to lose?
Why is Gastric Bypass Successful?
Gastric bypass surgery is successful for a few reasons…
- The stomach is made much smaller (into a golf-ball-sized “pouch”), so you feel fuller, faster following surgery (it’s a “restrictive” surgery)
- Less calories are absorbed following meals (it’s also “malabsorptive”)
- The part of the stomach that is bypassed is the part that produces the hormone ghrelin, which many believe is one of the hormones responsible for feelings of hunger.
How does it impact health problems?
As with other types of bariatric surgery, patients experience a significant improvement in or complete elimination of obesity health issues following laparoscopic gastric bypass surgery.
For example, following gastric bypass surgery…
- Hypertension, hyperlipidemia, diabetes mellitus, obstructive sleep apnea, GERD, and asthma either are resolved or improved in 80% to 100% of patients.
- Arthritis, back or extremity pain, and depression improve in 52% to 73% of patients.
- Quality of life improves for over 80% of patients.2
Other improved health problems include…
"Quality of life improves for over 80% of patients."
- Bladder incontinence
- Certain types of headaches
- Heartburn
- High cholesterol
- Liver disease
- Venous stasis disease
In addition to the studies mentioned above, here is one more that evaluated comorbidities (obesity health problems) following Roux-en-Y gastric bypass surgery…
| Study Topic | Summary of Findings | Year | ||
|---|---|---|---|---|
| Reference: O | ||||
| Efficacy of Gastric Bypass in the Treatment of Obesity-Related ComorbiditiesO | Gastric bypass surgery for the treatment of morbidly obese patients has a profound positive impact on obesity-related comorbidities. Also, patients' quality of life is dramatically improved in the majority of patients when compared with their preoperative status. | 2007 | ||
How much weight can you expect to lose?
Now on to one of the biggest questions… how much weight can a patient expect to lose following laparoscopic gastric bypass surgery?
"...as much as 67% of excess weight being permanently lost on average."
In the first year following surgery, percent of excess weight lost is between 41% and 61% on average. And weight gain continues to increase over the long-term with as much as 67% of excess weight being permanently lost on average. Many surgeons contend that this amount is increasing as surgeon experience and technique evolves.
Following is a list of 5 studies that evaluated the weight loss success of laparoscopic gastric bypass surgery patients (click here to skip past the chart)…
| Studies | # of gastric bypass patients in study | Weight Loss (% of Excess Weight Lost at…) | Year of Study |
|---|---|---|---|
| References: P, Q, R, S, T | |||
| Study P | 16 | 6 Months – 50.2%
1 Year – 60.5% |
2008 |
| Study Q | 80 | 1 Year – 41.4% 3 Years – 48% |
2006 |
| Study R | 152 | 1 Year – 55.9% 18 Months – 62.8% 2 Years – 60.1% 3 Years – 54.9% |
2006 |
| Study S | 342 | 1 Year – 89% 2 Years – 87% 5 Years – 70% 10 Years – 75% |
2005 |
| Study T | 5,644 | 61.6% average
(studies ranged from 56.7% - 66.5%) |
2004 |
After hitting their lowest weight, about 80% of laparoscopic gastric bypass patients gain at least a small amount back.
See our Weight Gain After Gastric Bypass Surgery page for the details about how much and why.
Our Gastric Bypass Revision Surgery page reviews your options if weight regain becomes a significant issue in the years following surgery.
Hear It Straight from the Source... For Free
Most surgeons offer free seminars and/or free one-one-one consultations that teach you about your options and their office's specific results.
Otherwise, continue below for the rest of the laparoscopic gastric bypass surgery details, including risks, details about the procedure, recovery, life after surgery and cost.
Laparoscopic Gastric Bypass Surgery Complications & Risks
While better for weight loss and elimination of comorbidities, gastric bypass is riskier than less complicated types of bariatric surgery. Its mortality rate is between 0.2% and 0.5% compared to the 0.135% mortality rate across all procedures.3
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Complications are also more frequent than with simpler procedures like lap band surgery but less likely than with the more complicated duodenal switch.
We have several pages dedicated to complications and mortality, including…
- Gastric bypass side effects
- Gastric bypass surgery deaths & risks of gastric bypass
- Complications of gastric bypass surgery
- Gastric bypass revision surgery
When deciding whether the complication and mortality risks associated with surgery are “worth it”, it’s smart to evaluate the risks associated with not having surgery. See our Life After Weight Loss Surgery, Obesity Health Problems and Cause and Effect of Obesity pages for more on this.
The Laparoscopic Gastric Bypass Surgery Procedure
Roux-en-Y gastric bypass surgery is both restrictive and malabsorptive in nature, but the restrictive aspect is the main reason that it’s so effective.
From a very high level perspective, to perform gastric bypass surgery the surgeon (it sounds a bit confusing, but the below video will make sense of the description)...
- Cuts and staples the stomach to create a small pouch (about the size of a golf ball and able to hold around an ounce of food) at the end of the esophagus
- Leaves the remainder of the stomach attached to the top of the small intestines
- Goes further down the small intestine, cuts it, and attaches it to the pouch. This will cause the food to bypass the remainder of the stomach and top part of the small intestine.
- Takes the end of the small intestine that is still connected with the remainder of the stomach and attaches it to the bottom of the “Roux limb.” This allows the digestive juices produced by the stomach to meet up with the food in the intestines.
In addition, there are 2 catheters (tubes) used to keep both portions of your stomach clear – the first is inserted through your mouth and into the pouch. The second is for the larger portion of the stomach and is threaded through an opening in the side of your abdomen.
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The procedure itself takes about 4 hours to complete.
Take a look at the following two videos for a more in-depth understanding…
(click here to skip past both)
Computer-Animated Overview
(click here to skip past actual procedure video)
Actual Procedure Being Performed
Recovery from Laparoscopic Gastric Bypass Surgery
As with any major surgery, you will experience some discomfort and pain immediately following laparoscopic gastric bypass surgery. Any pain is usually eased by pain medicine through an IV.
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As soon as possible after surgery you will be asked to get up and walk around to reduce your risk of developing a blood clot or blood clot symptoms. Your surgeon may also have you wear compression stockings, hook you up to a pneumatic compression device that keeps the blood flowing in your legs or give you blood thinners.
To prevent gastrointestinal leaks, the two catheters inserted during surgery will remain in place for a couple of days to keep the stomach fluids drained.
Once the staple lines have healed, your stomach will still need additional time to heal before it can handle food. Your diet after gastric bypass surgery will consist only of liquids for up to a week following surgery and will slowly transition back to solids.
After your digestive system appears to be functioning normally (no vomiting) and your surgeon determines that your wounds are healing properly (usually 3 to 5 days after surgery), you will be given the go-ahead to return home.
Your surgeon will want to see you for a follow up visit 4 weeks after surgery, then every three months for the first year, then semi-annually. If you experience any issues in between visits, don’t wait for your next visit… call your doctor right away.
Life After Laparoscopic Gastric Bypass Surgery
Both laparoscopic gastric bypass surgery and the duodenal switch have what is known as the “honeymoon period” that lasts from 6 to 9 months after surgery. Patients usually lose a lot of weight quickly during this period, even if they don’t perfectly adhere to their bariatric diet and planned exercise after gastric bypass surgery.
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Although it will be tempting, it’s important that you don’t let yourself slip during this time. Getting away from your diet and exercise program can be easier to do if you see weight coming off without them. But you’ll pay for it in the long run by not reaching your goal weight and developing bad habits that can be tough to break.
As with all types of bariatric surgery, life will change dramatically after gastric bypass surgery.
Specific to Roux-en-Y gastric bypass…
- You’ll feel full sooner due to the small size of the stomach pouch
- Due to several hormone changes, including the reduction in ghrelin production mentioned above, you may no longer crave the unhealthy foods that you used to love.
"Patients usually lose a lot of weight quickly during the "honeymoon period", even if they don't perfectly adhere to their diet and exercise plan...but you'll pay for bad habits in the long run."
- Most patients (about 80%) will experience dumping syndrome when they eat the wrong foods. Conveniently, the wrong foods are the unhealthy ones, so while dumping syndrome symptoms are unpleasant, they help you keep your diet in check.
- Some patients experience diarrhea following surgery, but it is more common in other procedures such as gastric sleeve surgery and duodenal switch. Eating preplanned gastric bypass meals will usually get things back to normal, although some patients find that the diarrhea is caused by lactose intolerance (not necessarily caused by surgery, but the new stomach can make lactose intolerance symptoms more prevalent). If that’s the case, you’ll need to avoid dairy products.
AFFILIATE
- Constipation is more common after gastric bypass and usually means that you need to drink more water. Fiber supplements such as Fiber-Stat's liquid fiber supplement (aff) can also help.
- If you eat too quickly, you may have difficulty swallowing. This is the result of food backing up into the esophagus after the stomach pouch has been filled. To avoid this, chew your food thoroughly, eat slowly and eat foods that are more easily digested. This should get better as your pouch stretches over time. (See our Bariatric Eating page to learn about proper eating techniques that will avoid problems.)
- Due to the malabsorptive component of the surgery, your doctors will insist that you take gastric bypass vitamins for the rest of your life to avoid extremely dangerous vitamin deficiencies.
Our Life After Weight Loss Surgery page explains the additional changes patients experience for all types of bariatric surgery.
See our long-term diet for gastric bypass page for more about your eating habits following surgery.
Laparoscopic Gastric Bypass Surgery Cost & Financing
Roux-en-Y gastric bypass surgery can cost anywhere from $15,000 to $35,000 depending on your surgeon and region of the country. Your insurance may cover the costs, but if it doesn’t there are several places to get help.
Take a look at the following pages for more…
- Cost of gastric bypass surgery
- Gastric bypass surgery insurance
- Gastric bypass financing (all options for financing bariatric surgery, including procedures other than gastric bypass)
If you don’t have insurance, a less expensive alternative could be bariatric surgery in Mexico or abroad.
Bariatric Doctors Specializing in laparoscopic gastric bypass surgery
Since gastric bypass is the most commonly performed bariatric surgery procedure, there are numerous qualified surgeons throughout the country.
See our Bariatric Doctors page to learn how to interview and choose the best surgeon.
If you're ready to attend a free local seminar or schedule a free one-on-one consultation with a surgeon, click here to find a qualified surgeon in your area.
For additional research, search for your topic...
Also see...
References for Laparoscopic Gastric Bypass Surgery
- Gasteyger C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008 May;87(5):1128-33.
- Peluso L, Vanek VW. Efficacy of Gastric Bypass in the Treatment of Obesity-Related Comorbidities. Nutrition in Clinical Practice, Vol. 22, No. 1, 22-28 (2007)
- American Society for Metabolic and Bariatric Surgery. Brief History and Summary of Bariatric Surgery. May 2005. Available at: http://www.asbs.org/html/patients/bypass.html. Accessed: September 16, 2009.
[Last editorial review/modification of this page: 1/24/2012]
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