Gastric Bypass (RYGB) is characterized by a small (less than 30 mL) proximal
gastric pouch that is divided and separated from the distal stomach and anastomosed
to a Roux limb of small bowel that is 75 to 150 cm in length.
beginning, we divide upper part of the stomach (small gastric pouch) from the
Then we make an
anastomoses between the upper part of stomach and small bowel.
Finally, we make
another anastomoses in between proximal (biliopancreatic limb) and distal (alimentary limb) small bowel to
maintain the continuity of stomach and the bowel.
How is the procedure is performed?
is performed under general anesthesia and can be done both laparoscopic and
robotic. Both procedures are safe and reliable.
Duration of Surgery/Procedure
Although it depends on the BMI of patients and can be different from one patient to
another, laparoscopic gastric by-pass procedure takes about 60-75 minutes and
robotic gastric by-pass procedure takes about 75-90 minutes.
Gastric remnant distension:
Gastric remnant distension is a rare but potentially lethal complication following gastric bypass. Clinical features include pain, hiccups, left upper quadrant tympany, shoulder pain, abdominal distension, tachycardia, or shortness of breath. Radiographic assessment may demonstrate a large gastric air bubble. Immediate operative exploration and decompression are required if percutaneous drainage is not feasible or if perforation is suspected.
(anastomotic) stenosis has been described in 6 to 20 percent of patients who
have undergone RYGB. atients typically present several weeks after surgery with
nausea, vomiting, dysphagia, gastroesophageal reflux, and eventually an
inability to tolerate oral intake, including liquids. The diagnosis is usually
established by endoscopy or with an upper gastrointestinal series. Endoscopic
balloon dilation is usually successful.
have been reported in 0.6 to 16 percent of patients. Marginal ulcers occur near
the gastrojejunostomy and result from acid injuring the jejunum, or they can be
associated with a gastrogastric or, rarely, gastrocolic fistula. Patients with
marginal ulcers can present with nausea, abdominal pain, gastrointestinal
bleeding, stomal stenosis, or perforation. The diagnosis of a marginal ulcer is
established by upper endoscopy. The mainstay of medical therapy for marginal
ulcers is high-dose proton-pump inhibitors (PPIs).
develops in as many as 38 percent of patients within six months of surgery, and
up to 41 percent of such patients become symptomatic.
Ventral incisional hernia:
incisional hernias occur with a frequency of 0 to 1.8 percent in laparoscopic
series and as high as 24 percent in open series, underscoring a clear advantage
of the laparoscopic approach in this regard.
have been described in 0 to 5 percent of patients after laparoscopic gastric
bypass. To reduce the incidence of internal hernias, all mesenteric defects
should be closed with nonabsorbable sutures.
Small bowel obstruction:
obstruction (SBO) can occur at any time after an RYGB, with a lifetime
incidence of 3 to 5 percent.
can occur in up to 50 percent of post-gastric bypass patients when high levels
of simple carbohydrates are ingested. Patients should avoid foods that are high
in simple sugar content and replace them with a diet consisting of high-fiber,
complex carbohydrate, and protein-rich foods. Behavioral modification, such as
small, frequent meals and separating solids from liquid intake by 30 minutes,
is also advocated. Usually, early dumping is self-limiting and resolves within
7 to 12 weeks.
Metabolic and nutritional derangements:
nutritional derangements are common in patients with severe obesity and can be
exacerbated following after bariatric surgery, making postoperative life-long
compliance with appropriate dietary choices and vitamin supplementation
imperative. Decreased oral intake as well as altered absorption of food from
the stomach and small bowel reduces absorption of various micronutrients,
particularly iron, calcium, vitamin
B12, thiamine, and folate.
Nephrolithiasis and renal failure:
RYGB has been
linked to metabolic changes that could alter urine chemistry profiles,
resulting in both higher calcium oxalate supersaturation and urine oxalate,
lower citrate, and lower volume. Consequently, patients have a higher risk of
developing nephrolithiasis after RYGB (pooled relative risk 1.79, 95% CI
Change in bowel habits
Loose stool and
diarrhea are more common after RYGB. Steatorrhea and more frequent stools can
occur with excessive fat intake. In addition, these symptoms can be due to
subclinical lactose intolerance, which is only recognized when dairy products
are used in an effort to achieve adequate protein intake after bariatric
Failure to lose weight and weight regain:
Failure to lose
weight following Roux-en-Y gastric bypass is rare and is often due to
maladaptive eating patterns during the early postoperative period. By contrast,
significant late weight regain occurs in up to 20 percent of patients,
especially those with super-obesity (BMI >50 kg/m2) at the time
of the initial operation. It is often due to progressive noncompliant eating
and other behavioral habits, development of a functional GG fistula, gradual
enlargement of the gastric pouch, or dilatation of the gastrojejunal
My personal succes rate is high. I have not had any serious complication (leak,
bleeding, stenosis etc.) yet.
Recovery Process /
Period: About two
Days of Admission: 2-3 days.
Days of Stay in the
Country: About 7-10 days.
Expected After Care
We recommend dietitian and psychologist follow up to
our patients for at least 2 years after surgery.
Doctor experience with the Procedure
My personal experience for gastric by-pass is about
Laparoscopic or Robotic Roux-en-Y Gastric Bypass EUR €3400- €5150 Book Now!
- Pre-op Screening Tests and Examinations*
- Robotic Sleeve Gastrectomy Surgery
- Post-op Tests and in-patient medicine
- Days of Hospitalization
- Nutrition Counseling
- Airport Transfers
- English Translation of the surgery report and
the medical reports
Days of Hospitalization: 3 Days
Days of Stay in Turkey: 10 Days
*Pre-op Screening Tests
and Examinations inlcuded in the price:
- Gastroscopy, Required Diagnostic Tests,
Radiological Imaging, Bloodwork, Endocrinology Examination, Pulmonology
Examination, Cardiology Examination, Psychological Examination
- Diagnostic Tests and examinations vary for
Women, Men and for Women 40+
**Hotel Accomodation is not
included in the price
Buy Now !
*Click here, before buying the package, if you prefer to Start Conversation with Hospital
Author & Surgeon: Assoc. Prof. Abdulcabbar Kartal, MD
Posted: May 9, 2022 at 18:00 UTCLast Updated: May 23, 2022 at 17:40 UTC
Scanned original that contain the doctor stamp and signature
1) Complications of bariatric surgery: Presentation and emergency management on Pubmed
2) Less Morbidity with Robot-Assisted Gastric Bypass Surgery than with Laparoscopic Surgery on Pubmed
3) Laparoscopic gastric bypass surgery: equipment andnecessary tools on Pubmed
4) Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. on Pubmed