ROUX-EN-Y GASTRIC BYPASS FOR REFLUX

What is Roux-En-Y Gastric Bypass for Reflux

Roux-en-Y gastric bypass (RYGB) is a weight-loss surgery that involves creating a small pouch from the stomach and connecting it directly to the small intestine, bypassing most of the stomach and the first part of the small intestine. While commonly performed for obesity management, RYGB can also be an effective treatment for gastro-oesophageal reflux disease (GORD), or acid reflux, particularly when other treatments have not been successful, in those who are also wishing to pursue weight loss surgery. 

How Does RYGB Help with Reflux?

In patients with GORD, stomach acid frequently flows back into the esophagus, causing symptoms like heartburn, chest pain, and regurgitation. In severe cases, acid reflux can damage the esophagus and lead to complications such as ulcers, Barrett's oesophagus (changes in the cells of oesophagus) or a narrowing of the esophagus.

RYGB helps alleviate reflux by:

  1. Reducing Stomach Size: The creation of a small stomach pouch limits the amount of food that can be eaten at one time, reducing the volume of gastric acid produced.

  2. Bypassing the Duodenum: By bypassing the first part of the small intestine, where most bile and digestive juices mix, RYGB minimises the back flow of these substances into the stomach and oesophagus, which can contribute to reflux.

  3. Reducing Pressure on the Lower Oesophageal Sphincter (LOS): The procedure can help improve the function of the LOS, the muscle at the junction of the oesophagus and stomach, which can prevent acid from flowing back into the oesophagus.

Roux-En-Y Gastric Bypass for Reflux Details

Who is a Candidate for RYGB for Reflux?

RYGB for reflux may be considered for patients who:

  • Have severe GORD that is not controlled with medications or lifestyle changes

  • Have developed complications from GORD, such as oesophageal ulcers, oesophagitis, or a condition called Barrett’s oesophagus

  • Are overweight or obese (BMI > 40) and have struggled to lose weight through other means

  • Have other conditions that may improve with weight loss, such as diabetes or high blood pressure

What are the benefits of RYGB for Reflux:

  • Significant Reduction in Reflux Symptoms: Many patients experience a dramatic reduction or even complete resolution of their reflux symptoms after surgery

  • Weight Loss: RYGB helps with significant, sustainable weight loss, which can further reduce reflux symptoms, as excess weight can contribute to GORD

  • Improved Quality of Life: For many patients, the procedure leads to an improved quality of life with fewer daily symptoms of reflux and better overall health

What to Expect Before Surgery:

  1. Preoperative Evaluation: You will undergo a thorough evaluation, including a physical exam, lab tests, imaging studies (such as an upper GI Barium series and endoscopy), and possibly a pH monitoring test (24 hour ambulatory pH testing) to assess the severity of your reflux

  2. Lifestyle Modifications: You may need to make changes to your diet, stop smoking (smoking must be ceased for a minimum of 6 week prior to surgery and not re-commenced post surgery, especially after a RYGB), and avoid certain medications (like non-steroidal anti-inflammatory drugs) before surgery

  3. Education: Your surgeon and care team, in particular our senior dietitians, will provide detailed instructions about how to prepare for the surgery and what to expect in the days and weeks after

What Happens During the Surgery?

  • RYGB is typically performed laparoscopically, meaning through small incisions, using a camera and specialised instruments

  • The surgeon creates a small pouch at the top of the stomach, then connects it directly to the small intestine, bypassing a portion of the stomach and duodenum & small bowel

  • This reconfiguration of the digestive system reduces stomach acid production and prevents reflux of acid and bile back into the oesophagus, effectively managing GORD symptoms 

  • The procedure usually takes about 2 to 4 hours and is performed under general anesthesia

What to Expect After Surgery:

  • Hospital Stay: You will likely stay in the hospital for 2 to 3 days after surgery for monitoring and recovery

  • Dietary Changes: You will follow a special diet starting with liquids and gradually transitioning to soft foods and eventually solid foods over several weeks. Your surgeon will give you a detailed "patient information sheet" about dietary changes

  • Medications: You may need to take medications to prevent acid buildup (to aid in the healing of the stomach pouch and connection between the pouch and small bowel), as well as a good quality multivitamin daily to prevent deficiencies, especially of vitamins B12, D, and iron.

  • Follow-Up Care: Regular follow-up appointments will be required to monitor your recovery, weight loss progress, and any changes in reflux symptoms. It is very important that you follow your surgeons' post-operative instructions, including dietary guidelines, vitamin and mineral supplementation and regular follow-up appointments, to support healing and maximise the benefits of the procedure and prevent complications 

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