Medial Roux-en-y Gastric Bypass

The pouch in this operation is similar to the one created in the Proximal Gastric Bypass. This pouch is connected directly to the intestine which is rerouted so that the food stream bypasses the stomach, duodenum, and the upper half of the small intestine. 

Medial Roux-en-Y Gastric Bypass is different from the Proximal Gastric Bypass in that roughly two-thirds to three-fourths of upper small intestinal length is bypassed. It works by not only inducing a sense of fullness or satiety with small amounts of food but also by significantly reducing calorie absorption.  In this type of operation neither the stomach nor any of the intestine is removed.

Technical Details

The top half of the small intestine carries just digestive (bile & pancreatic) juices, with no access to the food stream and is referred to as the Bilio-Pancreatic Limb or BPL (which is long in this type of operation).  This is connected to the rest of the intestine that carries the food stream, 60-80 inches (5-7 feet) from the large intestine (colon).  This last 1/3 to ¼ of the total small intestinal length where the food stream and intestinal juices mix together is where absorption occurs and is called the “Common Channel (CC)”.  Absorption of nutrients and calories is determined by the CC length.  A long CC decreases the risk for nutritional problems. A short CC decreases the risk for weight regain by decreasing calorie absorption. The segment of the intestine from the pouch to colon (or large intestine) is called the “alimentary (food) channel (AL)”, because it serves as a conduit for food.




Results

Patients tend to lose roughly 80% of excess weight on average. This operation is associated with very good long-term weight loss and maintenance:

	Resolution of co-morbidities especially diabetes, and elevated blood lipids (cholesterol and triglycerides) is much better with this operation.
	Strict compliance with recommended supplements & nutritional surveillance with labs are critical.
	Must avoid sugars to prevent dumping syndrome - rapid assimilation of sugars from the food directly into the intestine causes a reaction characterized by flushing, palpitations, sweating, and abdominal cramps
	Gas, diarrhea and body odor can affect patients to a variable extent, usually reflects carbohydrate intake which can be medically managed.