Roux En Y

Now that I'm a float RN, I like to educate myself about procedures/labs/whatsits that I'm not familiar with. This one really has made my week. Roux-en-Y... now that is some Frankenstein business!

I was aware of its general purpose and idea behind it but I just tried to make sense of the whole thing tonight and it is spectacular!

This is what I understand but may not be entirely accurate: The stomach is split into a teeny portion up top (<30ml) and the rest. The small intenstine is then cut so that the jejunum is attached to the small stomach portion up top to immediately receive food. The hanging end of the duodenum is then anastomosed to a spot BELOW the jejunum (whaaa? crazy. when do we start adding the gills?). The teeny new stomach can't get that much food in plus the residual stomach still pumps out digestive juices but now mixes it down in the new jejunal location. We get physical limitation of intake, malabsorption, a little bit of unpleasant dumping syndrome to discourage the determined, and a suppressed appetite with a related hormone normally secreted from the duodenum now inactive.

AWEEEESOMMMME.


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I miss big upper GI surgery. I miss big GI /HB surgery of any location.

That's the big and small of it. With the RNY, malabsorption decreases the longer a person is post op. Foods that should not be consumed will result in increased caloric intake and weight gain will result. The first eighteen months post op are considered the "honeymoon period", where with no exercise the person will still have major weight loss. The duodenal switch (DS) is even more extreme.

Tell me about it!

I mean... literally, please.

I can talk from a personal perspective as I had RNY way back in 2005 and lost 100lbs I try not to abuse it and even now find I still have good restriction although do eat what I want I have taught myself to stop when my stomach tells me enough is enough. As my surgeon tells people plumbing is rerouted so absorption is less and if too much fat or sugar is eaten usually results in a quick dash to the bathroom and then a stint laying down due to the dumping syndrome although not everyone suffers from it and I didn't start suffering from it until at least 5 years post surgery and I know I didn't eat anything too fatty or sugary to cause it. Another thing I have noticed is a drop in sugar resulting in the shakes and feeling generally rough and don't feel better unless I eat either a banana or something high in sugar to give me that quick boost.Not sure if this was something you was looking for but I know for me it was one of the best things I ever did

There are quite a few websites (mostly patient perspective/education but some have medical professional input also) dsfacts, obesityhelp, and others that offer a wealth of information on various weight loss options (surgical and non-surgical). Just google to start.Duodenal switch basically they cut out more than half of the stomach and throw it away (there is no remnant like with the roux en y bypass), then reroutes the small intestine in an even more complicated way than the bypass. There is a significant reduction in fat absorption that for many is permanent (and works as great aversion therapy for some...if you remember Orlistat/Alli where it impeded the ability to absorb fat and if you overindulged and weren't near a bathroom, well hope you had a change in pants as loose oily stools also were rather malodorous and there is no hiding)From Wikipedia: "The duodenal switch (DS) procedure, also known as biliopancreatic diversion with duodenal switch (BPD-DS) or gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.The restrictive portion of the surgery involves removing approximately 70% of the stomach along the greater curvature.The malabsorptive portion of the surgery reroutes a lengthy portion of the small intestine, creating two separate pathways and one common channel. The shorter of the two pathways, the digestive loop, takes food from the stomach to the common channel. The much longer pathway, the biliopancreatic loop, carries bile from the liver to the common channel.The common channel is the portion of small intestine, usually 75-150 centimeters long, in which the contents of the digestive path mix with the bile from the biliopancreatic loop before emptying into the large intestine. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat. As a result, following surgery, these patients only absorb approximately 20% of the fat they intake." http://en.wikipedia.org/wiki/Duodenal_switch There is also a gastric sleeve that is just the restrictive portion of the duodenal switch whereby 70% of the greater curvature of the stomach is permanently removed.

When we first had started doing bariatric surgery at my facility several nurses took advantage of the discount. Two are dead (< 55 y /old) and many are now having serious metabolic issues. ALL OF THEM regained weight after a period of time. You have to be on a diet the rest of your life. Why not just be on a diet without the surgery? It prevents nutritional absorption so many have malnutrition. I personally think it is unethical. Yes, I realize people need it to survive sometimes, but I also realize many are just looking for a quick fix. I think it is sad to see so many nurses getting ill years after the surgery.