Roux-en-Y gastric bypass surgery

In many centers, laparoscopic Roux-en-Y gastric bypass has become the most common bariatric procedure for morbid obesity. 

In this operation, the stomach is stapled or divided to form a small pouch (typically <30 mL in volume), which empties into a Roux limb of the jejunum of varying length (typically 75-150 cm). 

The Roux limb may be brought up to the gastric pouch in two ways:

  • anterior to the transverse colon (antecolic-anterogastric)
  • posterior to the transverse colon (retrocolic-retrogastric)

There are two anastomoses: a proximal gastrojejunal anastomosis and a distal jejunojejunal anastomosis.

Although any visible defects that might allow potential bowel herniation are routinely closed at surgery 2, the antecolic approach has become preferred at some centers because a retrocolic approach requires bringing the Roux limb through the mesenteries and markedly increases the rate of an internal hernia.

Recognized gastrointestinal complications of gastric bypass surgery include 3:

  • early
  • late
    • anastomotic narrowing/stenosis/stricture
      • most common cause of postoperative nausea and vomiting
      • may require lateral or steep oblique views to visualize
      • rare at jejunojejunal anastomosis (0.9%)
    • bezoar formation in the gastric pouch
    • ulcer
    • haemorrhage and haematoma
    • adhesions / small-bowel obstruction
    • internal hernia  2

See also

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Article Information

rID: 14021
Section: Gamuts
Synonyms or Alternate Spellings:
  • Roux-en-Y procedure
  • Roux-en-Y gastric bypass

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    The Roux limb may...
    Figure 1: retrocolic-retrogastric roux limb
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    The same in stand...
    Case 1: with Petersen`s hernia
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    The Roux limb may...
    Figure 2: anterocolic-anterogastric roux limb
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    Small collection ...
    Case 2: with anastomotic leak
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    Upper gastrointes...
    Case 3: Roux limb obstruction
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    Case 3: Roux limb obstruction : CT
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    Case 4: with internal hernia
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