What is gastric bypass weight-loss surgery?

Roux-en-Y gastric bypass (RYGB) is a type of weight-loss surgery. Weight-loss surgery is also called bariatric surgery. 它通常是腹腔镜手术，在腹部有小切口.

这个手术将你的上胃缩小到一个鸡蛋大小的小袋子. 外科医生通过缝合胃的上部来做到这一点. This reduces the amount of food you can eat. 然后，外科医生将这个小袋直接连接到小肠的一部分，称为Roux肢. This forms a “Y” shape. 然后你吃下的食物绕过胃的其余部分和小肠的上部. 这样可以减少你从食物中吸收的脂肪和卡路里. 它还会减少你从食物中吸收的维生素和矿物质.

Why might I need gastric bypass weight-loss surgery?

Gastric bypass surgery is used to treat severe obesity. It’s advised for people who have tried other weight loss methods, such as diet and exercise, without long-term success. 如果你严重肥胖，身体质量指数(BMI)超过40，你的医生可能会建议你做胃旁路手术. 如果你的身体质量指数在35到40之间，并且有睡眠呼吸暂停等健康问题，你的医生也可能会建议你这样做, high blood pressure, heart disease, or type 2 diabetes.

胃旁路手术可以帮助一个人减掉大约100磅的多余体重. It may also improve, or in some cases even reverse type 2 diabetes. It can also improve or stop heartburn and reflux. 减肥手术还可以降低患高血压的风险，或者改善已经患有高血压的人的血压. A gastric bypass can also help with sleep apnea, and certain other health problems such as high cholesterol.

What are the risks of gastric bypass weight-loss surgery?

Bleeding, infection, 你腿上的血块是任何手术后可能出现的副作用. 全身麻醉也可能引起呼吸问题或其他反应. You may also have leaks from the stomach pouch or the Roux limb.

Possible problems over time may include: 

• 如果你在你的余生中不每天服用补充剂，维生素水平会很低(在某些情况下), even if you do take supplements)

• Low levels of iron and calcium

• Trouble getting enough protein

• Dumping syndrome. This can cause nausea, fast heartbeat, belly (abdominal) cramping or pain, fainting, and diarrhea after eating.

• 肠连接部位的狭窄(狭窄或狭窄)

• 危险的内疝，小肠可能被困住并堵塞

• Hernia at the port sites

• Poor healing of the incision sites

• Need for additional surgery 

• Failure to lose enough weight

• Weight regain, if you snack on high-calorie foods and don’t exercise

• Loss of too much weight too quickly. This can cause sagging skin that may need to be removed surgically.

• Gallstones. This requires surgery to remove the gallbladder. 

You may have other risks based on your health. 在手术前一定要和你的医疗团队谈谈你的顾虑.

How do I get ready for Roux-en-Y gastric bypass surgery?

你的医疗团队需要确保胃旁路手术对你来说是一个好的选择. 不建议滥用药物或酗酒的人做减肥手术, 或者无法终生改变饮食和锻炼习惯的人.

在做手术之前，你需要参加减肥手术教育课程. This will help you prepare for surgery, and life after surgery. You’ll have nutritional counseling. And you may have a psychological evaluation. 你还需要身体检查和心电图(ECG)等检查。, a chest X-ray, and sleep study. You will need blood tests. 你可能会对你的胃进行影像学检查，或者进行上腹内窥镜检查. 

If you smoke, you will need to stop several months before surgery. Your surgeon may ask you to lose some weight before surgery. This will help make your liver smaller, and make surgery safer. You’ll need to stop taking aspirin, ibuprofen, and other blood-thinning medicines in the days before your surgery. You shouldn’t eat or drink anything after midnight before surgery.

What happens during Roux-en-Y gastric bypass surgery?

• The surgery usually takes several hours.

• You will have general anesthesia for your surgery. This will cause you to sleep through the surgery, and not feel pain.

• Your surgeon may use laparoscopy. They will make several small cuts (incisions) in your abdomen. 然后，外科医生将插入腹腔镜，并将小型手术工具放入这些切口.

• 外科医生会用腹腔镜吻合器在你的胃上部做一个小胃袋.

• 然后，外科医生用订书机将小肠上部分成两端的管子.

•  小肠的一端(Roux肢)向上伸展至胃袋, and a small connection (anastomosis) is made between them. 然后，小肠的另一端与小肠的另一部分相连.

• 然后你的外科医生可能会用染色检查或上内窥镜检查来检查是否有泄漏.

What happens after Roux-en-Y gastric bypass surgery?

You may stay in the hospital for 1 to 2 days after the surgery. Talk with your doctor about wound care, safe pain medicines, and when you can start physical activity. 你的医生会告诉你多久换一次切口上的敷料. 

Tell your doctor right away if you have any of the below:

• Fever

• Your wound becomes painful or hot to the touch or leaks fluid

• Coughing or trouble breathing

• Vomiting and diarrhea

• Blood in your bowel movement

• Pain in the abdomen, chest, shoulder, or legs

• Any other problems or symptoms

手术后的前一到两周你可能只会有液体. 你的医生可能会在手术后大约一个月慢慢地给你的饮食添加软性食物，然后是常规食物. 你需要慢慢地、充分地咀嚼，不要在吃饭前后30分钟喝东西.

Your initial weight-loss may occur quickly, 所以在你恢复的过程中，摄取你需要的所有营养和维生素是很重要的. 你的医生会给你开维生素和矿物质补充剂，你的身体可能不再从食物中很好地吸收.

为了防止胃分流手术后出现营养问题，许多医生建议:

• Daily multivitamins. 你应该每天服用含有每日摄入量200%的复合维生素.

• Daily calcium supplements. Multivitamins with calcium may not protect bone health. You may need 1,600 to 2,000 IU vitamin D and 1,600 mg calcium daily. Take a calcium supplement at least 2 hours after your multivitamin.

• Vitamin B-12 supplements. 医生建议所有做过减肥手术的人补充维生素B-12，以帮助预防骨折. You can take this by mouth several times a week. Or you may have B-12 injections every month.

• Oral vitamin D supplements. You may need this if you have low levels. 你的医生可能会给你开50000国际单位的维生素D，每周口服一次，持续8周. Some people need lifelong vitamin D supplements.

• Iron supplements. After gastric bypass surgery, 复合维生素中的铁含量可能不足以预防贫血. You may need an additional 50 to 100 mg of elemental iron a day. Taking vitamin C will help your body absorb iron. Ask your doctor about the recommended dose for you.

Because nutritional deficiencies can happen after this surgery, 专家建议在你的余生中至少每6个月进行一次血液测试，以确保你获得适量的维生素和矿物质. 

During weight-loss, you may have body aches, dry skin, mood changes, and temporary hair thinning, and feel tired and cold. As your weight stabilizes, these problems should go away. Weight loss continues for about a year, and then will stop. After a year, you may be able to eat more if the pouch stretches. 你应该在第一年养成良好的饮食和锻炼习惯，防止体重反弹.

Along with follow-up appointments with your doctor and surgeon, 你可能会去看一个营养师，他会教你如何吃以及吃什么，因为你的胃变小了. 你可能还需要去看心理医生，帮助你处理生活方式改变带来的感受和担忧.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• 谁来做测试或程序，那个人的资格是什么

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• 在测试或程序后，如果您有疑问或问题，可以打电话给谁

• How much you will have to pay for the test or procedure