Roux-en-Y Gastric Bypass

The condition

The Roux-en-Y bypass surgery is a bariatric (weight loss) procedure that has been performed for about 30 years.  Most doctors and insurance companies have accepted it as preferred treatment for morbid obesity when diets and exercise fail.

The procedure

The traditional Roux-en-Y gastric bypass was performed through open surgery with one long incision, but with advancement in surgical instrumentation and stapling techniques most RNY are performed laparoscopically.  This is both restrictive and malabsorptive procedure.   In this technique the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples.  The smaller stomach is connected to the middle portion of the small intestine (jejunum). The patient will feel full more quickly than when their stomach was its original size, which reduces the amount of food eaten and thus calories consumed.  Bypassing the intestine also results in fewer calories being absorbed.

Risks

• Leaks
• Pulmonary embolism
• Incisional hernia-wound infection
• Atelectasis-Pneunomia
• Bleeding
• Anastomotic (connection) stricture
• Internal herniation
• Nutritional/mal-absorptive complications
• Small bowel obstruction
• Injury to the spleen

Medical negligence

The above mentioned risks and complications are known to happen with gastric bypass and such complications do not necessarily constitute deviation from the medical standard of care.  The following examples however may be considered as medical negligence.

• Failure to diagnose and treat anastomotic (intestinal connection) leaks.  Fever, sustained tachycardia (high pulse rate), and low urine output are hallmarks of a leak at the connection and warrant prompt clinical evaluation.
• Nutritional deficiencies due to physician’s failure to follow-up, may result in permanent ailments (i.e. encephalopathy due to B1 deficiency)
• Failure to optimize co-morbidities before surgery. Morbidly obese patients suffer of heart disease, diabetes, hypertension (high blood pressure), sleep apnea, and they are prone to deep vein thrombosis (clot formation in their legs). Failure to pre-operatively treat and optimize these conditions may lead to complications that may be life threatening.