The name Roux-en-Y is derived from the surgeon that first described it (Cesar Roux) and the stick-figure representation. Diagrammatically, the Roux-en-Y procedures looks like the letter Y; typically, the two upper limbs of the Y represent a proximal segment of small bowel and the distal small bowel it joins with (which is often a blind end), and the lower part of the Y the distal small bowel (beyond the anastomosis). Roux-en-Y’s are used in several operations and collectively called Roux surgery. Roux-en-Y is currently the most commonly performed bariatric operation in the United States, and roughly 7 out of 10 bariatric surgeons use it as their primary weight loss procedure.

What is Roux-en-Y Surgery?

Roux-en-Y (often abbreviated RNY and pronounced roo-en-why) is gastric bypass surgery known as the gold standard of weight loss surgeries - is a Gastric bypass procedure, which involves creating a stomach pouch out of a small portion of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum. Not only is the stomach pouch too small to hold large amounts of food, but by skipping the duodenum, fat absorption is substantially reduced.

How does Roux-en-Y Surgery Work?

The Roux-en-Y Surgery procedure accomplishes two important tasks. First, it separates the stomach, creating a smaller pouch for food that gives patients a sense of "feeling full" after eating significantly smaller amounts of food. Second, a bypass of the upper portion of the small intestine reduces the ability to absorb calories and nutrients. This quality is known as a "malabsorptive" property. Roux-en-y bariatric surgery does not involve removal of the stomach. The stomach is still able to produce digestive juices. While the duodenum (the first section of the small intestines) is no longer attached to the stomach, this "bypassed" section is surgically connected further down the intestinal tract — at a "Y" intersection — to provide some of the benefits of normal food breakdown. The "proximal" approach, the method most commonly used, involves a higher attachment of the upper small intestine. In fewer cases, a "distal" roux-en-y involves reattachment of the small intestine further down intestinal tract. The further the duodenum is attached, the more like a patient will experience malabsorptive values, resulting in even less caloric processing (and less nutrient absorption). Another variation of the Roux-en-Y procedure involves creating a "Y" formation between the stomach pouch and the intestinal attachment.

Am I the Candidate for Roux-en-Y Surgery?

There are many criteria when determining if a patient is a suitable Candidate for Roux-en-Y Surgery.

• These eligible candidates for this surgery will be clinically obese and will have failed to loose weight through non-surgical methods or other weight loss surgery procedures, such as gastric banding, will have failed.
• Candidates for Roux-en-Y Surgery will view surgery as a last resort to weight loss.
• Suitable candidates will have a BMI of 30+ and a high waist-to-hip ratio.
• Bariatric surgeons will access patients individually to decide if they are a suitable candidate.

How to Prepare for Roux-en-Y Surgery?

The way you prepare for Roux-en-Y Surgery sets the tone for the success of your operation and recovery. Patients who are not committed to their pre-operative duties may find that their doctors postpone or cancel the surgery itself. Roux-en-Y surgery makes it easier to lose weight but the patient still has to do a lot of hard work. Prepare diligently for pre-op to prove you are ready for the challenges of post-op. Try following the tips given below as for the preparation of your surgery:

• Participate in pre-operation screenings to conclude whether or not you are a candidate for Roux-en-Y gastric bypass surgery.
• Sit down with your family or chosen representative to discuss your wishes should there be an extensive recovery period or other unforeseen circumstances.
• Lessen the length of time spent in surgery and recovery by dieting before the procedure. Patients who weigh less may be suited for laparoscopic surgery as opposed to traditional gastric bypass surgery. The traditional technique is more difficult for the doctor and the patient.
• Aim for a pre-surgery weight loss of 10 to 15 or even 25 percent of your total weight.
• Begin to adapt your diet to post surgery standards.
• Decrease the sugar and caffeine in your diet.
• Cut back on your alcohol and tobacco intake. Shoot for totally abstaining from both items.
• Avoid carbonated beverages.
• Start an exercise routine. Walk five to ten minutes a day and gradually increase the time.
• Seek out patients who have undergone Roux-en-Y Surgery to discuss life after the procedure. Many patients are not prepared for the depression and continued food cravings after surgery.

What is the Procedure of Roux-en- Y Surgery?

Roux-en-Y Surgery is performed as either an open or a laparoscopic procedure, a single-incision operation that typically takes less time to complete. Benefits of laparoscopy include a reduction in overall postoperative pain and a shorter recovery process. Both involve the same, or similar, techniques. During a Roux-en-Y Surgery, the surgeon creates a small stomach pouch (15-30 ml in volume) at the upper part of the stomach either by using surgical staples or a gastric band. The site for the small pouch is usually sited in a section of the stomach which is least likely to stretch. The stomach pouch is totally separated from the rest of the stomach and instead is connected directly to the middle portion of the small intestine (jejunum), bypassing the lower part of the stomach and the early segment of the small intestine (duodenum). The tube connecting the pouch to the jejunum is called the "roux limb" or "food channel". Meanwhile, gastric juices from the stomach and digestive enzymes from the pancreas, and bile, continue to flow from the lower part of the stomach and duodenum down the small intestine which is referred to as the "alimentary channel".

These two channels meet at a Y-shaped junction - which gives the procedure its name - and together form a common channel where absorption of nutrients and calories begins. There are two basic variants of the Roux-en-Y Surgery procedure: a proximal roux-en-Y, in which Y-intersection occurs at the upper or proximal part of the small intestine, and a distal roux-en-Y in which the Y-intersection is joined to the lower or distal part of the small intestine. The proximal roux variant allows for greater absorption of nutrients, while the distal variant provides less absorption of food - mainly of fats and starches, but also of various minerals and fat-soluble vitamins - but greater weight loss. In both cases, the roux-en-Y patient experiences a very rapid feeling of fullness in the stomach, followed by a feeling of growing satiety after starting to eat.

What is the Post Operative Care after Roux-en-Y Surgery?

This could be bifurcated into two ways, care to be taken during the hospital stay and at home.

At Hospital: While you are recovering at the hospital, you may receive the following care:

• One day after surgery-You will have an x-ray to check for leaks from the stomach pouch. For this test, you will drink a special liquid while x-rays are taken. If the upper GI x-ray is normal, you will be given 30 milliliters (ml) of liquids every 20 minutes. If leaks are found, you will receive nutrition through an IV until the leaks are fixed.
• On the second day after surgery-You will take 1-2 tablespoons of pureed food or 1-2 ounces of liquids every 20 minutes. While in the hospital, you may be asked to use an incentive Spiro meter to help you take deep breaths. And, secondly, will be asked to wear elastic surgical stockings or boots which helps to promote blood flow in your legs.

At Home: Be sure to follow your doctor's instructions. You will need to practice lifelong healthy eating and exercising habits. Keep in mind after your surgery:

• You may be out of work for 2-6 weeks after the surgery. Do not drive or lift anything heavy until your doctor tells you it is safe. This may be up two weeks or more.
• Walk as soon as possible, with a goal of exercising daily. You may have emotional ups and downs after this surgery. You will meet regularly with your healthcare team for monitoring and support. Your new stomach is the size of a small egg. It is slow to empty, causing you to feel full quickly. Therefore, you need to eat very small amounts and eat very slowly:
• You will begin with 4-6 meals per day. A meal is two ounces of food. For the first 4-6 weeks after surgery, all food must be pureed. Once you move to solid foods, they must be chewed well. When making food choices, you will need to consume enough protein.
• Avoid sweets and fatty foods.
• Eating too much or too quickly can cause vomiting or intense pain under your breastbone. Most people quickly learn how much food they can eat.

You may need to take medicines, as directed by your doctor, which may include:

• Antacids
• Pain medicines
• Vitamin and mineral supplements

What is the Weight Loss after Roux-en-Y Surgery?

Typically the patients lose roughly 70 percent of their initial excess body weight during the first 24 months after Roux-en-Y Surgery. Occasionally, patients’ experiences a weight regain of about 10 percent between years 2 and 5. Bariatric experts attribute this to two factors. First, the functional capacity of the small pouch increases in volume to accommodate more food. Second, roux patients learn how to take in extra calories without incurring symptoms of dumping syndrome and making themselves sick. This second factor can only be corrected by greater patient compliance with post-op dietary guidelines brought about by greater post-op counseling and support services.

What are the Benefits of the Roux-en-Y Surgery?

The following are the benefits of Roux-en-Y Surgery:

• Roux-en-Y offers the best balance between weight loss and risk of complications. On average, weight loss can average 80 percent of excess body weight one year after surgery.
• The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with restrictive procedures.
• Studies show that after 10 to 14 years, patients on average have only gained back 10 to 13 percent of the lost weight.
• A 2000 study of 500 patients showed that 96 percent of some associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.

What are the Risks of Roux-en-Y Surgery?

Dumping syndrome," the situation in which the body quickly expels food after eating, is a common side effect of following RNY. While RNY prevents the body from being able to process fats and sugars as it did before, it also causes the body to react adversely to eating too fast or too much at one time.

What are the Alternatives to Roux-en-Y Surgery?

The following are the recommended alternatives for Roux-en-Y Surgery

Mini-Gastric Bypass: uses the loop reconstruction, has been suggested as an alternative to the Roux en-Y procedure, due to the simplicity of its construction, which reduced the challenge of laparoscopic surgery. MGB combines two surgeries: Collis gastroplasty — lengthening of the esophagus by creating a tube from the upper part of the stomach — and Bill Roth II loop Gastrojejunostomies, which involves connecting the small intestine to the stomach. Essentially, a narrow, long pouch is formed and reconnected to the intestines about 6 feet from the stomach without actually severing the small intestines. No food is emptied into the larger, sectioned-off portion of the stomach or small intestine, thereby limiting calorie absorption.

Why Roux-en-Y Surgery in India?

Roux-en-Y Surgery in India is one of the most prominent obesity surgery procedures that are being undertaken by global patients coming from all across the world. The medical and healthcare amenities in India are excellent in terms of cost and quality. This surgery comes with the best medical care for weight loss benefit.

The medical infrastructure in India has state of the art Hospitals and the best qualified doctors and obesity surgeons. With the best infrastructure, high quality medical amenities, accompanied with the most competitive prices, the foreign patients are amazed by the hospitality and treatment for Roux-en-Y Surgery in India in India.

The hospitalization amenities at the obesity surgery hospitals in India have modern amenities equipped with state of art technologies for effective medical treatments at quiet affordable costs. These hospitals are available in the following Indian cities:

Mumbai	Hyderabad	Kerala
Delhi	Pune	Goa
Bangalore	Nagpur	Jaipur
Chennai	Gurgaon	Chandigarh

Besides, getting effective medical treatment one can also get a view of Indian cultural heritage by enjoying holiday vacations at the best Indian tourism resorts.

What is the Cost of Roux-en-Y Surgery in India?

Cost comes first to decide the Roux-en-Y Surgery in India, since it comes with high quality as witnessed in developed nations. The lower cost includes significantly longer post-operative care in the hospital itself. The costs are usually a lot lower than even the deductible most insurance company's levy on a patient. The following figure indicates the cost of certain treatments in US and India, which are makes the overseas patients to look abroad for their medical treatment in India.

Surgery	USA	India
Roux-en-Y Surgery	$26,500	$7,200
Gastric Banding Surgery	$24,000	$8,970
Intragastric Balloon Surgery	$24,809	$4,860

Some of the common countries from which patients travel to India for surgery are:

USA	UK	Canada
Australia	New Zealand	Nigeria
Kenya	Ethiopia	Uganda
Tanzania	Zambia	Congo
Sri Lanka	Bangladesh	Pakistan
Afghanistan	Nepal	Uzbekistan

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