Bariatric surgery for weight loss has become a common practice in the United States, with about 179,000 operations performed in 2013. The second most common bariatric procedure done today is the Roux-en-Y gastric bypass (RYGB). To be a practicing health professional in the modern era, one must understand the more common chronic complications that may result from altering the gastrointestinal (GI) tract and how to manage these complications.
To understand the sequela of the operation, one must have a basic understanding of the anatomy of the GI tract and the resulting physiologic effects of altering that anatomy. Roux-en-Y gastric bypass involves creating a small gastric pouch (restricting food intake) connected to a roux limb (typically between 75 to 150 cm) which bypasses a large portion of the small intestine (preventing the absorption of nutrients.) This results in the food bolus bypassing most of the stomach (bypasses the part of the stomach containing most of the parietal cells and stomach acid), the duodenum, and the first 40 to 50 cm of jejunum. Nutrients will only be absorbed distal to these bypassed segments, and the majority will be absorbed in the "common channel," which is distal to where the biliopancreatic and the roux limb connect.
The common chronic complications following an RYGB are briefly described concerning epidemiology, presentation, diagnosis, and treatment.
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