Roux-en-Y Procedure
- Commonly used as a weight-loss (bariatric) surgery: it reduces the stomach size and amount of nutrient absorption.
– Creates a small gastric pouch that comprises only the fundus and bypasses rest of stomach (the body and antrum) and the duodenum.
– Jejunum is attached to the gastric fundus.
– Duodenum attached further down along the jejunum; this allows digestive juices from the stomach and pancreas as well as bile from the gallbladder release into the intestine.
– "Roux Limb" = portion of the jejunum between two attachments.
- Following surgery, food passes: esophagus ? gastric pouch ? Roux Limb ? through Roux Limb ? remaining jejunum.
– Because the duodenum is bypassed, these patients lack the absorptive and secretive properties of the duodenum.
– Patients supplement diets with: iron, vitamin B12, and other vitamins and mineral supplements (no longer absorbed)
– Also: no longer secrete intrinsic factor from bypassed duodenum ? cannot bind to vitamin B-12 in bypassed duodenum ? unable to absorb vitamin B12 in ileum.
- Physicians prescribe vitamin B-12 supplements (nasal spray, sublingual drops, or tablets) ? ensures B-12 directly absorbed into circulation.
