ROUX-EN-Y

Gastric Bypass
By
Marefil Jane Pasaquian
Princess Brigitte Pateña
BSN - 4F
 Table of Contents
What is Gastric Bypass?

Pre-operative and Post-Operative care of the patient

Skin Prepping, Special Instruments, Supplies and Equipment

Position of the patient on the operating table

Proper draping of the patient
Type of anesthesia used
What is Gastric Bypass?
Gastric bypass, also known as Roux-en-Y gastric bypass, is a weight-loss
procedure that involves forming a small pouch from the stomach and
connecting it to the small intestine directly. Swallowed food will travel via
this small pouch in the stomach and then into the small intestine, skipping
the majority of your stomach and the first section of your small intestine.
The gastric bypass procedure is one of the most common types of bariatric
surgery. When diet and exercise haven't succeeded or you're having major
health problems as a result of your weight, a gastric bypass is performed.

Criteria for surgery

The patient’s age is between 18 and 65 years. In exceptional cases,
surgery may be considered in patients of 13–17 years.
Prior to surgery, the patient has participated successfully (weight loss
about 5%) in a weight management program offered by a health care
unit (group, individual or internet-based 6-month treatment) but the
result has not been sufficient in relation to the weight loss target or
has not been maintained after treatment.
It is essential that the patient has been shown to be able to make
lifestyle changes and that the results were not achieved with a very
low calorie (VLCD) diet, alone.
Criteria for surgery
BMI :
exceeding 40 kg/m2
exceeding 35 kg/m2 in a patient with a related disease or a risk factor for such a disease,
such as:
-type 2 diabetes or its preliminary stage
-sleep apnea requiring CPAP therapy
-hypertension requiring medication
-osteoarthritis of weight-bearing joints (or other severe disease of the musculoskeletal
system)
-dyslipidemia
-asthma
-polycystic ovary syndrome (PCOS)
-infertility
30–35 kg/m2 in a person with type 2 diabetes, if conservative treatment of obesity and
diabetes has not produced adequate results.
Pre-Operative Care for the Patient
1. PROVIDE DETAILED INFORMATION REGARDING THE PROCEDURE TO BE DONE.

2. RAISE AWARENESS OF THE PROCEDURE'S POTENTIAL DANGERS.

3. COLLECT OR COMPLETE MEDICAL HISTORY AND PHYSICAL EXAMINATIONS.

4. COLLECTION OF DIET HISTORY, EATING HABITS AND EATING TENDENCIES

5. ENSURE THAT ALL LABORATORY TESTS ARE DONE (FULL BLOOD COUNT, BLOOD

GROUP, CHOLESTEROL LEVELS, KIDNEY, LIVER AND THYROID FUNCTION,

DIABETES SCREENING TEST AND VITAMINS AND MINERALS BASE LEVEL).

6. SECURE INFORMED CONSENT.

Pre-Operative Care for the Patient
7. DISCUSS THE MEDICATIONS THAT THE PATIENT CAN AND SHOULD NOT TAKE.

8. TEACH PATIENT THE PROPER BREATHING EXERCISE AND USE OF AN INCENTIVE

SPIROMETER. LET HER DEMONSTRATE IT AFTERWARDS.

9.EDUCATE THE PATIENT WHAT IS TO BE EXPECTED AFTER THE SURGERY.

10. PERFORM TESTS SUCH AS BMI, COLONOSCOPY OR ENDOSCOPY JUST PRIOR TO

THE SURGERY.

11. GIVE BOWEL PREPARATION TO CLEANSE THE PATIENT’S BOWEL.

12. ENSURE THAT THE CLIENT WON’T EAT ANYTHING 8 HOURS BEFORE THE

SURGERY.
 Post-Operative Care for the patient
1. THE PATIENT WILL BE MONITORED CLOSELY IN THE RECOVERY ROOM. THE

PATIENT WILL BE TRANSFERRED TO THE HOSPITAL ROOM ONCE HIS OR HER BLOOD

PRESSURE, PULSE, AND RESPIRATION HAVE STABILIZED.

2. CONTINUOUS INTRAVENOUS ANALGESIA / PATIENT CONTROLLED ANALGESIA

(PCA) ARE THE METHOD OF PAIN MANAGEMENT USED FOR BARIATRIC SURGERY

PATIENTS.

3. THE PATIENT WILL BE PROVIDED WITH AN "INCENTIVE SPIROMETER" AFTER

SURGERY.
 Post-Operative Care for the patient
4. PATIENT IS ENCOURAGED TO MOVE AROUND AS MUCH AS HE/SHE CAN WHILE

HE/SHE IS IN BED, AND THEN TO GET OUT OF BED AND WALK AROUND AS HIS/HER

STRENGTH IMPROVES.

5. COMPRESSION STOCKING WHILE IN BED AFTER SURGERY.

6. PATIENTS MAY HAVE AN UPPER GASTROINTESTINAL FLUOROSCOPY OR X-RAY

TEST.

7. FOR DIET OF PATIENT: EVERY PATIENT WILL RECEIVE THOROUGH NUTRITION

COUNSELLING BY THE CLINICAL DIETICIAN. PATIENTS WILL NEED TO LEARN TO

TAKE SMALL BITES AND SWALLOW SLOWLY.

 Skin Prepping
Once the patient is admitted for surgery, an effective
perioperative skin preparation agent is required to
ensure optimal skin antisepsis at the time of incision.

Preadmission shower/cleansing strategy is necessary

It gives physicians and their patients an added layer of security in
knowing that the skin was prepped preoperatively using a 4%
CHG shower or 2% CHG cleansing cloth, resulting in high
antiseptic skin surface activity prior to the traditional surgical
skin prep performed within the operating room.
 Antiseptic products are frequently applied with a
hand-held applicator.
It is often challenging to use these applicators on patients
who are obese due to redundant skin folds; therefore,
patience is required when prepping the skin to
thoroughly cover all appropriate areas.

Hair removal is deemed necessary prior to the surgical

procedure
The current standard of practice dictates that the hair is
removed using surgical clippers rather than shaving the
incisional area with a razor.
Skin Preparation
 Special Instruments,
Supplies and Equipment

VIDEO MONITOR LAPAROSCOPE LIGHT SOURCE &

LIGHT CABLE
 Special Instruments,
Supplies and
Equipment

Trocars Insufflator Veress

Needle
 Special Instruments,
Supplies and Equipment

5-MM-DIAMETER HAND CLIP APPLIER

ENDOFLEX INSTRUMENTS
RETRACTOR
 Special Instruments,
Supplies and
Equipment

Endoscopic linear Circular stapler Endostitch

stapler
 Special Instruments,
Supplies and Equipment

SUCTION/IRRIGATION UNIPOLAR OR FLEXIBLE

INSTRUMENT BIPOLAR ENDOSCOPE
ELECTROCAUTERY
 Position of the patient
Supine position or supine position with the legs abducted on straight
leg boards (French position)


LAPAROSCOPIC ABDOMINAL DRAPING Proper

Draping

https://drive.google.com/drive/folders/1thhs8p4NMJ
AaqSCum1El4oQttAKDuI3G
FRENCH POSITION DRAPING Proper
Draping

 Type of
Anesthesia
GENERAL ANESTHESIA
Gastric bypass surgery requires a
stay in the hospital.
The procedure will be performed
while you’re asleep under general
anesthesia

 HTTPS://WWW.MAYOCLINIC.ORG/TESTS-PROCEDURES/GASTRIC-BYPASS-
SURGERY/ABOUT/PAC-20385189

HTTPS://STANFORDHEALTHCARE.ORG/MEDICAL-TREATMENTS/G/GASTRIC-
BYPASS-SURGERY/PROCEDURES/DURING-PROCEDURE.HTML

HTTPS://WWW.THEOSSI.COM/PERI-OPERATIVE-CARE-OBESITY-SURGERY.HTML

HTTPS://WWW.RESEARCHGATE.NET/PUBLICATION/225881323_OPERATING_ROO
M_SETUP_AND_PATIENT_POSITIONING_FOR_LAPAROSCOPIC_GASTRIC_BYPAS
S_AND_LAPAROSCOPIC_GASTRIC_BANDING

HTTPS://WWW.SAGES.ORG/IMAGE-LIBRARY/PATIENT-POSITION-AND-ROOM-
SETUP-FOR-GASTRIC-BYPASS/

REFERENCES