R-Y gastric bypass and its modifications

© Annals of Laparoscopic and Endoscopic Surgery. All rights reserved. Ann Laparosc Endosc Surg 2020 | http://dx.doi.org/10.21037/ales-2019-bms-11 It is now clear that sleeve gastrectomy (SG) in a vertical manner is the most preferred weight loss surgical procedure in general, but we can objectively declare that Rouxen-Y gastric bypass (RYGB) is yet one of the most opted procedures in the globe. The announced outcomes of the RYGB studies have a longer history than the relatively contemporary developed methods such as mini-gastric bypass, SG or gastric plication, and the cumulative information on RYGB is more and more than the new techniques (1). Although these recently developed surgical methods have become more popular among the weight loss surgery options, RYGB's former peers such as gastric bands and biliopancreatic diversion lost their supporters over time due to their less efficacy or higher morbidities (1). Some less comprehensive surgical procedures increase the risk of ineffective weight loss and/or failure to cure obesity-related comorbidities and on the other hand, some more complex but more effective procedures cause severe postoperative morbidity that can be hardly treated. RYGB now keep its popularity in most obesity surgery centers and we believe that its popularity is originated from the good balance between its effectiveness and morbidity (1). As with all bariatric procedures, weight regain can be seen after RYGB. For this reason, besides proximal RYGB, which is accepted as a classic, some modified applications are used in primary or revisional surgery. The objective of this article is making a review that reminds the modified RYGB techniques. Although there are many studies on RYGB modifications in literature, it is seen that there are four types of RYGB operations, proximal, distal, long pouch and banded.