**2. Laparoscopic Roux-en-Y gastric bypass (LRYGB)**

LRYGB is the most commonly used restrictive method. It is reported to be the gold standard in the surgical treatment of morbid obesity as it provides long-term weight loss and has acceptable morbidity and mortality [5]. The gastric bypass method in bariatric surgery was first suggested by Edward E. Mason [6]. While 90% of the stomach volume is reduced, malabsorption is ensured by bypassing the duodenum in this method. The main aim is to create a proximal small-volume (<20 ml) gastric pouch that is completely detached from the stomach (**Figure 1**). The Roux limb can be pulled up from the front of the colon and stomach, from the front of the colon and the back of the stomach, or from the back of the colon and stomach for gastrojejunostomy. Transoral circular stapling, linear stapling, manual suturing, or transgastric circular stapling can be used for gastrojejunostomy. The biliopancreatic limb is prepared at a length of 50 cm and the Roux limb at a length of 100–150 cm distal to the Treitz ligament. Once the stomach is cut perpendicularly to the small curvature and 3–5 cm distal to the esophagogastric junction with a linear stapler (60 mm long and 3.8 mm thick), the pouch is formed by completing the cutting action toward the angle of His. Postoperative fluid support and ensuring adequate urine output are very important. The results and any nutritional deficiency should be checked at the postoperative third week, the third and sixth months, and the first year [7]. These patients lose 60–80% of their extra weight within 1 year after the surgery. Consequently, a significant improvement is seen in

**Figure 1.** *Roux-en-Y gastric bypass.*

the comorbid diseases. Mortality is <1% and morbidity is 15%. Complications such as postoperative leakage (1–2%), stenosis (1–19%), small bowel obstruction-internal hernia (7%), and marginal ulcer (3–15%) can be seen. Urgent surgical intervention is required when intestinal obstruction is suspected as it may cause long segment necrosis. Roux-en-Y gastric bypass is more effective than a laparoscopic adjustable gastric band especially in the treatment of type 2 DM and gastroesophageal reflux disease (GERD) symptoms.
