Obesity Surgery

, Volume 27, Issue 8, pp 2194–2206 | Cite as

Contribution of Malabsorption to Weight Loss After Roux-en-Y Gastric Bypass: a Systematic Review

  • Kamal K. MahawarEmail author
  • Alistair J. Sharples
Review Article


Roux-en-Y gastric bypass (RYGB) is traditionally classified as a combined restrictive and malabsorptive operation. This notion of the operation influences its technical variations and revisions for patients who do not achieve significant weight loss after this surgery. There is an increasing body of literature suggesting a role for appetite suppression mediated by neuro-hormonal signals after RYGB. The purpose of this paper was to systematically review published English language scientific literature to determine the role of malabsorption towards weight loss achieved with RYGB. This review finds that there is little or no malabsorption of carbohydrates or protein after RYGB but there is some fat malabsorption. Overall, malabsorption makes a little (approximately 11.0% in the early period) overall contribution to weight loss after RYGB.


Gastric bypass Roux-en-Y-gastric bypass Malabsorption Malabsorptive Absorption Carbohydrate Protein Fat 


Author Contribution

KM conceived the idea for the topic, performed the review, and wrote most of the manuscript. AS critically reviewed the manuscript. Both authors participated in discussions on the topic and contributed to manuscript writing. Both authors have seen the final version and approved of it.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

Not applicable.

Statement of Informed Consent

Not applicable.

Source(s) of Funding



  1. 1.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017; doi: 10.1007/s11695-017-2666-x.
  2. 2.
    Welbourn R, Small P, Finlay I, Sarela A, Somers S, Mahawar K. Second National Bariatric Surgery Report. Last Accessed on 22nd March ’ 2017
  3. 3.
    Seeley RJ, Chambers AP, Sandoval DA. The role of gut adaptation in the potent effects of multiple bariatric surgeries on obesity and diabetes. Cell Metab. 2015;21(3):369–78.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    O’Brien PE. Bariatric surgery: mechanisms, indications and outcomes. J Gastroenterol Hepatol. 2010;25(8):1358–65.CrossRefPubMedGoogle Scholar
  5. 5.
    Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575–84.CrossRefPubMedGoogle Scholar
  6. 6.
    Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(3):660–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Pihlajamäki J, Grönlund S, Simonen M, et al. Cholesterol absorption decreases after Roux-en-Y gastric bypass but not after gastric banding. Metabolism. 2010;59(6):866–72.CrossRefPubMedGoogle Scholar
  8. 8.
    Carswell KA, Vincent RP, Belgaumkar AP, et al. The effect of bariatric surgery on intestinal absorption and transit time. Obes Surg. 2014;24(5):796–805.CrossRefPubMedGoogle Scholar
  9. 9.
    Odstrcil EA, Martinez JG, Santa Ana CA, et al. The contribution of malabsorption to the reduction in net energy absorption after long- limb Roux-en-Y gastric bypass. Am J Clin Nutr. 2010;92:704–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Moreland AM, Santa Ana CA, Asplin JR, et al. Steatorrhea and hyperoxaluria in severely obese patients before and after Roux-en-Y gastric bypass. Gastroenterology. 2017;152(5):1055–1067.e3.CrossRefPubMedGoogle Scholar
  11. 11.
    Griffo E, Nosso G, Lupoli R, et al. Early improvement of postprandial lipemia after bariatric surgery in obese type 2 diabetic patients. Obes Surg. 2014;24(5):765–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Borbély Y, Plebani A, Kröll D, et al. Exocrine pancreatic insufficiency after Roux-en-Y gastric bypass. Surg Obes Relat dis. 2016;12(4):790–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Kumar R, Lieske JC, Collazo-Clavell ML, et al. Fat malabsorption and increased intestinal oxalate absorption are common after Roux- en-Y gastric bypass surgery. Surgery. 2011;149(5):654–61.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Forbes R, Gasevic D, Watson EM, et al. Essential fatty acid plasma profiles following gastric bypass and adjusted gastric banding bariatric surgeries. Obes Surg. 2016;26(6):1237–46.CrossRefPubMedGoogle Scholar
  15. 15.
    Bojsen-Møller KN, Jacobsen SH, Dirksen C, et al. Accelerated protein digestion and amino acid absorption after Roux-en-Y gastric bypass. Am J Clin Nutr. 2015;102(3):600–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Khoo CM, Muehlbauer MJ, Stevens RD, et al. Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction. Ann Surg. 2014;259(4):687–93.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Laferrère B, Reilly D, Arias S, et al. Differential metabolic impact of gastric bypass surgery versus dietary intervention in obese diabetic subjects despite identical weight loss. Sci Transl Med. 2011;3(80):80re2.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Andalib I, Shah H, Bal BS, et al. Breath hydrogen as a biomarker for glucose malabsorption after Roux-en-Y gastric bypass surgery. Dis Markers. 2015;2015:102760.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Nguyen NQ, Debreceni TL, Bambrick JE, et al. Rapid gastric and intestinal transit is a major determinant of changes in blood glucose, intestinal hormones, glucose absorption and postprandial symptoms after gastric bypass. Obesity (Silver Spring). 2014;22(9):2003–9.CrossRefGoogle Scholar
  20. 20.
    Nguyen NQ, Debreceni TL, Bambrick JE, et al. Upregulation of intestinal glucose transporters after Roux-en-Y gastric bypass to prevent carbohydrate malabsorption. Obesity (Silver Spring). 2014;22(10):2164–71.CrossRefGoogle Scholar
  21. 21.
    Anderwald CH, Tura A, Promintzer-Schifferl M, et al. Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric Roux-en-Y gastric bypass surgery. Diabetes Care. 2012;35(12):2580–7.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Jacobsen SH, Bojsen-Møller KN, Dirksen C, et al. Effects of gastric bypass surgery on glucose absorption and metabolism during a mixed meal in glucose-tolerant individuals. Diabetologia. 2013;56(10):2250–4.CrossRefPubMedGoogle Scholar
  23. 23.
    Camastra S, Muscelli E, Gastaldelli A, et al. Long-term effects of bariatric surgery on meal disposal and β-cell function in diabetic and nondiabetic patients. Diabetes. 2013;62(11):3709–17.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Falkén Y, Hellström PM, Holst JJ, et al. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab. 2011;96(7):2227–35.CrossRefPubMedGoogle Scholar
  25. 25.
    Rodieux F, Giusti V, D’Alessio DA, et al. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity (Silver Spring). 2008;16(2):298–305.CrossRefGoogle Scholar
  26. 26.
    Wang G, Agenor K, Pizot J, et al. Accelerated gastric emptying but no carbohydrate malabsorption 1 year after gastric bypass surgery (GBP). Obes Surg. 2012;22(8):1263–7.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Wilms B, Ernst B, Schmid SM, et al. Enhanced thermic effect of food after Roux-en-Y gastric bypass surgery. J Clin Endocrinol Metab. 2013;98(9):3776–84.CrossRefPubMedGoogle Scholar
  28. 28.
    Savassi-Rocha AL, Diniz MT, Vilela EG, et al. Changes in intestinal permeability after Roux-en-Y gastric bypass. Obes Surg. 2014;24(2):184–90.CrossRefPubMedGoogle Scholar
  29. 29.
    Caruana JA, Monte SV, Jacobs DM, et al. Distal small bowel bypass for weight regain after gastric bypass: safety and efficacy threshold occurs at <70% bypass. Surg Obes Relat dis. 2015;11(6):1248–55.CrossRefPubMedGoogle Scholar
  30. 30.
    Manning S, Pucci A, Batterham RL. Roux-en-Y gastric bypass: effects on feeding behavior and underlying mechanisms. J Clin Invest. 2015;125(3):939–48.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bradley 3rd EL, Isaacs JT, Mazo JD, et al. Pathophysiology and significance of malabsorption after Roux-en-Y reconstruction. Surgery. 1977;81(6):684–91.PubMedGoogle Scholar
  32. 32.
    Cosnes J, Lamy P, Beaugerie L, et al. Adaptive hyperphagia in patients with postsurgical malabsorption. Gastroenterology. 1990;99(6):1814–9.CrossRefPubMedGoogle Scholar
  33. 33.
    le Roux CW, Bueter M. The physiology of altered eating behaviour after Roux-en-Y gastric bypass. Exp Physiol. 2014;99:1128–32.CrossRefPubMedGoogle Scholar
  34. 34.
    Flancbaum L, Choban PS, Bradley LR, et al. Changes in measured resting energy expenditure after Roux-en-Y gastric bypass for clinically severe obesity. Surgery. 1997;122(5):943–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Borg CM, le Roux CW, Ghatei MA, et al. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93(2):210–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Savassi-Rocha AL, Diniz MT, Savassi-Rocha PR, et al. Influence of jejunoileal and common limb length on weight loss following Roux-en- Y gastric bypass. Obes Surg. 2008;18(11):1364–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Bariatric UnitSunderland Royal HospitalSunderlandUK
  2. 2.Department of Upper GI and Bariatric SurgeryUniversity Hospital of North MidlandsStoke-on-TrentUK

Personalised recommendations