Gastric Bypass Surgery
Written by: Dr Kristie McNealy
Gastric bypass is a type of weight loss surgery which involves stapling the stomach to create a small pouch, and then attaching that pouch to a segment of the small intestine at a location which bypasses a part of the intestine called the duodenum. There are two main types of gastric bypass surgery: biliopancreatic diversion bypass and Roux-en-Y gastric bypass. Biliopancreatic diversion bypass is more complicated than Roux-en-Y bypass, and has a higher risk or nutritional deficiencies, so it isn't performed frequently.
What to Expect As a Gastric Bypass Patient
Before Gastric Bypass Surgery
Preparing for gastric bypass surgery can be a lengthy process. An initial consultation will assess your weight and health, and previous weight loss attempts to see if you are a candidate for weight loss surgery. Usually, psychological and nutritional counseling will then be required to determine whether you are mentally prepared to make the permanent lifestyle changes to make your surgery a success, and to jump start your weight loss.
If your surgeon decides that you are a good candidate for weight loss surgery, they may require you to lose some weight prior to your surgery. The amount will depend on your current weight and health status, but a pre-surgery weight loss of 5-10% of your excess weight is often required to reduce the risks of surgery, and assure your commitment to the lifestyle changes that will be required after surgery.
If you smoke, you'll be advised to quit before surgery to help improve your recovery and reduce the risk of complications. You may also be asked to stop taking certain medications that could cause problems like excess bleeding.
The Gastric Bypass Procedure
The day of your surgery, a doctor or nurse will check your blood pressure and examine you to make sure you are health enough for surgery. You may need blood or urine tests as well. Once you are ready for surgery, you will be taken to the operating theater, and the anesthesiologist will give you medicine to put you to sleep.
Roux-en-Y gastric bypass takes between 1 and 4 hours. It can be performed through a single large incision, or laparoscopically through several small incisions. The type of surgery will depend on your weight and health, and the training of your surgeon. Once an incision has been made, the surgeon will create a pouch by stapling part of the stomach. Then they will connect that pouch to a portion of the small intestine. Incisions will be closed with stitches or staples. And then you will be awakened and taken to recovery.
After Gastric Bypass Surgery
After surgery your belly will be swollen and sore, and you will be given medication to control any pain. You'll need to stay in the hospital after your surgery. Typical hospitalizations after gastric bypass last from 1 to 7 days, but can be longer depending on your overall health. It will take several weeks before you'll be able to return to normal activity.
After gastric bypass surgery, you'll start out on a clear liquid diet. From there, you'll progress to semi-liquids and then to semi-solids after a couple of weeks. It will usually take 8 to 10 weeks to progress to eating solid foods. At that point, you'll be on a low fat, solid food diet. You will be given nutritional counseling, and placed on a regimen of dietary supplements and exercise.
You'll need to make regular visits to your doctor to monitor your weight loss, health conditions and have blood tests. Your doctor and nutritionist will use the information from these appointments to make changes to your diet and supplements so that you will lose weight and avoid nutritional deficiencies.
You will lose the most weight during the first 6 months after gastric bypass surgery, and will usually continue to lose weight for 2 years. You can expect to lose about 60-70% of your excess weight, but you may lose more depending on your level of activity and your diet. While most gastric bypass patients maintain about 50% weight loss long term, if your stomach pouch becomes stretched, or your staples come out, you can gain back weight. Usually this happens if you don't follow your post operative diet plan carefully.
After massive weight loss, you can expect to have excess skin left on your body. Body contouring plastic surgery can help remove and tighten sagging skin when your weight loss is complete.
Risks of Gastric Bypass
Aside from common surgical risks like bleeding and infection, the risks of gastric bypass surgery include:
- blood clots in the legs or lungs
- leaking at the site where the pouch is connected to the intestines
- hernias
- a narrowing of the connection of the stomach to the intestine, aka stomal stenosis
- ulcers
- gallstones
- dumping syndrome
- nausea, vomiting, gas, diarrhea
- nutritional deficiencies including B12, calcium and iron
- failure to lose as much weight as expected
Patients who weigh more or are in poorer overall health are at the highest risk for complications. About 1 in 200 patients die from complications during or immediately after gastric bypass surgery. Certain complications, like leaking and hernias can require additional surgeries.
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