What Is Gastric Bypass Surgery?
It's estimated that about 380,000 around the world and nearly 220000 in the U.S. had weight loss surgery in 2008.
"Roux-en-Y" gastric bypass surgery -- where most of the stomach is bypassed and a small stomach pouch is made -- is the most commonly performed weight loss surgery today, accounting for about 80% of all weight loss surgery in the U.S.
What Is 'Roux-en-Y' Gastric Bypass Surgery?
As performed today, gastric bypass surgery has two parts:
Creation of a small stomach pouch During this part of the surgery, the stomach is divided into a large portion, and a much smaller portion. The small part of the stomach is then sewn or stapled together to make a small pouch (this part is sometimes called “stomach stapling"). The small stomach pouch can only hold a cup or so of food causing restriction of food intake.
With such a small stomach, people feel full quickly and eat less. This strategy is also called "restrictive," since the new stomach size restricts food intake.
"Roux-en-Y" creation (bypass)
In this part of the surgery, the new, small stomach pouch is disconnected from the first part of the small intestine (the duodenum). The surgeon then reconnects the stomach to a portion of intestine slightly further down (the jejunum). This surgical technique is called a "roux-en-Y."
After a roux-en-Y, food passes directly from the stomach into the jejunum, bypassing the duodenum. This leads to reduced absorption of calories and nutrients. This weight loss method is called "malabsorptive."
Stomach stapling and gastric bypass are typically performed during the same surgery. Together, this surgery is called a "roux-en-Y gastric bypass." The roux-en-Y procedure accounts for about 80% of all U.S. weight loss surgery procedures.
Advantages of Laparoscopic Gastric Bypass RNY
More predictable weight loss and usually maintained.
On an average one year after gastric bypass surgery, weight loss can be up to 65% to 70% of excess body weight which can easily be maintained up to 50-60% of excess body weight loss.
Nearly 95% of the fat related health conditions like back pain, sleep apnea, high blood pressure, diabetes and depression improve or get resolved. It also helps in leg swelling, high cholesterol, urinary incontinence etc.
Risks of Laparoscopic Gastric Bypass RNY
General risks associated with Gastric Bypass are poor absorption of iron and calcium resulting in to lowering of total body iron and predisposition to iron deficiency anemia leading to weak bones. Most of the vitamins deficiencies which occur due to Gastric Bypass Surgery can be managed through proper diet and vitamin supplements.
Nearly 10% of people have complications after gastric bypass surgery. These are usually minor and include:
Wound infections
Digestive problems
Ulcers
Bleeding
FREQUENTLY ASKED QUESTIONS FOR GASTRIC BYPASS SURGERY
What are the main differences between the Adjustable Gastric Band and the gastric bypass?
Factors to be Considered
Lap-Band
Gastric Bypass
Nature of Surgery
Simple
Moderate
Is this reversible surgery
Yes (in general)
Reversible but moderately
difficult
Laparoscopic
Yes
Yes
Risk Factor
Lower
Moderate
Expected hospital stay
2-3 nights
3-4 nights
Mortality Rate
0.1%
0.4%
Expected Average
Weight Loss ( in 02 years)
50-60% of Excess weight
70 -75% of Excess weight
Possible Late-Term Risks
Band slippage, port
complications, erosions,
Lap-Band infection,
esophageal dilatation
Ulcers, anemia, vitamin/ calcium /
iron deficiencies,
intestinal obstruction
Risk of Malnutrition
Minimal
Low
How long will I stay in the hospital?
Hospital stay is generally 03 days for a laparoscopic gastric bypass, and 05 days for an open gastric bypass.
What can I eat after gastric bypass surgery?
You will be on intravenous fluids on the day of surgery. The day after we may do a swallow study to be sure there is no leak in the staple line. If there is no leak, you will be started on liquid diet 24 to 48 hours after surgery. Intake is limited to 1 or 2 ounces per meal so that the stomach can heal properly. If this is well tolerated, next day you will be advanced to bland soup. You will be discharged on liquid diet. We begin patients with liquid diets, moving next to semi-solid foods and about 4 to 6 weeks later, back to solid foods. This transition is necessary to allow time for your newly created stomach pouch to heal properly. Drink 2 liters or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
What if I am really hungry?
There may also be a psychological problem with lack of food in your life "head hunger" which is usually caused due to the types of food you may be consuming, especially starches (rice, pasta and potatoes) which would go away within few days.
Will I need supplemental vitamins?
Most surgeons recommend a daily multivitamin for the rest of your life. Vitamin B12 injections are sometimes suggested once a month for the first year and every six months thereafter. It may also be taken orally or sublingually (under the tongue) by many patients.
What happens to the lower part of the stomach that is bypassed?
The stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food. It still produces the secretion necessary to absorb Vitamin B12 and contributes to endocrine hormonal balance and motility of the intestines in ways that are not entirely understood.
Is sexual activity restricted?
Patients can return to normal sexual intimacy when wound healing and discomfort permit.
I am thinking about getting pregnant. Will I be able to have children after weight loss surgery?
Many women have had successful pregnancies after weight loss surgery. There is nothing per se that would prevent pregnancy. In fact, Bariatric surgery enhances fertility in those who have had difficulty in conceiving. We recommend, however, that you wait until your weight loss is complete before becoming pregnant. This may take a year or more. The effect of rapid and prolonged weight loss on the developing fetus is unknown but it could have dire consequences and pregnancy is not recommended until a stable weight has been attained.
What can I do to prevent excess hanging skin?
The amount of excess skin depends on the age, skin elasticity, and total weight loss and how much the skin was stretched. Many people, heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back". Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight.
Will exercise help with excess hanging skin?
Exercise is good in so many other ways that a regular exercise program is recommended. Unfortunately, most patients may still be left with flaps of loose skin.
What will my long term diet be like?
Eat three small meals a day.
Keep a record of your dietary intake. Include everything you eat and drink: the date, time and amount of each meal. Start keeping this record (food diary) from one week after the surgery so if you begin having problems with vomiting, diarrhea or malabsorption which can be reviewed by your doctor to make nacessary recommendations.
Not only is there an adjustment to make about the quantity but also quality of food you should eat. When you are able to eat solid foods again, eat food high in protein. Protein foods are very important for the healing of staple line of your pouch. Protein in the form of lean meats (chicken, turkey, and fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods. Hair loss is one effect of not eating
You will also have to learn to eat slowly and chew your food thoroughly. Food not chewed properly will not pass through the narrow stoma and may cause vomiting.
Stop eating as soon as you feel full. If you do not stop, you may have vomiting and it will put strain on the staple line.
Do not eat sweets! This includes sweetened chewing gum, candy and regular sodas. Beware of hidden sweets (cereals with honey or sugar coatings).
You may be unable to tolerate certain foods, especially those containing fat and sugar. A balanced diet of 1000 – 1200 calories a day is recommended.
Drink 2 liters or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
Never drink water or any fluid with the meal. Drink fluids thirty minute to an hour after meals. Taking fluids before or at meal time may cause bloating, low food intake, vomiting, or dumping syndrome. It will also flush the food through the stoma and you will feel hungry again.
Do not drink flavored beverages, even diet soda, between meals
Will I be allowed to drink alcohol?
You will find that even small amounts of alcohol will affect you quickly. Alcohol is high in calories and will significantly alter your calorie balance. It is suggested that you drink no alcohol for the first year. Thereafter, you may have a glass of wine or a small cocktail for social purpose not more than once a fortnight.
Will I have to stop smoking?
Patients are encouraged to stop smoking at least one month before gastric bypass surgery. Smoking increases the risk of lung problems and can reduce the rate of healing. It increases the rate of incisional hernia and leaks by interfering with the blood supply of healing tissues.
How soon can I drive?
For your own safety, you should not drive until you are no longer taking narcotic medication for pain and respond quickly to traffic. Usually this takes 7-14 days after surgery.