Gastric Bypass Surgery
BENEFITS AND RISKS OF THE PROCEDURE
What is Gastric Bypass Surgery?
Gastric Bypass Surgery via the Roux-en-Y is generally
considered to be the best surgical procedure for permanent
weight loss. Weight loss is achieved by reducing the
functional portion of the stomach during a laparoscopic
procedure reducing the stomach to a pouch one ounce or less
in size, and by creating a stoma, a small opening between
the stomach and the intestine. For information about lap
band surgery please follow this link:
Picture of gastric bypass surgery via rouex-en-y gastric
The small size of the stomach pouch causes the patient to
have a sensation of fullness after eating only a small
portion of food. The small stoma delays stomach emptying,
making the sensation of fullness last longer. These are
called the Restrictive components of the procedure.
The limb of intestine coming down from the small pouch is
called the Roux limb. The limb of intestine coming down from
the bypassed portion of the stomach can be called the
Biliary or Bypassed limb. The remaining portion of the
intestine is called the Common Channel.
Food does not pass down the Bypassed limb, only the Roux
limb and the Common Channel. The longer the Bypassed limb,
the less the length of intestine actively working to absorb
nutrients from the food that is eaten. Digestive juices that
normally help absorb nutrients from the food enter the
Bypassed limb from the larger portion of the stomach, the
liver, and the pancreas, and pass down the Bypassed limb to
the Common Channel.
These juices do not mix with the food while it is passing
down the Roux limb. The longer the Roux limb, the longer the
portion of intestine trying to absorb nutrients without the
benefit of these digestive juices. Both of these changes
result in less absorption of nutrients and contribute to
weight loss, and are called the Malabsorptive components of
Exactly how the operation is done for an individual patient
depends on their individual anatomy, their general health
status, whatever changes they may have from prior surgeries,
and what they hope to be achieve from the operation. The
stomach compartments can be completely divided from each
other or simply partitioned, the small stomach pouch and the
intestinal limbs may be connected to each other with either
staples or sutures, a small band may be placed around the
stomach pouch, and the two intestinal limbs may be made
longer or shorter.
Patients will be on a clear liquid diet for the first few
days immediately following gastric bypass surgery, and then
advance to a pureed diet. These foods will be very soft, so
as to pass through the small, newly formed pouch and stoma.
One of the main issues during this period will be adequate
fluid intake, and dehydration can be a problem for patients
recovering from this surgery. We will ask patients to take
in at least 32 ounces of liquid a day before leaving the
Gastric Bypass Surgery Center.
Approximately one month after the gastric bypass surgery the
patients can expect to advance to a transitional diet. They
begin to take more regular table foods, but will often still
go back to eating the pureed foods that they have tolerated
well. They will still be learning how to eat right,
including chewing food carefully, learning to drink most of
their liquids between rather than with meals, and learning
that eating the wrong foods, such as sweets or fatty foods,
can make them ill.
Patients experience the most rapid weight loss during this
period. They are often thrilled to see the weight coming
off, sometimes at the rate of 20 pounds a month, but it is
not an easy time. Patients feel the loss of calories taken
in, and are sometimes low in energy. Their small pouch will
make them uncomfortable when they eat too much or too fast.
They may have diarrhea, which can usually be controlled by
avoiding certain foods or by taking medication. They may
experience hair loss, though the hair usually begins to grow
back within a few months.
At 6 months after the gastric bypass surgery the patients
will probably be on their long-term maintenance diet, which
is more or less what and how they will eat for the rest of
their lives. The maintenance diet for the most part consists
of regular table foods, but in small portions. Most patients
describe their meals as child sized, and they often do not
finish what they are served. The patients generally become
comfortable eating these small meals, and almost always say
the loss of the ability to enjoy large meals or certain
foods is more than compensated for by being able to
successfully control their weight.
Patients may expect to lose approximately 70% of their
excess body weight during the first 2 years following
surgery. Sometimes a weight regain of about 10% is seen
between years 2 and 5, perhaps because the small pouch
increases several ounces in size, and perhaps because the
patients learn how to take in extra calories without making
The surgical community involved in gastric bypass surgery is
very concerned about this late 10% or any other weight
regain. There is a national effort underway to keep patients
involved in support groups and in follow-up with their
doctors to reinforce what they had been taught after
surgery, and what had worked for them the first 2 years.
Long term success with this operation requires a team effort
of both the patients and their doctors.
Gastric Bypass Surgery patients take in less food and absorb
less of what they take in, making them at risk for
developing nutritional deficiencies. They must also make a
life long commitment to taking vitamin, mineral, and
possibly protein supplements, and may become very ill if
they don't. These supplements will cost about $30.00 a month
and can be purchased almost anywhere.
What To Expect After Surgery:
When you are able to move about without too much discomfort,
to take in food by mouth, and can do without pain medication
(about 3 days), you are ready to leave the hospital. At the
time of discharge, you will be given specific instructions
indicating what you may and may not do and when to come back
to the office for follow-up. You will need to remain on a
liquid diet after discharge and you will receive additional
instructions regarding your diet from the surgeon.
Several weeks after you have left the hospital, you will be
able to eat regular food in small quantities. Always
remember that a few bites of food will make you feel full.
The following points need to be reemphasized: Listen to your
stomach, not your eyes. Stop eating when you feel full, even
if it seems that you have not eaten enough. One bite too
many may cause significant discomfort. One extra bite may
cause you to vomit. You do not need a lot of food.
Eating After Gastric Bypass Surgery:
After about six weeks, it should be relatively easy for you
to enjoy a small meal. Eat only three meals a day. Establish
regular mealtimes. Your diet should consist of solid food,
mostly meat, including poultry and fish, and vegetables, in
very small quantities. Take very small bites, chew all your
food well, and eat slowly. A meal should take at least
thirty minutes to an hour to consume. DO NOT drink liquids
30 minutes prior to a meal to 30 minutes after a meal, and
no drinking during the meal. Drinking during the meal will
cause a sensation of pressure in the chest that is
uncomfortable and can cause the food to backup.
Take the time to relax just before, during, and after
mealtime. Between meals, it is advisable to drink five or
six glasses of water, coffee, or tea without sugar or
non-carbonated diet drinks to maintain your fluid intake. Do
not drink liquids that are high in calories. Remember, if
you take in extra calories between meals, weight loss will
be slower and you will not achieve the weight you desire.
Exercise After Gastric Bypass Surgery:
Exercise is important in the recovery from any operation.
Walking is one of the most effective forms of exercise for
this purpose. A regular exercise program is highly
recommended. Begin with very short walks several times a day
and gradually increase the distance. Walking also improves
muscle tone while you are losing weight. Do not, at first,
engage in strenuous exercise. For example, do not lift more
than ten pounds at a time. About six weeks after surgery,
you should be able to tolerate all but the most strenuous
Do not sit or stand in one place for a long period of time.
Light housekeeping chores may be performed when you feel you
are able. Driving a car is usually permitted one week after
surgery. Sexual activities may be resumed unless otherwise
Most people are able to return to light work after two weeks
and to heavy labor after six weeks. The time of your return
to work will depend upon the physical demands of your job
and the rate of your recovery.
Expected Weight Loss After Gastric Bypass Surgery:
In the first year, patients lose, on the average,
approximately one hundred pounds, or two-thirds of their
excess weight. By the end of the second year, the average
patient has lost 36% of his or her total body weight. About
10% of patients fail to experience significant weight loss,
primarily because they persist in consuming high-calorie
liquids or soft foods, such as peanut butter, ice cream and
sodas, which readily slide through the little stomach pouch.
You will need to return for follow-up visits periodically
until your weight has stabilized. Blood tests may be
required to help assess your progress.
Unless you understand all of the problems that can arise
from this surgery, accept the risks, and are willing to
cooperate fully in follow-up and treatment, you should not
have this operation.
Surgery by itself will not miraculously cure obesity. Best
results are obtained when patients practice good dietary and
exercise habits. Your cooperation is essential. The surgical
procedure was the physical vehicle you needed to curb
There are many changes and adjustments to be made with
weight loss. However, the frustrations you may experience
will seem insignificant in comparison to the overwhelming
satisfaction produced by increased self-esteem and a sense
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