Gastric bypass surgery is a weight loss surgical procedure where the stomach is divided into an upper and lower pouch. After that division is made, the small intestine is rearranged so that it connects both of these pouches. This restricts the amount of food the patient can consume thus leading to weight loss. There are several different ways to reconnect the intestine leading to different types of gastric bypass surgeries.
This surgery is typically done to help treat morbid obesity (for those with a body mass index of 40 or more) or as a way to help treat a comorbidity such as high blood pressure, sleep apnea or Type II Diabetes (BMI 35 or more). As with any other surgery, complications can occur, however according to recent studies only 15% of patients experience any surgery related complications.
The surgery can even be done using small incisions or a port with a laparoscope (laparoscopy approach). This provides a shorter recovery time for patients. A skilled surgeon can complete the surgery faster too while reducing the scars and trauma done to the insides.
Types of Gastric Bypass Surgeries
The Roux-en-y proximal variation is the most commonly performed bariatric surgery in the United States. During this surgery, the small intestine is divided below the lower stomach and is rearranged into a Y that allows food to flow from the upper stomach pouch. In the proximal variation of this, the y intersection is formed at the end of the small intestine. The roux limb is constructed of parts of the small intestine, which absorbs nutrients. Patients will feel full very quickly and later have an indifference to food after the start of a meal.
During the mini gastric bypass variation, a long narrow tube in the stomach is made with a loop of the small gut. This loop is later hooked into the tube at the start of the small intestine. This surgery can also be used in order to treat ulcers, stomach injuries and stomach cancer. It is often regarded as an alternative to the Roux-en-Y procedure because of the way it is constructed. It is fast becoming one of the most popular weight loss surgery procedures because of its low risk of complications and a continued and steady weight loss from past patient.
Some risks common to all weight loss surgeries include infection in the incision, stomach leakages, blood clots in the legs (deep vein thrombosis), pulmonary embolism, gallstones, anemia or osteoporosis. Some risks associated with gastric bypass surgery include stomach pouch problems where a repeat surgery is done in order to repair the stomach. Hernia is another risk that can be related directly to the incisions that the surgeon makes or is caused by the intestines twisting around itself. Kidney stones and gallstones is another risk with Roux-en-Y surgery. Typically the gallbladder is removed during this surgery to prevent the onset of gallstones in the future.
Rapid weight loss occurs for six month to a year following the procedure. Also, there is a considerable reduction in comorbidities associated with morbid obesity. Results are produced when diet, exercise and other measures have failed for the patient. It is the most reliable operation for long-term weight loss with 60-75% of excess body weight loss average. The procedure is generally covered by insurance companies. The disadvantages of gastric bypass are that it is not reversible. Also, there is a long-term risk of protein and vitamin deficiency. The operation also is not adjustable much like gastric banding. It also is a more complex operation then other types and has a slightly higher complication rate.
The average cost of gastric bypass surgery in the United States varies from $15,000-$35,000. The price fluctuations come from the geographical region, the surgeon’s fees, the anesthesiologist fees, the medical facility’s fee, the follow-up costs and many other factors. Just because someone prices them lower then another surgeon does that mean they are less skilled. For a more cost-effective approach, research bariatric surgery in Mexico where gastric bypass surgeries can go for one-third of what is charged in the United States.
Most people stay 3-5 days in the hospital following their bariatric surgery. In the hospital you will be asked to sit on the side of the bed and walk a little the same day of surgery. You may have a catheter that goes from the nose into the stomach for a few days which helps to drain fluids. You may also have a cathether in your bladder for urine. You will not be able to eat for the first few days except for liquids. You will have to wear support stocking to help prevent blood clots. You will receive your medication through shots in order to prevent blood clots too. You will receive your pain medicine through an IV. You will be able to go home when you can eat liquid or pureed food without vomiting, you can move around without a lot of pain and you no longer need pain medicine through an IV.
You will have some belly pain and will need pain medication for at least the first week following gastric bypass surgery. The incision the surgeon made may feel sore or tender. Because the surgery is done to make the stomach smaller, you will feel full faster. Food also may empty into the small intestine too fast leading to dumping syndrome. This can cause digestive problems whether constipation or diarrhea and can make the patient feel nauseous, shaky and faint.
Follow all the instructions given to you following surgery. For the first month following gastric bypass, your stomach will only be able to handle a small amount of food at one time. It’s important to stay hydrated throughout the day. Bowel movements may not be regular following surgery; this is not uncommon.
You will need to take extra Vitamin B12, calcium, iron, magnesium and other vitamins. Depending on how long the surgery was (whether open or laparoscopic), you will have to watch your activity. If you had open gastric bypass surgery, you must avoid heavy lifting and strenuous exercise during recovery. You should be able to return to work within 4-6 weeks.
Patients will go from several stages of liquids only, soft foods and then reintroducing solid foods back into the diet. During the clear liquids stage (typically 1 to 2 days after surgery), patients can have water, diet gelatin, sugar free juice, broth and flat diet soda, 2-3 ounces at a time. If a patient has no problems with liquids, they move onto the high-protein liquids such as Ensure and Carnation Instant Breakfast. This stage lasts 1 to 2 weeks. From there a nutritionist will decide when to begin the soft/puree diet where scrambled eggs, low-fat cheese and cottage cheese and blenderized tuna, chicken or pork are enjoyed. Eight weeks or so after gastric bypass surgery, a regular diet can be enjoyed. A dietician can help devise a meal plan for patients to follow for optimal weight loss.
It’s important to eat slowly and chew all food well. Eat 3 to 6 small meals each day. Remember the new stomach can only hold about ½ cup of food at a time. Do not overeat as you will feel sick and can stretch your stomach.
On average, people who have Roux-en-Y weight loss surgery lose more than half of their excess weight. Most people lose about 10-20 pounds each month in the first year following gastric bypass surgery. The weight loss of course will decrease overtime. You should expect to lose half or more of your excess weight in the first 2 years.
Ten years following their bariatric surgery, many people gain 20-25% of their lost weight back. The long term success is highest in those who are realistic about their weight loss goals and who follow up with their medical team regularly.
Losing enough weight can help improve medical conditions such as GERD, asthma, high blood pressure, high cholesterol, Type II Diabetes and obstructive sleep apnea.
Ultimately choosing to have gastric bypass surgery or any other bariatric surgery means making a lifelong commitment to living a healthy lifestyle. Surgery is not a quick fix to obesity. Proper nutrition and regular exercise are required in order to lose weight, continue to lose weight and to maintain weight later in life. By attending all follow-up visits after surgery, going to support groups and following a strict diet, patients can reach their weight loss goals following gastric bypass surgery with ease.