FAQs - Gastric Bypass

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

The most common gastric bypass surgery is a Roux-en-Y gastric bypass. In normal digestion, food passes through the stomach and enters the small intestine , where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.

In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).

This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach

You qualify if:

• You weigh twice your ideal body weight or You are overweight by 100 lbs or more
• You have a BMI (body mass index) more than 40 or
• You have a BMI more than 35 with co-morbidities (illnesses related to being overweight).
• You are overweight for 5 years or more
• You have failed to lose weight or sustain weight loss under supervision
• You are willing to comply with lifestyle and diet changes .

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.

As long as it takes to be self-sufficient. Although it can vary, hospital stay (excluding the day of surgery) can be 3 to 4 days for a laparoscopic gastric bypass, and 5-7 days for an open gastric bypass. After leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.

For your own safety, you should not drive until you are no longer taking narcotic medication for pain and can respond quickly to traffic. Usually this takes 7-14 days after 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 blanderised 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.

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.

This is usually caused by the types of food you may be consuming, especially starches (rice, pasta and potatoes). Increasing protein intake is helpful. There may also be a psychological problem with lack of food in your life "head hunger". Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.

Patients can return to normal sexual intimacy when wound healing and discomfort permit.

Many women have had successful pregnancies after weight loss surgery. There is nothing per se that would prevent pregnancy. Infact, 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.

The amount of excess skin depends on the age, skin elasticity, 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.

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.

• 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. we can review your food record and make 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, 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 enough protein.
• 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

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.

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.