Prior to any weight loss operation, particularly Gastric Bypass, your physician will give you a complete medical examination and evaluate your overall health. You will also receive extensive nutritional counseling before and after your surgery. This surgery is performed under general anesthesia.
The Roux-en-Y Gastric Bypass Surgery is performed in two steps:
The first step in this surgical procedure makes the stomach smaller. The surgeon divides the stomach into a small upper section and a larger bottom section using staples that are similar to stitches. The top section of the stomach (called the pouch) will hold a patient’s food.
After the stomach has been divided, the surgeon connects a section of the small intestine to the pouch. He then reconnects the base of the Roux limb with the remaining portion of the small intestines from the bottom of the stomach, forming a y-shape. Now, when a patient eats the food will travel from the pouch through this new connection (“Roux limb”), bypassing the lower portion of the stomach. The “y-connection” allows food to mix with pancreatic fluid and bile, aiding the absorption of important vitamins and minerals.
While all malabsorptive operations carry a risk for nutritional deficiencies, the Roux-en-Y Gastric Bypass procedure carries less risk than surgeries that bypass the duodenum and the jejunum (Biliopancreatic Diversion).
The surgeon performs the Roux-en-Y Gastric Bypass using a laparoscope. This less-invasive technique allows him to make small (less than one half inch) incisions, which lowers the risk of large scars and hernias after the procedure.
To perform this laparoscopic procedure, small incisions are made in the abdomen. The doctor then passes slender surgical instruments through the narrow openings, and a camera (laparoscope) is then passed through. The surgeon utilizes a lens and video monitor as he performs the surgery.
The normal hospital stay for Gastric Bypass Surgery is one night, and patients are discharged after the surgeon examines them and they can do the following:
- Move without too much discomfort
- Eat liquid and/or pureed food without vomiting
- No longer require pain medication given by injection
Patients remain on liquid or pureed food for several weeks after the surgery, and even after that time will feel full very quickly, sometimes only being able to take a few bites of solid food. This is because the new stomach pouch initially only holds a tablespoonful of food. The pouch will eventually expand, however it will hold no more than about one cup of thoroughly chewed food (a normal stomach can hold up to one quart).
After having gastric by-pass surgery, patients should eat small meals frequently throughout the day, rather than large meals that their stomach cannot accommodate. The new, smaller stomach also will not tolerate large amounts of fat, alcohol, or sugar. Patients should reduce fat intake, especially fast food meals, deep-fried foods, and high-fat foods, as well as high-sugar foods like cakes, cookies, and candy.
Exercise and the support of others (for example a support group comprised of people who have undergone weight loss surgery) are extremely important to help patients lose weight and maintain that loss following gastric bypass. Patients can generally resume exercise 6 weeks after the operation and, even sooner, will be able to take short walks at a comfortable pace, with the approval and guidance of the doctor.
The risks of gastric bypass surgery include: bleeding, infections, follow-up surgeries to correct complications, or to remove excess skin, gallstones due to significant weight loss in a short amount of time, gastritis (inflammation of the lining of the stomach), vomiting from eating more than the stomach pouch can hold, iron or vitamin B12 deficiencies (if they occur) can lead to anemia, calcium deficiency (if it occurs) can contribute to the development of early osteoporosis or other bone disorders. Follow up surgeries are less likely because gastric bypass is performed with a laparoscope.