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Weight & Wellness Program
Laparoscopic Roux-en-Y Gastric Bypass

 

  The Procedure 

Advantages of Gastric Bypass

Serious Risks Immediately After Surgery

Long-Term Risks After Surgery

Gastric Bypass Handbook 


Weight & Wellness Program Home 

Surgical Services Home 

 


Patient Handbook for Gastric Bypass

Gastric Bypass Handbook (PDF)


Weight & Wellness Program
12 Andover Road
Portland, ME 04102
Map Directions

Phone: 207-761-5612
Toll Free: 1-866-268-9274
Fax: 207-253-6073

The Procedure

Gastric bypass surgery works in two ways; it is both restrictive and malabsorptive. Restrictive, because the stomach is divided into two parts, one larger and one small, decreasing the amount of food a person can eat. Most people will feel satisfied after eating a very small amount of food. The procedure is also considered malabsorptive because part of the small intestine is bypassed, causing some calories and nutrients not to be absorbed. With the smaller pouch and bypassed stomach/intestine, people eat less and absorb less of what they eat, resulting in weight loss.

The gastric bypass operation begins by separating a small, golf ball sized portion of the upper stomach from the main chamber of the stomach. This small portion of the stomach becomes what we call the “pouch”. This is the restrictive portion of the operation. The rest of the stomach is called the remnant stomach. The remnant stomach remains in place and continues to produce digestive juices.

The malabsorptive part of the operation involves connecting the small intestine to the new small pouch. This allows food to go around (bypass) the remnant stomach and part of the intestine. The stomach and intestine that have been bypassed are reconnected to another part of the small intestine so that digestive juices can rejoin the food stream. This is your second hook up, or anastomosis, and it gives the reconfigured bowel a “Y” appearance. This is why the procedure is called a Roux-en-Y gastric bypass.

The laparoscopic gastric bypass surgery will take approximately 2-3 hours in the operating room. Patients can plan on staying in the hospital for about 1 day after surgery. Most patients return to work or usual daily activities in 2-3 weeks.

Gastric Bypass Illustration

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Advantages of Gastric Bypass

The advantages of laparoscopic gastric bypass surgery are significant. Many patients experience an improvement in medical conditions, a decrease in prescription medications and an increase in quality of life. On average a patients will lose 60-80% of his or her excess body weight (amount over their ideal body weight) within the first 18-24 months. The majority of the weight loss occurs within the first six months. After five years, some weight gain is normal. On average, patients regain 10-15% of the weight they lost. Maintaining long term weight loss depends on a patient’s commitment to a healthy lifestyle and diet changes.

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Risks of Gastric Bypass Surgery

There are risks involved with having any surgery. The risks associated with having gastric bypass surgery can be divided into immediate risks and long term risks.

Serious Risks Immediately After Surgery

Anastomotic Leak [0.5-1%] – Immediately after surgery the stomach and intestine are connected to each other only by tiny staples and stitches. They heal together rapidly, but initially there is a chance that food and saliva will leak into the abdominal cavity, potentially causing a serious infection. This problem usually requires immediate medical attention.

Pulmonary Embolism – This occurs when blood clots form in the large veins of the legs and pelvis, break loose and travel to the heart and lungs. We administer a gentle blood thinner while in the hospital, but the best way to prevent a pulmonary embolism is to get up and walk.

Death – Rarely, death may occur due to a complication of the operation, usually a leak or pulmonary embolism. Those patients who have serious complications from their obesity (such as severe heart or pulmonary disease or poorly controlled diabetes) may have greater difficulty recovering from any operative complications.

Bleeding – Patients occasionally receive a blood transfusion after surgery. This is usually for postoperative bleeding that stops on its own, but reoperation can be necessary to stop more serious bleeding.

Atelectasis/Pneumonia – It can be uncomfortable to take deep breaths and cough immediately after surgery. When patients fail to do so, portions of their lungs tend to collapse (atelectasis). This can cause fevers, a fast heart rate and can lead to pneumonia. The best way to avoid this complication is to breathe deeply, cough, and walk.

Infection – Infection can occur after surgery. Patients should report any fevers to the program nurse. Incision site infections occur occasionally. Keeping the sites clean will allow them to heal without infection.

Nausea - Some patients feel nauseated for weeks or even a few months after surgery. Medication is available for this problem but it cannot always correct the nausea. Fortunately the nausea usually resolves on its own. Regardless of nausea, you must drink 64 ounces of fluid a day.

Vomiting – Vomiting is expected during the first few months after surgery. It is often difficult to explain or to prevent. It can happen when overeating or eating too fast. It is important that you do not force yourself to vomit.

Adhesions/Small Bowel Obstruction – Adhesions are scar tissue inside the abdomen. Small bowel obstruction means there is a blockage in the intestines. Vomiting is a common symptom associated with small bowel obstruction.

Pain – Gastric Bypass is a major abdominal surgery. You will be given a prescription for narcotics. Pain is normal at incision sites and sometimes in the shoulder area. If pain is not relieved by pain medication or gets worse, you should call the Weight & Wellness Program immediately.

Anastomotic Stricture – In the first 1-2 months patients may develop a narrowing (stricture) where the intestine connects to the gastric pouch. This narrowing causes vomiting that will gradually get worse over a few days or week. A stricture can usually be easily fixed. The surgeon will give you a sedative and then will stretch out the stricture using an endoscope.

Re-operation – Our surgeons do not hesitate to re-operate on patients who are not progressing well the first few days after surgery. Complications that are detected early, before a patient gets critically ill, can more often be easily managed without a major setback.

Long Term Risks After Surgery

Dumping Syndrome - Many people who have had gastric bypass experience "dumping syndrome" after eating sweet, sugary, or fatty foods. Symptoms of dumping syndrome include gas, cramping, diarrhea, and sweating. Usually sugars are digested slowly in the stomach and are passed into the small intestine. Because your stomach is bypassed the sugars are instead being flushed rapidly into the small intestine, causing the symptoms of dumping syndrome. Although dumping syndrome is unpleasant, it is not dangerous and usually goes away in about one hour.

Gallstones - During any period of rapid weight loss, some people may form stones in their gallbladder. Gallstones usually present with pain on the right side of the abdomen that radiates through to the back. If a patient already had gallstones before surgery, the surgeon may remove the gallbladder at the time of surgery. This decision is made on an individual basis and will be discussed with the surgeon before the operation.

Internal Hernia – An internal hernia occurs when the intestine slips underneath or spins around another part of the small intestine. It occasionally happens after substantial weight loss. An internal hernia usually causes cramping or severe mid-abdominal pain that comes without warning. The pain can last for hours, and then disappear. It can be extremely serious and usual tests may not locate it. Laparoscopic surgery is sometimes necessary to diagnose an internal hernia.

Calcium Deficiency – Calcium is not absorbed well after gastric bypass surgery and it will be necessary to take three daily calcium supplement.

Vitamin B12 Deficiency – This vitamin is poorly absorbed after gastric bypass surgery, therefore it will be necessary to take a daily pill, a weekly nasal spray or a monthly injection to prevent deficiency.

Iron Deficiency – This problem is more common in menstruating women, but can occur in any patient. If a patient is iron deficient, a daily supplement may be indicated. Any patient who has gastric bypass should have their iron levels monitored through regular laboratory testing.

Other Vitamin Deficiencies – Vitamin deficiencies can cause serious and permanent nerve damage. It is essential to take a daily multivitamin.

Dissatisfaction With The Operation – Not everybody achieves his or her desired weight loss results. Others lose weight but don't like the diet restrictions. A gastric bypass revision operation can be a high risk operation. For that reason, our surgeons will not reverse a gastric bypass unless it is absolutely necessary for health reasons.

Ulcers – Gastric Bypass patients are at a higher risk for ulcers for the rest of their lives. Ulcers usually occur where the stomach and intestines have been reconnected after surgery. Symptoms of an ulcer include pain with eating, Nausea, vomiting, and regurgitation of stomach acid. The most common causes of ulcers after Gastric Bypass surgery are the use of NSAIDS (Non-steroidal anti-inflammatory medications), smoking, steroid medications, excessive alcohol intake, and stress. Certain medications and possibly an endoscopy will help to heal an ulcer.

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