Gastric Bypass Surgery also known as Roux-en-Y is a bariatric surgery, or weight loss surgery performed on patients who are severely overweight or have failed to lose weight through the normal methods of diet and exercise.
Patients who choose this type of bariatric surgery must drastically change their lifestyle, learn to control portion sizes at meal times, and incorporate exercise into their daily routines.
Gastric bypass procedures are commonly performed on patients with a body mass index (BMI) greater than 40 and on patients who suffer from obesity-related health conditions.
Gastric bypass surgery, often referred to as Roux-en-Y Gastric Bypass, is among the most common form of weight loss surgery performed globally. It is also considered to be the “gold standard” of weight loss surgery.
Surgical Techniques
In the majority of cases, gastric bypass is performed laparoscopically. This means that the surgeon uses long instruments to operate through tiny incisions.
Less commonly, the surgery is performed as open surgery. This means that the surgeon accesses the stomach and small intestine through a large incision in the abdomen.
Am I a candidate for gastric bypass?
Qualifications for gastric bypass surgery in most cases include:
- You have a body mass index (BMI) > 30
- You are more than 100 pound over your ideal body weight
- You have attempted to lose weight with diet and exercise, but were not successful
- You have a body mass index > 29 and suffer from negative health conditions related to obesity such as high blood pressure or diabetes
3 types of gastric bypass surgery
There are 3 types of gastric bypass surgery. Each procedure is performed in nearly the same manner with small variations.
- Gastric bypass Roux-en-Y (proximal) is the most common procedure used today. The Y-intersection is formed near the upper (proximal) end of the small intestine. The Roux limb is constructed using about 31 to 59 inches of the small intestine. This preserves the rest of the small intestine for “absorbing nutrients”.
- Gastric bypass Roux-en-Y (distal) is where the Y-connection is formed much closer to the lower (distal) end of the small intestine. Because of the closer distance, its causes reduced absorption of calories: primarily of fats and starches, but also of various minerals and the fat-soluble vitamins.
- Mini-gastric bypass surgery creates a long narrow tube of the stomach along its right border. A loop of the small gut is brought up and hooked to this tube at about 180 cms from the start of the intestine.
How to Prepare
Once you are cleared for surgery and your procedure date is scheduled, your surgical team will give you instructions on how to prepare.17
These instructions may include:
- Stopping smoking several months prior to surgery
- Meeting with a bariatric registered dietitian weeks or months before surgery to learn about food preparation and what your post-surgical diet plan will look like
- Consuming a low-calorie diet for about two weeks prior to surgery (to reduce liver volume, which can help the surgeon during the operation)18
- Stopping certain medications for a period of time before surgery (for example, non-steroidal anti-inflammatory medications, or NSAIDs)
- Refraining from eating or drinking anything after midnight on the eve of your surgery
- Packing personal items (e.g., toothbrush) for your hospital stay
What Is Gastric Bypass Surgery?
Part One: Making a Small Pouch in the Stomach
The surgeon divides the stomach into a large portion and a much smaller one. Then, in a process sometimes called “stomach stapling,” the small part of the stomach is sewn or stapled together to make a pouch, which can hold only a cup or so of food.
With such a small stomach, people feel full quickly and eat less. This strategy is also called “restrictive,” because the new stomach size restricts how much food it can hold.
Part Two: Bypass
The surgeon disconnects the new, small stomach pouch from the majority of the stomach and first part of the small intestine (the duodenum), and then connects it to a part of the small intestine slightly farther down (the jejunum). This surgical technique is called a “Roux-en-Y.”
After a Roux-en-Y, food passes directly from the stomach into the jejunum, bypassing the duodenum. This curbs your absorption of calories and nutrients. This weight loss method is called “malabsorptive.”
Stomach stapling and Roux-en-Y are typically done during the same surgery and together are called a “Roux-en-Y gastric bypass.”
Usually, surgeons do both laparoscopically (using tools inserted through small cuts in the belly). When laparoscopy isn’t possible, surgeons may do a laparotomy (involving a large cut in the middle of the belly).
Recovery
While recovering in the hospital after gastric bypass surgery, your surgical team will monitor your vital signs carefully and help control common post-surgical symptoms like pain, nausea, and vomiting.19
On the morning of the second day after your surgery, you will begin sipping small, but frequent amounts of clear liquids. If you are tolerating clear liquids, you might be able to advance to full liquids (including protein shakes) by lunchtime.10
You will engage in some form of physical activity (usually leg exercises) with the assistance of your nurse. Soon thereafter, you will begin getting out of bed and walking around. If you are experiencing any difficulties performing these exercises (perhaps due to post-surgical weakness or obesity-related mobility problems), your nurse or surgeon may call a physical therapist to assist you.20
Upon discharge, your surgeon will give you specific instructions about recovering at home. You will likely be asked to:
- Keep the incision site(s) clean and dry.
- Avoid strenuous activities for three to six weeks after surgery.
- Avoid heavy lifting for three months after surgery.
- Gradually increase your activity every day (by six weeks, you should be walking two miles or more a day).
- Maintain a full liquid diet that can slowly be advanced (under the guidance of your dietitian) to pureed and soft foods. By about six weeks, based on your individual tolerance, you will be able to eat solid foods.21
- Take daily nutritional supplements (complex multivitamin, calcium, vitamin D, iron, vitamin C, and vitamin B12)
What is the cost of a gastric bypass procedure abroad?
You can save between 50 and 70% by having your gastric bypass surgery abroad, which could amount to several thousands, so it is definitely worth considering.
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