In this procedure, the surgeon creates a small stomach pouch and attaches a section of the small intestine directly to the pouch. This allows food to bypass the larger remaining portion of the stomach and a section of the small intestine.
By creating a smaller stomach pouch, a gastric bypass limits the amount of food that can be eaten at one time, so you feel full sooner. By bypassing a portion of the small intestine, it also causes your body to absorb fewer calories. This procedure also alters the levels of hormones in the body which have been linked to obesity.
As you eat less food and absorb fewer calories, your body will stop storing excess calories and start using its fat supply for energy.
What is Gastric Bypass (Roux-En-Y) Surgery?
Gastric bypass is a type of weight loss surgery. It is referred to as a combination procedure (restrictive and malabsorptive). The size of the stomach is reduced so that the amount of food that can be eaten is “restricted” due to the smaller stomach. The small intestine is attached directly to this small stomach pouch so the food no longer travels through the larger remaining stomach, or a length of small intestine. This changes the way your body absorbs calories and nutrients. While malabsorptive procedures are more effective in causing excess weight to be lost than procedures that are solely restrictive, they also carry more risk for nutritional deficiencies.
This procedure is performed laparoscopically at Natividad. Laparoscopic procedures use several small incisions and three or more laparoscopes — small thin tubes with video cameras attached — to visualize the inside of the abdomen during the operation. The surgeon performs the surgery while looking at a TV monitor. Laparoscopic procedures often reduce the length of hospital stays, the amount of scarring, and results in quicker recovery than an open procedure.
Risk Versus Benefit
Surgery for weight loss is not a universal remedy, but these procedures can be highly effective in people who are motivated after surgery to follow their physician’s guidelines for nutrition and exercise and to take nutritional supplements.
Because weight loss surgery can have serious side effects, the long-term health benefits must be considered and found greater than the risk. Despite the fact that these surgeries are done laparoscopically with reduced risk, all bariatric surgery is considered to be major surgery.
Although not all risks with each procedure are fully known, bariatric surgery does help many people to reduce or eliminate some health-related obesity problems.
It may Help to:
- Lower blood sugar
- Lower blood pressure
- Reduce or eliminate sleep apnea
- Decrease the workload of the heart
- Lower cholesterol levels
As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to the following:
- Blood clots
- Bleeding ulcer
- Development of gallstones
There is a risk that additional surgery may be necessary because of complications, including gallstones.
- Stomal stenosis
- Stomal stenosis occurs when there is a stricture (tightening) of the opening between the stomach and intestine after surgery. When this occurs, vomiting after eating and sometimes after drinking may occur. Stomal stenosis can be treated easily but should be treated immediately.
- One of the most serious complications is a stomach leak that can cause peritonitis to develop. Peritonitis is an inflammation of the peritoneum, the smooth membrane that lines the cavity of the abdomen.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
With gastric bypass procedures, malabsorptive symptoms may be more serious with an increased risk of anemia and loss of fat-soluble vitamins (vitamins A, D, E, and K). Adequate amounts of iron, calcium, and vitamin B12 may not be absorbed. This can cause metabolic bone disease and osteoporosis.
Dumping syndrome is more likely to occur with these procedures because the food in the stomach moves to the intestines quickly. Symptoms include nausea, sweating, fainting, weakness, and diarrhea. Dumping syndrome is usually caused by eating or drinking foods high in fat, or sugar.
Before the Procedure
When you arrive on the day of your surgery, the patient service representative will check you in. Then, one of the outpatient surgery nurses will escort you to a room to help get you ready for your procedure. You will get undressed completely — yes, everything — and put on a hospital gown. Tell us if you are cold in the gown. We have warm blankets, and may be able to hook up a warmer to your gown. The nurse will start an IV and let the anesthesiologist know that you are ready.
The anesthesiologist interviews every patient before their surgery. Let the anesthesiologist know if you are having problems controlling your anxiety (don’t worry, this happens to a lot of people).
The surgical nurse will come and get you when they are ready to take you to the operating room. If you have a visitor present, they will be shown where to wait. Once in the operating room, the nurses will help you move over onto the operating bed and the anesthesiologist will give you medications to help you relax and fall asleep.
During the Procedure
Gastric Bypass surgery will be performed while you are asleep under general anesthesia. Your physician will discuss this with you in advance.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
At the completion of the procedure, a small plastic tube or drain may be placed in the incision site to remove any fluid that may accumulate.
Your small incisions will be closed with glue, stitches, or surgical staples.
After the Procedure
After the procedure, you will be taken to the recovery room for observation. Once your blood pressure, pulse and breathing are stable and you are alert, you will be taken to your hospital room. Lap-Band® surgery usually sometimes requires an in-hospital stay of one night, though it can safely be performed as a ‘same-day-surgery’ procedure. You will receive pain medications as needed through your intravenous line. You will be encouraged to get out of bed and walk around as soon as possible after arriving in your hospital room. This is very important as it helps to prevent blood clots from forming. At first you will receive fluids through an IV.
Like any surgery, there will be discomfort after your surgery. The nurses will give you medications to help control your pain, but we need you to be alert enough to get in and out of bed safely. Remember, we want you going to the bathroom and walking the hallway often.
As long as your nausea is under control, you will be given sips of clear liquids. Once you can take these liquids without difficulty, you and the doctor will talk about going home later today, or spending the night and going home the next morning. Once you get home, be sure to follow the post-surgery diet.
When you go home, you will be following the “10-10-10” postoperative diet for the first 30 days. Before you are released from the hospital, the registered dietitian will review this diet with you to answer any question you may have. Before you are discharged from the hospital, arrangements will be made for a follow-up visit with your physician.
It is a long road to travel for weight loss surgery. This is the beginning of a lifestyle change that will have long lasting effects on your health. Congratulate yourself on taking this step.
Once you are home, it is important that you follow the instructions your surgeon has provided. The surgical drain will be removed during a follow-up visit. There may be some aching of the abdominal muscles, and at the incision sites. Take the pain reliever for soreness as prescribed. Be sure to take only recommended medication. Aspirin or other certain pain medications may increase the chance of bleeding. You should continue the breathing exercises used in the hospital. You should gradually increase your physical activity as tolerated. It may take several weeks to return to your previous levels of stamina. You may be instructed to avoid lifting heavy items for several weeks in order to prevent strain on your abdominal muscles and surgical incisions.
Weight loss surgery can be emotionally difficult because you will be adjusting to new dietary habits and a body in the process of change. You may feel especially tired during the first month following surgery. Exercise and attending a support group may be helpful at this time.
Your physician may give you additional or alternate instruction, depending on your particular situation.
Creating Your Support System
You may find that your postoperative recovery period is smoother if you have people around you that are supportive of your decision to have weight loss surgery. Talk to your family and friends. Let them know, in advance, that you will be having weight loss surgery and that your eating habits will be changing drastically. Also, you should share that improved health is your goal with surgery.
You are not alone after surgery. Feel free to call the office with any questions. Dr. Di Stante will see you in the office the week following your surgery. A support group might be just the thing to give you a little boost. Don’t forget, our Support Group meets in the Outpatient Surgery registration area on the fourth Tuesday of each month (5:30 pm to 7:00 pm). We will also have you follow up with our registered dietitian to help you transition back to solid food.