Gastric Bypass Surgery: The Gold Standard Surgery for Losing Weight

Gastric bypass is the most effective type of weight-loss surgery to date. You can lose more than 80% of you excess body weight in the first year.

However, this surgery can’t be seen as a quick fix or a shortcut for obesity! It can only be considered when diet and exercise are not enough or if you have serious medical conditions because of your weight.

Whichever your case, if you are considering weight loss surgery, talk to your surgeon about the different techniques to decide which one is the right fit for you.

What is Gastric Bypass Surgery?

Gastric bypass surgery, also known as Roux-en-Y gastric bypass, is the gold standard of bariatric surgery.

This surgical procedure involves using surgical staples to create a small pouch at the top of the stomach. Indeed, the procedure can reduce your stomach size from 1500ml to 30ml. It will have about the size of a walnut, with a capacity of only an ounce of food.

Then, the newly created stomach pouch is directly connected to the small intestine through a join or anastomosis. Also, the main stomach is sewn far down to the middle part of the small intestine.

How Does Gastric Bypass Surgery Work?

With a gastric bypass, the food you take avoids or bypasses (hence the name) most of your stomach and the beginning of the small intestine.

Food goes straight into your middle and lower small intestine. Thus, you will feel full faster and with less food. This is known as the restrictive method.

You will not be able to eat as much as you were used to. Therefore, less food intake will translate into fewer calories! However, surgery goes well beyond downsizing your stomach capacity.

By rerouting the food’s passage and avoiding the first section of the small intestine, you will absorb fewer calories (and nutrients) from the already limited amount of food you eat. This is known as the malabsorptive method.

Also, the procedure causes hormonal changes that will make you feel satiated or less hungry. In some cases, you may even find yourself avoiding sugar.

You may feel dizzy, sweaty, and sick if you eat sugary foods. This is called ‘dumping syndrome’. It happens because your body produces too much insulin or when food is quickly washed into the small intestine.

This surgery is not ideal for all overweight patients. You must meet strict medical guidelines to qualify for weight-loss procedures.

The Consensus Panel of the National Institutes of Health (NHS) recommended bariatric procedures, including gastric bypass surgery for patients with:

– A body mass index (BMI) of 40 or higher, also known as morbid obesity.

– A BMI of 35-39.9 with one or more related comorbid conditions, such as high blood pressure, type 2 diabetes, or severe sleep apnea.

The BMI is a measure of body fat that uses your body weight (expressed in kilograms), divided by the square of your height (expressed in meters). The resulted number is expressed in units of kilograms per square meter.

Healthy adults should have a BMI between 18.5 to 24.9. A BMI above 30 is considered obese, and a BMI less than 18.5 is rendered as underweight.

What Are the Benefits of Having Gastric Bypass Surgery?

Gastric bypass can provide long-term weight loss. Also, more patients tend to achieve significant weight loss with this procedure, compared to the gastric band or gastric balloon.

You could lose nearly 70%, or even more, of your excess weight in under two years. However, the total amount of weight loss will depend largely on your lifestyle changes, including dieting and exercise.

As long as you stay healthy and committed, any weight-related conditions may disappear altogether or improve, such as type 2 diabetes, hypertension, high cholesterol, heart disease, sleep apnoea, gastroesophageal reflux, and polycystic ovaries.

Reaching your ideal weight will also improve your quality of life and make it much easier for you to do your everyday activities.  Your mental state will be better too.

Before Surgery

You must have a thorough assessment before your surgery to check your suitability for the procedure. This will include a series of lab tests, x-rays, and other exams.

You not only must be medically fit for surgery and anaesthesia. You may also need to talk to a psychologist to check your mental health. After all, there are many emotional aspects involved, and you must be able to cope with the necessary long-term lifestyle changes after the surgery.

Once you are cleared for surgery, your doctor will give you some recommendations. For example, you must stop taking blood thinners and ibuprofen-like medication days before surgery.

Also, you may be advised to follow a low-calorie-controlled diet several weeks before surgery to reduce the size of your liver. This can make surgery easier for the surgeons and safer for you.

How is the Procedure?

Gastric bypass is usually performed under general anaesthesia (you will be asleep) using keyhole or laparoscopic surgery. Keyhole surgery has the advantage of a much faster recovery time and a shortened hospital stay than traditional open surgery.

However, if your doctor thinks that keyhole surgery isn’t the right fit for you, they may suggest traditional open surgery. However, this approach involves making one single, larger cut, resulting in more complications, pain, and discomfort.

For laparoscopic gastric bypass surgery, the surgeon makes a few small incisions in your tummy to insert the instruments inside your abdomen. He will also use a flexible tube with a camera to see everything inside while performing surgery.

The first step is using surgical staples to divide the stomach and create a small pouch at its top. This will be your “new stomach”. Then, the doctor will cut your small intestine a short distance below the main stomach and connect it directly onto the new pouch.

However, the main part of the stomach will continue to produce digestive juices. So, the first section of the intestine still attached to the main stomach is later sewn or reattached farther down. This will allow the digestive juices to flow down the small intestine.

Hence, bypass surgery involves two anastomoses or join points. It is a re-construction of the gastrointestinal tract with a Y-configuration to enable drainage of both segments of the stomach. That’s why it is called Roux-en-Y gastric bypass.

Finally, the surgeon will close your incisions. Surgery usually takes a few hours. Then, you will be taken to the recovery room, where the doctors will monitor you to avoid any complications.

Gastric bypass surgery

How is the Recovery from a Gastric Bypass?

You’ll usually stay in the hospital between two and five days depending on the surgical approach (open or laparoscopic) and if you have any complications.

It’s normal to feel pain after surgery. However, the doctor will provide you with intravenous painkillers to ease any discomfort.

When it comes to nutrition, immediately after surgery, you will not be able to eat during the first 24-72 hrs. A catheter (tube) going from your nose right into your stomach may be in place for 1 or 2 days to drain fluids from your intestine.

After that time, you may have liquids but no solid food. You must give your stomach and intestines time to heal. Then, if you can keep liquids down, you’ll follow a special diet that changes slowly from liquids to pureed or soft foods. After that, you will progress to firmer foods if you can tolerate them.

You could return to your normal routine six weeks after following a strict diet plan. However, don’t be surprised if you experience changes as your body adapts to the rapid weight loss you may experience in the first few months.

Possible Complications After Having Gastric Bypass Surgery

Most patients have surgery without complications, but all surgeries carry risks.

Some complications include infections, bleeding, and deep vein thrombosis (DVT), also known as blood clots. To prevent the latter, you will receive anti-clotting medication, and you will have to wear compression stockings after the surgery.

Also, you could present an anastomotic leaking, which means that digestive contents and fluid may leak through the new join created between the stomach and the intestine. In that case, you will need a new surgery to repair it.

Other complications include internal hernias, gallstones, and strictures, where the newly created connection between the pouch and the small intestine becomes narrow.

Also, a small group of patients may develop depression and maladaptive eating. For that reason, it is so important to keep close attention to the patient’s mental health status.

How Is Life After Having a Gastric Bypass?

You may have many restrictions or limitations on what and how much you can eat or drink. So, you should follow your nutritionist’s recommendations. For example, you’ll need to increase the protein intake in your diet to prevent your body from using the protein in your muscles, weakening them.

Also, you should drink enough water or fluids (around 2 liters) spread out during the day. However, avoid drinking and eating at the same time to prevent vomiting and dumping syndrome.

Your doctor will recommend supplements after surgery, including iron, calcium, and vitamin B-12 (remember that gastric bypass causes malabsorption), to complete the minimum daily requirements of vitamins and minerals.

You’ll also have frequent medical check-ups to monitor your health in the first several months after weight-loss surgery. You may need lab tests, bloodwork, and other exams.

Additionally, after having surgery, you must also be committed to a healthier lifestyle. Craving unhealthy or sugary foods won’t go anywhere. So, you must change your mindset! Indeed, you will be included in long-term follow-up programs closely monitoring your nutrition, lifestyle choices, physical activity, and behavior.

Also, remember that you’ll need to have annual follow-up appointments for the rest of your life to ensure your bypass is working correctly.

So, signing up for a gastric bypass is a lifelong commitment that you shouldn’t take lightly!

Dr.-Eduard-Targarona Specialist in Bariatric Surgery and Obesity Surgery at the Servidigest clinic Barcelona (Spain). President of the Spanish Association of Surgeons (AEC).

Doctor Eduard Mª Targarona Soler

Specialist in Bariatric Surgery and Obesity Surgery.

Current President of the Spanish Association of Surgeons (AEC).

Other articles that may interest you – External links – Bibliography

The effects of gastric bypass surgery on drug absorption and pharmacokinetics. Brocks DR, Ben-Eltriki M, Gabr RQ, Padwal RS.Expert Opin Drug Metab Toxicol. 2012 Dec;8(12):1505-19. doi: 10.1517/17425255.2012.722757. Epub 2012 Sep 24

Gastric bypass versus sleeve, pros and cons. Andreasson K, Videhult P.Lakartidningen. 2017 Sep 27;114:ER3H.

Laparoscopic Roux-en-Y gastric bypass. Hauk L.AORN J. 2018 Mar;

Gastric bypass procedures. Fisher BL, Barber AE.Eur J Gastroenterol Hepatol. 1999 Feb

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