Laproscopic Gastric Bypass Surgery

Gastric pouch 30 ml. Part of small intestine is bypassed. Greater weight loss. Hospital stay 5-7 days Vitamin mineral supplementation required.

In this procedure a small stomach pouch is created by stapling the stomach. This causes restriction of the food intake.

Next a “Y” shaped section of the small intestine is attached to the pouch to allow food to by-pass the first part of small intestine. This causes reduced calorie and nutrient absorption.

Advantages of Laproscopic Gastric Bypass RNY

After gastric bypass surgery, weight loss is more predictable and usually maintained. Average excess weight loss is usually higher than with purely restrictive procedures.
One year after gastric bypass surgery, weight loss can average 65% to 70% of excess body weight. After 10 to 14 years, some patients have maintained 50-60% of excess body weight loss.
96% of certain associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved according to a 2000 study of 500 patients. It also helps in leg swelling, high cholesterol, urinary incontinence etc.

Risks of Laproscopic Gastric Bypass RNY

Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia...
Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

Frequently Asked Questions for GASTRIC BYPASS SURGERY

What are the main differences between the Adjustable Gastric Band and the gastric bypass?

A	Lap-Band	Gastric Bypass
Complexity	Simple	Moderate
Reversibility	Easier in general	Reversible but moderately difficult
Laparoscopic	Yes	Yes
Relative Early Risk	Lower	Moderate
Expected hospital stay	2-3 nights	3-4 nights
Mortality	0.1%	0.4%
Statistical Average Weight Loss (2 years)	50-60% of Excess weight	70 -75% of Excess weight
Possible Late-Term Risks	Band slippage, port ncomplications, erosions, Lap-Band infection, esophageal dilatation	Ulcers, anemia, stricture, vitamin/ calcium / iron deficiencies, intestinal obstruction
Risk of Malnutrition	Minimal	Low

How long will I stay in the hospital?

As long as it takes to be self-sufficient. Although it can vary, hospital stay (excluding the day of surgery) can be 3 to 4 days for a laparoscopic gastric bypass, and 5-7 days for an open gastric bypass. After leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.

What will I eat after gastric bypass surgery?

You will be on intravenous fluids on the day of surgery. The day after we may do a swallow study to be sure there is no leak in the staple line. If there is no leak, you will be started on liquid diet 24 to 48 hours after surgery. Intake is limited to 1 or 2 ounces per meal so that the stomach can heal properly. If this is well tolerated, next day you will be advanced to blanderised soup. You will be discharged on liquid diet. We begin patients with liquid diets, moving next to semi-solid foods and about 4 to 6 weeks later, back to solid foods. This transition is necessary to allow time for your newly created stomach pouch to heal properly. Drink 2 liters or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.

What if I am really hungry?

This is usually caused by the types of food you may be consuming, especially starches (rice, pasta and potatoes). Increasing protein intake is helpful. There may also be a psychological problem with lack of food in your life "head hunger". Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.

Will I need supplemental vitamins?

Most surgeons recommend a daily multivitamin for the rest of your life. Vitamin B12 injections are sometimes suggested once a month for the first year and every six months thereafter. It may also be taken orally or sublingually (under the tongue) by many patients.

What happens to the lower part of the stomach that is bypassed?

The stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food. It still produces the secretion necessary to absorb Vitamin B12 and contributes to endocrine hormonal balance and motility of the intestines in ways that are not entirely understood.

Is sexual activity restricted?

Patients can return to normal sexual intimacy when wound healing and discomfort permit.

I am thinking about getting pregnant. Will I be able to have children after weight loss surgery?

Many women have had successful pregnancies after weight loss surgery. There is nothing per se that would prevent pregnancy. In fact, Bariatric surgery enhances fertility in those who have had difficulty in conceiving. We recommend, however, that you wait until your weight loss is complete before becoming pregnant. This may take a year or more. The effect of rapid and prolonged weight loss on the developing fetus is unknown but it could have dire consequences and pregnancy is not recommended until a stable weight has been attained.

What can I do to prevent excess hanging skin?

The amount of excess skin depends on the age, skin elasticity, and total weight loss and how much the skin was stretched. Many people, heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back". Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight.

Will exercise help with excess hanging skin?

Exercise is good in so many other ways that a regular exercise program is recommended. Unfortunately, most patients may still be left with flaps of loose skin.

What will my long term diet be like?

Eat three small meals a day.
Keep a record of your dietary intake. Include everything you eat and drink: the date, time and amount of each meal. Start keeping this record (food diary) from one week after the surgery so if you begin having problems with vomiting, diarrhea or malabsorption. we can review your food record and make recommendations.
Not only is there an adjustment to make about the quantity but also quality of food you should eat. When you are able to eat solid foods again, eat food high in protein. Protein foods are very important for the healing of staple line of your pouch. Protein in the form of lean meats (chicken, turkey, and fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods. Hair loss is one effect of not eating enough protein.
You will also have to learn to eat slowly and chew your food thoroughly. Food not chewed properly will not pass through the narrow stoma and may cause vomiting.
Stop eating as soon as you feel full. If you do not stop, you may have vomiting and it will put strain on the staple line.
Do not eat sweets! This includes sweetened chewing gum, candy and regular sodas. Beware of hidden sweets (cereals with honey or sugar coatings).
You may be unable to tolerate certain foods, especially those containing fat and sugar. A balanced diet of 1000 – 1200 calories a day is recommended.
Drink 2 liters or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
Never drink water or any fluid with the meal. Drink fluids thirty minute to an hour after meals. Taking fluids before or at meal time may cause bloating, low food intake, vomiting, or dumping syndrome. It will also flush the food through the stoma and you will feel hungry again.
Do not drink flavored beverages, even diet soda, between meals

Will I be allowed to drink alcohol?

You will find that even small amounts of alcohol will affect you quickly. Alcohol is high in calories and will significantly alter your calorie balance. It is suggested that you drink no alcohol for the first year. Thereafter, you may have a glass of wine or a small cocktail for social purpose not more than once a fortnight.

Will I have to stop smoking?

Patients are encouraged to stop smoking at least one month before gastric bypass surgery. Smoking increases the risk of lung problems and can reduce the rate of healing. It increases the rate of incisional hernia and leaks by interfering with the blood supply of healing tissues.

How soon can I drive?

For your own safety, you should not drive until you are no longer taking narcotic medication for pain and can respond quickly to traffic. Usually this takes 7-14 days after surgery.