Gastric bypass surgery
Gastric bypass is surgery that helps you lose weight by changing how your stomach and small intestine handle the food you eat.
After the surgery, your stomach will be smaller. You will feel full with less food.
The food you eat will no longer go into some parts of your stomach and small intestine that absorb food. Because of this, your body will not get all of the calories from the food you eat.
Description of Procedure
You will have general anesthesia before this surgery. You will be asleep and pain-free.
There are two steps during gastric bypass surgery:
- The first step makes your stomach smaller. Your surgeon will use staples to divide your stomach into a small upper section and a larger bottom section. The top section of your stomach (called the pouch) is where the food you eat will go. The pouch is about the size of a walnut. It holds only about 1 ounce of food. Because of this you will eat less and lose weight.
- The second step is the bypass. Your surgeon will connect a small part of your small intestine (the jejunum) to a small hole in your pouch. The food you eat will now travel from the pouch into this new opening and into your small intestine. As a result, your body will absorb fewer calories.
Gastric bypass can be done in two ways. With open surgery, your surgeon will make a large surgical cut to open up your belly. Your surgeon will do the bypass by working on your stomach and small intestine.
Another way to do this surgery is to use a tiny camera, called a laparoscope. This camera is placed in your belly. The surgery is called laparoscopy.
In this surgery:
- First, your surgeon will make 4 to 6 small cuts in your belly.
- Then your surgeon will pass the laparoscope through one of these cuts. It will be connected to a video monitor in the operating room. Your surgeon will look at the monitor to see inside your belly.
- Your surgeon will use thin surgical instruments to do your bypass. These instruments will be inserted through the other cuts.
The gastric bypass is the same whether you have open or laparoscopic surgery.
Advantages of laparoscopy over open surgery include:
- Shorter hospital stay and quicker recovery
- Less pain
- Smaller scars and a lower risk of getting a hernia or infection
This surgery takes about 2 to 4 hours.
Why the Procedure Is Performed
Weight-loss surgery is only recommended if you cannot lose a large amount of weight and keep it off by dieting, changing your behavior, and exercising alone.
Gastric bypass surgery is not a "quick fix" for obesity. You must diet and exercise after surgery. You also need to know about the risks of surgery, and what your life will be like after the surgery.
Risks of Gastric bypass surgery
Gastric bypass is major surgery and it has many risks. Some of these risks are very serious. You should discuss these with your surgeon. Risks for any surgery or anesthesia include:
- Allergic reactions to medicines
- Blood clots in the legs that may travel to your lungs
- Blood loss
- Breathing problems
- Heart attack or stroke during or after surgery
- Infection, including in the cut, lungs (pneumonia), bladder, or kidney
There are a number of risks for any weight-loss surgery. There are also risks that are more likely after gastric bypass surgery. These include blockage of the stomach or intestine (obstruction) and infection inside the abdomen.
Before the Procedure
Your surgeon will ask you to have tests and visits with other health care providers before you have this surgery.
If you are a smoker, you should stop smoking several weeks before surgery and should not start smoking again after surgery. Smoking slows recovery and increases the risk of problems. Tell your doctor or nurse if you need help quitting.
Always tell your doctor or nurse:
- If you are or might be pregnant
- What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription
During the week before your surgery:
- You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that affect your blood's ability to clot.
- Ask your doctor which drugs you should still take on the day of your surgery.
- Prepare your home for after the surgery.
After the Procedure
Most people stay in the hospital for 3 to 5 days after surgery.
In the hospital:
- You will be asked to sit on the side of the bed and walk a little on the same day you have surgery.
- You may have a (tube) catheter that goes through your nose into your stomach for 1 or 2 days. This tube helps drain fluids from your stomach.
- You may have a catheter in your bladder to remove urine.
- You will not be able to eat for the first 1 to 3 days. After that, you can have liquids and then pureed or soft foods.
- You may have a catheter connected to the larger part of your stomach that was bypassed. The catheter will come out of your side and will drain fluids.
- You will wear special stockings on your legs to help prevent blood clots from forming.
- You will receive shots of medicine to prevent blood clots.
- You will receive pain medicine. You will take pills for pain or receive pain medicine through an IV (a catheter that goes into your vein).
You will be able to go home when:
- You can eat liquid or pureed food without vomiting.
- You can move around without a lot of pain.
- You do not need pain medicine through an IV or given by shot.
Most people lose about 10 to 20 pounds a month in the first year after surgery. Weight loss will decrease over time. Sticking to your diet and exercise plan will help you lose more weight.
You may lose half or more of your extra weight in the first 2 years. You will lose weight quickly after surgery if you are still on a liquid or pureed diet.
Losing enough weight after surgery can improve many medical conditions, including:
- Gastroesophageal reflux disease (GERD)
- High blood pressure
- High cholesterol
- Obstructive sleep apnea
- Type 2 diabetes
Weighing less should also make it much easier for you to move around and do your everyday activities.
To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your doctor and dietitian have given you.
Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.
Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-73.
Richards WO. Morbid Obesity. In: Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012; chap 15.
|Review Date: 5/8/2014
Reviewed By: Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.