What is Gastric Bypass Surgery?

English हिन्दी Bengali

What is the meaning of Gastric Bypass Surgery?

Various types of weight loss surgeries are performed to treat patients with obesity and other complications resulting from obesity. These procedures are collectively known as bariatric surgeries. The gold standard among all bariatric surgeries is Gastric Bypass Surgery. It is said to have an excellent safety profile and the least complications. The patients are expected to lead a healthy lifestyle that consists of a nutritious diet and exercise in order to ensure the long-term success of bariatric surgeries.

Gastric bypass surgery called Roux-en-Y (roo-en-wy) is one of the most commonly performed types of bariatric surgery to lose weight. ‘Roux-en-Y’ is a French word that means “in the form of a Y”. It has now been performed for more than 50 years and the laparoscopic approach has been refined since 1993. Gastric bypass is done after diet and exercise have been tried by the patient but they haven’t shown significant results. It is also recommended when body weight leads to serious health problems. During gastric bypass surgery, surgical alterations are made by the surgeon to the stomach and small intestine. This modifies the way food is absorbed and digested. 

This surgery helps reduce the amount of food intake as well as the amount of intestinal absorption. A small pouch is created out of one part of the stomach.  This small pouch now can hold only a small amount of food. Swallowed food will go into this small pouch of the stomach and then directly into the small intestine, after gastric bypass; thereby bypassing most of your stomach and the first section of your small intestine. The small intestine is divided into two parts:

• The lower part of the small intestine is connected to the stomach.
• The top part of the intestine is connected to the lower part of the intestine. 

Gastric bypass surgery proves to be very beneficial in reducing weight. After the surgery, almost 70% of excess body weight is lost. Once the surgery is performed, the patient will feel satisfied after consuming smaller amounts of food. This occurs due to the absorption of fewer calories and as a result of hormonal changes, the metabolic activity also improves. After gastric bypass surgery, the risk of high blood pressure, cholesterol, and diabetes are reduced in a person. 

Let us learn more about Gastric bypass surgery.

• What is Obesity? 
• What causes Obesity?
• What is Body Mass Index (BMI)?
• Which patients are the best candidates for Gastric Bypass Surgery based on their (Body Mass Index) BMI?
• Why is Gastric Bypass Surgery done? 
• How does Gastric Bypass Surgery work? 
• What should patients know before doing a Gastric Bypass Surgery?
• What are the procedures followed before Gastric Bypass Surgery?
• What is the Procedure of Gastric Bypass Surgery? 
• What are the side effects noticed after Gastric Bypass Surgery?
• What are the advantages of Gastric Bypass Surgery?
• What are the disadvantages of Gastric Bypass Surgery?
• Success Rate of Gastric Bypass Surgery
• Failure Rates of Gastric Bypass Surgery
• How to care after Gastric Bypass Surgery?
• What are the Risks of Gastric Bypass Surgery? 
• Dumping syndrome due to Gastric Bypass Surgery
• What should a patient expect after Gastric Bypass surgery?
• What are the other medical conditions that show improvement due to Gastric Bypass Surgery?
• What is the cost of Gastric Bypass Surgery in India?

What is Obesity? 

Obesity is a complex disease that occurs due to an excess amount of body fat. When the body mass index (BMI) is 30 or higher, the person is said to have obesity. It isn’t only a cosmetic concern. It is a medical condition that leads to a cascade of health problems. It thus increases the risk of other diseases, like high blood pressure, heart disease, diabetes, and some cancers. ( Know more about- What is Obesity? )

What causes Obesity?

Obesity results from genetic, behavioral, metabolic, and hormonal abnormalities in the body. It occurs when you consume more calories than you burn out. These calories are stored by the body as fat. In order to lose weight, patients should increase physical activity and ensure dietary changes are made. -Prescribed medications and weight-loss surgeries are additional options to treat obesity. Even a little amount of weight loss goes a long way in improving and preventing health problems associated with obesity. Some causes of Obesity include:

• Unhealthy diet- Any diet that has a lot of calories with the absence of fruits and vegetables. A diet full of fast food, high-calorie beverages, and large portions also contributes to obesity.
• Sedentary Lifestyle– Calories can be burnt every day through an exercise routine and daily activities. 
• Pregnancy- Some women find it difficult to lose weight after pregnancy. An easy way to lose weight is through breastfeeding. ( Know more about- What is Pregnancy care? )
• Irregular sleep patterns– Lack of sleep or too much sleep can cause hormonal imbalance that increases your appetite. (Know more about- What is Hormonal Imbalance in Females? )
• Stress- External factors that affect the mood may contribute to obesity. People often consume more high-calorie food during stressful situations.
• Microbiome- The bacteria in the gut may contribute to a gain in weight and decreases the ability of the body to lose weight. 
• Previous attempts at losing weight- When people attempt to lose weight but rapidly gain weight after that, it could give rise to obesity as well.  This phenomenon, called yo-yo dieting, can reduce metabolism.

What is Body Mass Index (BMI)?

Body mass index (BMI) is a measure of fat in the body based on the height and weight of adult men and women. 

The formula is BMI = kg/m2 where kg is the weight of the person in kilograms and m2 is their height in meters squared.

BMI Categories are as follows: 

• Underweight- less than 18.5
• Normal weight- 18.5–24.9
• Overweight- 25–29.9
• Obesity- 30 or greater. 

BMI thus should be in the range of approximately 19 to 25. 

Which patients are the best candidates for Gastric Bypass Surgery based on their (Body Mass Index) BMI?

When the BMI of a patient is greater than 35, the chances of attaining normal body weight are said to be less than 1%. Due to this reason, surgery is considered to be a good option for patients with severe obesity i.e., BMI over 35. 

For patients with BMI over 30, a doctor can be approached to control weight gain. But people falling within this range are not advised to have bariatric surgery unless there are significant comorbidities. Thus, bariatric surgery is also recommended for patients with a BMI of less than 35 if he/she has some underlying health condition such as high BP, diabetes, heart disease, etc. 

Why is Gastric Bypass Surgery done? 

Gastric Bypass should only be done after the patient has tried to lose weight through diet and exercise regimes. It is also advised when other health conditions due to obesity get out of hand and risk the life of the patient.                                                                                                    

Gastric bypass surgery is mainly done for the following gastro-intestinal conditions:

• Obesity 
• Acid reflux or indigestion 
• Nausea and vomiting 

Other conditions that might require Gastric Bypass Surgery are: 

• Heart disease.
• High blood pressure.
• High cholesterol level 
• Obstructive sleep apnea 
• Diabetes Mellitus (Type 2). ( Know more about- What is Diabetes?)
• Stroke
• Cancer 
• Infertility ( Know more about- What is Infertility in women ? )

How does Gastric Bypass Surgery work? 

Gastric bypass surgery creates structural modifications leading to metabolic changes in the body. It works by:

• Reducing the food holding capacity of the stomach by decreasing the size
• Decreasing the number of calories and nutrients absorbed by the body 
• Altering the gut hormones, which thus give rise to the patient feeling full after a smaller meal  
• Decreasing the appetite of the patient 
• Reversing obesity

What should patients know before doing a Gastric Bypass Surgery?

Gastric Bypass Surgery requires permanent changes to lead a healthier lifestyle. Patients would have to participate in long-term follow-ups that include monitoring their nutrition, lifestyle, and behavior. They need to be fully aware of the commitment they need to make to eat healthy, nutritious food.

What are the procedures followed before Gastric Bypass Surgery?

Gastric bypass cannot be done for everyone who is severely overweight. Certain medical guidelines need to be met to qualify for weight-loss surgery. An extensive screening process is conducted. Before Gastric Bypass Surgery, a physical examination of the patient has to be completed. This is necessary to check if the patient is physically fit for the surgery. The tests are done are:

• BMI of the patient’s body is measured
• Complete Blood Count (CBC)-  The test is performed to check for blood abnormalities
• Blood test to check for hemoglobin of the patient 
• ECG to check if obesity has caused heart disease 
• 2D ECHO, Ultrasound Abdomen, Upper GI Scope. ( Know more about- What is Echocardiography? )

If any medicines are consumed, the doctor should be informed. The doctor recommends stoppage of blood-thinning medications before the surgery 

What is the Procedure of Gastric Bypass Surgery? 

A small stomach bowel is made and a bypass of the intestine is done to create a different pathway for digestion. 

Before Gastric Bypass Surgery   

• General anesthesia is given to the patient by the anesthesiologist. This is administered through an IV line (intravenously) or by inhaling
• A breathing tube is inserted
• After this process, the patient’s body becomes numb and the patient stays unconscious for the duration of the surgery     
• The vitals of the patient such as pulse rate, body temperature, oxygen levels, breathing rate, and heart rate, are continuously checked

During the Gastric Bypass Surgery

The type of Gastric bypass depends upon the individual’s choice. Nowadays, most gastric bypass surgeries are done ‘Laparoscopically’. 

A laparoscope is a long fiber-optic tube with a camera attached to it. The surgeon uses this to see the internal structures of the abdomen on a larger screen outside the patient’s body. Small incisions are made on the abdomen and thus this is a minimally invasive procedure that results in fewer complications. 

• A small stomach pouch is made which is the size of an egg. This is done by detaching the top of the stomach from the rest of the stomach.
• The small pouch is able to hold only 30-50 ml of the food. Normally, the stomach can hold 1-1.5 liter of food in it. 
• The small intestine is cut at the region of the jejunum, which is the first part of the small intestine. 
• The bottom end of the cut small intestine is taken above and connected to the small pouch of the stomach that has just been created. 
• The top part of the divided small intestine is connected to the small intestine below.  This is done so that the stomach acids and digestive enzymes from the cut-off part of the stomach that has been bypassed can travel down to the small intestine and mix with the food.
• The food then travels from the pouch made from the stomach to the small intestine sewed into it. The food thus bypasses the major portion of the stomach and also the first portion of the small intestine and instead enters directly into the mid-portion of the small intestine.
• The gastric bypass surgery requires approximately 2-4 hours. 
• The patient is then taken to the recovery room after the surgery.
• The patient needs to be kept under continuous monitoring and observation. 
• Vital signs such as pulse rate, body temperature, oxygen levels or breathing rate, and heart rate, are checked by the nurse at regular intervals of time.

After Gastric Bypass Surgery

• The patient cannot eat solid foods for 1 to 2 days. This is necessary to allow the digestive tract and the stomach to heal. 
• A special diet is advised by the doctor for 12 weeks. The diet consists of liquids first, followed by soft food, and later, regular food.
• The doctor may also get some lab tests done.

What are the side effects noticed after Gastric Bypass Surgery?

There are some changes experienced by the patient over the initial few months after Gastric Bypass Surgery. This occurs because the body takes time to react to sudden weight loss. They are:

• Feeling cold
• Body aches
• Dry skin
• Mood swings
• Feeling fatigued like when the patient has flu
• Hair loss and hair thinning ( Know more about- What are hair loss problems ? )

What are the advantages of Gastric Bypass Surgery?

1. Increases insulin sensitivity and is hence beneficial for patients with diabetes 
2. Reliable procedure 
3. Reduces obesity-associated conditions
4. Refined technique
5. Fewer  complications
6. Very good progress for short term weight loss 
7. Long-lasting

What are the disadvantages of Gastric Bypass Surgery?

1. Technically more complex when compared to sleeve gastrectomy or gastric band
2. More vitamin and mineral deficiencies are seen in comparison to sleeve gastrectomy or gastric banding
3. Risk of small bowel complications and obstruction
4. Risk of developing ulcers, especially with NSAIDS which are pain killers or tobacco use
5. May cause “dumping syndrome”
6. The long-term complication rate is slightly higher than sleeve gastrectomy 
7. Patients are not allowed to take aspirin or other NSAIDS after surgery
8. All patients need to take vitamins for the rest of their life after surgery. Failure to consume them could lead to long-term vitamin/mineral deficiencies, like deficits in vitamin B12, iron, calcium, and folate

Success Rate of Gastric Bypass Surgery

Weight loss is approximately 65% for most patients. More than 85% of patients lose more and maintain the initial 50% excess weight loss (EWL). Mortality rates of approximately 0.1% have been documented.  Rates of early complications do not exceed 5%. [1]

Failure Rates of Gastric Bypass Surgery

Maintaining less than 50% of excess weight loss (EWL) over 18 to 24 months or a body mass index (BMI) of greater than 35 is defined as Failure after bariatric surgery.  The failure rate of Laparoscopic Roux-en-Y gastric bypass (LRYGB) is said to be ∼15% with a long-term failure rate of 20–35%. [2]=

How to care after Gastric Bypass Surgery? 

• After gastric bypass surgery, the patient is kept in the hospital for three days for recovery. The patient is kept in the ICU for a day if he/she is having trouble breathing. 
• Apart from this; the patient’s condition is continually observed by doctors, to check for pain or some other issue.
• Some medications are given to relieve the pain. 
• On seeing improvement in the patient’s condition, he/she/they are discharged from the hospital and asked to take care of certain things. 
• After surgery, the patient should drink a sufficient amount of water. 
• An adequate amount of rest should be taken and the upper abdomen should be kept elevated using pillows. 
• The area of the surgical incision should be cleaned using a wet towel.
• The patient should avoid a bath until 2 days after surgery. 
• All types of physical activity should be avoided for a few days after surgery. Although, light walking can be done. 
• After the surgery, patients are advised to drink plenty of fluids. After some time they can start consuming light and soft food. 

What are the Risks of Gastric Bypass Surgery? 

The metabolic and bariatric operations that are performed today have been modified and improved over the course of a decade. These surgeries require small incisions and are minimally invasive. Especially in the case of laparoscopic and robotic techniques. Thanks to these advancements, the patient has less pain, decreased number of possible complications, comparatively shorter hospital stays, and quick recovery. The overall experience thus significantly improves. These surgeries are said to have lesser risk than common operations like gall bladder surgeries, hysterectomies, hip replacement, etc.

There is no risk of life in gastric bypass surgery, but there may be some risks associated with the surgical procedure.  Some of them are:

• Excessive bleeding
• Formation of blood clots 
• Infection 
• Adverse effects of anesthesia
• Leakage in the gastrointestinal system
• Difficulty breathing 

However, the long-term risks and complications of bypass surgery may vary depending on the type of surgery. Some are:

• Blockage in the intestines 
• Ulcers
• Vomiting
• Gallbladder stones 
• Hernia 
• Low blood sugar (hypoglycemia) 
• Malnutrition
• Dumping Syndrome 

Dumping syndrome due to Gastric Bypass Surgery

Dumping syndrome is a condition that may occur after any surgery in which all or part of the stomach has been removed. It sometimes occurs after Gastric Bypass surgery. It is also called rapid gastric emptying. It occurs when food, mainly sugar, goes from the stomach to the small intestine too fast.

It results in abdominal cramps and diarrhea, 10 to 30 minutes after eating sugar. Some people have symptoms one to three hours after eating. This can be avoided by changing the diet after the surgery. Smaller meals and food with less sugar should be consumed. ( Know more about- What is Diarrhea? )

What should a patient expect after Gastric Bypass surgery?

Initially, after the surgery, the patient will only be able to consume small amounts of soft food and liquids for the 1st month. Over a period of time, solid foods and regular healthy diet can be resumed. A significant change will be experienced by the patient wherein he/she/they will feel full quickly, after eating a much lesser quantity of food as compared to earlier. Nutritional supplements will be recommended by the physician and must be taken by the patient.

In most cases, half or two-thirds of excess body weight is lost in the first 2 years. The weight loss then stabilizes. 

What are the other medical conditions that show improvement due to Gastric Bypass Surgery?

After the surgery, the doctor recommends a healthy lifestyle and food habits to all patients. The success of the surgery and long-term benefits depend on this.  Patients face various problems due to being overweight. This surgery doesn’t just help the patients lose weight but also improves various health conditions that are seen due to overweight such as:

• High blood pressure (Hypertension)
• Diabetes mellitus (Type 2) 
• Gastroesophageal reflux disease (GERD). ( Know more about- What is Acid Reflux? )
• Sleep apnea- a condition in which breathing repeatedly stops and starts while sleeping 
• Heart diseases
• Stroke

What is the cost of Gastric Bypass Surgery in India? 

The total cost of Gastric Bypass Surgery in India is around INR 3,00,000 to 5,00,000. The cost varies across different hospitals.

If you are coming from abroad, apart from the cost of treatment of Gastric Bypass Surgery, there will be an additional cost of staying in the hotel, the cost of living, and the cost of local travel. Apart from this, after surgery, the patient is kept for two days in the hospital and five days in the hotel for recovery. So, total cost of Gastric Bypass Surgery in India comes to a total of around INR 8,00,000- INR 9,00,000. 

We hope that we could answer your questions regarding Gastric Bypass Surgery through this article. 

If you want more information about Gastric Bypass Surgery and its treatment, contact the Bariatric Surgeon. 

We aim to provide you with information through this article. We do not recommend any medicine or treatment to anyone. Only a doctor can give you the best advice and correct treatment plan.