Gastric Bypass Surgery

Bariatric surgery is a surgical procedure performed to cause weight loss by restricting the amount of food the stomach can accommodate. It is carried out with an aim to cause malabsorption of nutrients and gastric restriction. Procedures falling under Bariatric surgery often hormonal changes and entail their own risks.

Gastric bypass is one of the most common types of bariatric surgery in the world. It is done when diet and exercise haven't shown you any results or when you have serious health problems because of your weight.

Roux-en-Y gastric bypass or simply called gastric bypass is a type of weight-loss surgery that involves creating a small pouch from the stomach and connecting the newly created sack directly to the small intestine. After gastric bypass, swallowed food goes into this small pouch of the stomach and then directly into the small intestine, whereby bypassing most of the stomach and the first section of the small intestine.

• A person with a body mass index (BMI) of 40 or higher
• Someone with BMI 35 or more and has a serious weight-related health problem like type 2 diabetes, high blood pressure, or severe sleep apnea
• A teenager who has gone through puberty and his BMI is 35 or more and has serious obesity-related health problems like type 2 diabetes or severe sleep apnea
• A person whose efforts to lose weight with diet and exercise have been unsuccessful.

Risks associated with the surgical procedure in gastric bypass surgery can include:

• Excessive bleeding
• Blood clots
• Infection
• Adverse reactions to anesthesia
• Leaks in your gastrointestinal system
• Lung or breathing problems
• Death (rare)

Longer term risks and complications of bypass surgery vary depending on the type of surgery and can

• include:
• Bowel obstruction
• Ulcers
• Vomiting
• Dumping syndrome, causing diarrhea, nausea or vomiting
• Gallstones
• Hernias
• Low blood sugar (hypoglycemia)
• Malnutrition
• Stomach perforation
• Death (rare)

Gastric bypass surgery is able to lead to an average of 65% excessive weight loss after two years, which makes the procedure quite effective.

In India, gastric bypass bariatric surgery can costs anywhere between INR 250000to INR 500000.

A gastric bypass diet helps people who are recovering from gastric bypass surgery, which is also known as Roux-en-Y gastric bypass surgery, and to heal and to change their eating habits. Liquids For the first day or so after surgery, the patient is only allowed to drink clear liquids. Once the patient starts handling clear liquids, they can start having other liquids, such as:

• Milk
• Unsweetened juice
• Decaffeinated tea or coffee
• Sugar-free gelatin or popsicles
• About one week after consuming nothing else but liquids, the patient is allowed to have mashed up food.
• Soft scrambled eggs
• Lean ground meat, poultry or fish
• Cottage cheese
• Strained cream soups
• Soft fruits and cooked vegetables

A few weeks after that, the patient can move to soft food like rice and eggs. And then after completing around eight weeks of the gastric diet, the patient can return to eating solid food.

Yes, you may have to endure some pain for a few weeks after gastric bypass surgery as abdominal pain is one of the most common and nagging problems after gastric bypass.

Although gastric bypass is a more complicated operation compared to sleeve gastrectomy, it is often described as the “gold standard” for weight loss surgery as it has been performed for many years with solid long-term outcomes.

A lot of surgeons prefer gastric bypass surgery over other weight-loss surgeries because it generally has fewer complications. Yet, all forms of bariatric surgery, including gastric bypass, are major procedures in someone's life and even can pose serious risks and side effects.

If one follows the doctor's gastric diet plan along with other medication, the recovery can be made within ten weeks.

Gastric bypass surgery is not reversible as in addition to reducing the size of the stomach, the procedure also rearranges the digestive system and also causes alterations in gut hormones, improving satiety, the absorption of calories, and restricting the amount of food consumed.

All major surgeries present their risks which usually vary with each patient. The same can be said for gastric bypass surgery, however, in the appropriate patients, the health risks from obesity far outweigh the risks associated with gastric bypass surgery. The surgery is now associated with major reductions in risk of premature death over a 5-year period versus not having surgery.

Gastric bypass surgery is a kind of weight-loss surgery that helps obese people to lose weight and improve their health. 

Gastric bypass surgery helps in shrinking the pathway for food absorption by bypassing a part of the digestive system.
Gastric bypass surgery is performed by the creation of a small pouch from the stomach and the connection of this newly created pouch directly to the small intestine.

Gastric bypass surgery is usually performed to help an individual lose excess weight, thereby reducing the risk of developing life-threatening weight-related health disorders, such as:

• Heart disease
• High cholesterol
• High blood pressure
• Diabetes
• Gastroesophageal reflux disease 
• Cancer 
• Stroke
• Obstructive sleep apnea
• Infertility 

The following are considered to be good candidates for gastric bypass surgery:

• A person having a body mass index or BMI (calculated as weight in kilograms divided by height in meters square) of 40 or more
• A person having BMI between 35 and 39.9 along with a weight-related health disorder
• A person having BMI between 30 and 34 along with some serious weight-related health disorders

Gastric bypass surgery is performed by a bariatric surgeon.

The following diagnostic tests may be performed before a gastric bypass surgery:

• Physical examination: The patient’s overall physical health is checked by the doctor.
• Blood tests: The various blood parameters of the patient are checked along with the presence of any underlying medical conditions.
• Urine analysis: It helps the doctor to check for any underlying urinary infections.
• Barium swallow test: The severity of acid reflux and the presence of any abnormalities in the upper gastrointestinal tract can be detected using this test.
• Ultrasound: An ultrasound of the gallbladder may be recommended in cases of gallstones or gallbladder inflammation.
• Chest x-ray: This test helps the doctor to check the condition of the organs in the chest area.
• Electrocardiogram (ECG): The electrical activity of the heart can be measured using this test.
• Echocardiogram: The heart condition can be evaluated using this test.

The following preparation is done before a gastric bypass surgery:

• The doctor should be told if the patient has any medical illnesses.
• The doctor should be informed about any medications, supplements, or herbs that the patient may be taking.
• If the patient is allergic to any medications, anesthesia, latex, iodine, or tape, inform the doctor.
• The doctor will ask the patient to stop taking blood thinners like warfarin and aspirin a couple of days before the procedure.
• The patient should quit smoking at least two weeks before the surgery.
• The patient is told to not eat or drink anything after midnight, the day before the procedure.

Gastric bypass surgery can be done in the following different ways:

1. Roux-en-Y gastric bypass procedure is done by cutting across the top of the stomach and sealing it off from the rest of the stomach.
2. Biliopancreatic diversion with duodenal switch or extensive gastric bypass is done by the removal of about 80% of the stomach and leaving behind a tube-like pouch. This is followed by connecting the end part of the intestine to the duodenum.
3. There are different techniques that are used to perform a gastric bypass surgery, which may include the following:
4. Open surgery or the traditional method is done by making a large, open incision in the abdominal region. The top of the stomach is then cut off and sealed from the rest of the stomach. This results in a small pouch formation that can hold only a small quantity of food. 
5. Laparoscopic surgery or minimally-invasive surgery involves making small incisions and inserting a tube with a camera on one end, known as a laparoscope, along with other small surgical instruments through the incisions to perform the surgery. This procedure has a quicker recovery and fewer complications than open surgery.
6. Robotic-assisted surgery is a type of laparoscopic surgery performed using robotic arms, which are controlled by the surgeon.
7. The surgery normally takes two to four hours to complete.

The following post-procedure steps are followed after gastric bypass surgery:

• The patient is kept on a liquid diet after the surgery. The diet gradually changes to pureed food, and then to solids after some weeks.
• Painkillers are recommended to the patient to get relief from pain and discomfort.
• The patient should take enough rest after the surgery and should keep the upper abdomen in an elevated position by using pillows or a recliner.
• The incision area can be cleaned using a wet towel. 
• The patient is recommended to avoid taking a bath for at least two days after the surgery.
• The patient should avoid strenuous exercises for a couple of days after the surgery.

Depending on the type of procedure performed, the patient generally loses weight for up to 2 or 3 years after gastric bypass surgery.

Yes, unfortunately many people tend to regain their lost weight after gastric bypass surgery due to unhealthy lifestyle choices and eating habits.

The various complications associated with gastric bypass surgery may include the following:

• Bleeding
• Infection 
• Formation of blood clots
• Allergic reaction to the anesthesia used
• Difficulty in breathing 
• Gastrointestinal system leaks
• Bowel obstruction 
• Dumping syndrome causing nausea, vomiting, or diarrhea
• Gallstones
• Hernia
• Hypoglycemia (low blood sugar)
• Vomiting
• Ulceration
• Malnutrition 
• Stomach perforation 
• Death (extremely rare)

The cost of gastric bypass surgery varies depending on the type of surgery performed, the health status of the patient, and the technique used for performing the procedure.
The cost is different among different doctors in different hospitals. Normally, the cost of gastric bypass surgery is between INR 3,00,000 to INR 5,25,000.

A. The following tips can help in a quicker recovery following gastric bypass surgery:
Start with a liquid diet and gradually move to a semi-solid and solid diet
Eat small, frequent meals
Drink lots of fluids
Chew your food thoroughly
Eat a high-protein diet
Avoid food items that are high in sugar and fat
Take all your recommended mineral and vitamin supplements
Take pain-relieving medications as prescribed by the doctor
Avoid strenuous activities during the recovery period 

A. Most patients can resume work within one or two weeks of having gastric bypass surgery.

A. Gastric bypass surgery is performed by a bariatric surgeon.

A. No, a gastric bypass surgery will not affect your ability to get pregnant. However, most doctors advise waiting for 12 to 18 months after surgery before planning a pregnancy.

A. You can start with low-impact exercises like walking immediately after the surgery. However, you should avoid heavy lifting and strenuous activities for about two to three weeks after gastric bypass surgery.

A. Most patients need to take prescription vitamin supplements for life after gastric bypass surgery.

A. The different types of gastric bypass surgeries are:
Roux-en-Y gastric bypass surgery: This procedure is performed by cutting across the top part of the stomach and then sealing it off from the remaining stomach.
Biliopancreatic diversion with duodenal switch or extensive gastric bypass: This procedure is done by removing approximately 80% of the stomach and leaving behind a tube-like pouch. The end portion of the intestine will then be connected to the duodenum (the first part of the small intestine). 

A. Gastric bypass surgery can be performed using any one of the following techniques:

1. Open surgery or the traditional method: 
This procedure is performed by the surgeon by making a large, open incision in the abdominal area. 
The top part of the stomach is then cut off and sealed from the rest of the stomach.
This results in the formation of a small pouch that can hold only a small quantity of food.
 
2. Laparoscopic surgery or minimally-invasive surgery:
This procedure involves the surgeon creating small incisions or cuts.
A tube with a camera on one end, known as a laparoscope, as well as other small surgical instruments are then inserted through these incisions to perform the procedure. 
This type of procedure has a more rapid recovery, lesser complications, and is less painful than open surgery.

3. Robotic-assisted surgery:
This is a type of laparoscopic surgery performed using robotic arms controlled by the surgeon by viewing the computer monitor attached to the laparoscopic camera.
Although this procedure is more expensive, it offers better precision and can maneuver hard-to-reach areas compared to the other techniques used.

A. Gastric bypass surgery may take about two to four hours to complete.

A. Most patients need to stay in the hospital for two to three days after gastric bypass surgery.

A. One study shows that patients could lose about 30 to 50 percent of their excess weight in the first six months after surgery, and about 77 percent of their excess weight about twelve months after surgery. Another study shows that a person can maintain about 50 to 60% of the excess lost weight ten to fourteen years after gastric bypass surgery.