Frequently asked questions about gastric bypass surgery
Einstein Bariatrics
Do you do the operations laparoscopically?
What does the phrase "Roux-en-Y gastric bypass" mean?
Are there important aspects of the anatomy of the stomach that help with long-term weight control?
Will I be able to eat normally after the gastric bypass?
What are the expected results?
What complications can occur after my procedure?
I have a severe medical problem. Am I still a candidate for surgery?
Is there any pain with the laparoscopic operation?
Can this operation be reversed?
What happens to the bypassed stomach?
Will I ever be able to eat after surgery?
Are there any tubes used for the surgery?
How long is the hospital stay?
What about my quality of life?
Will this operation cure my diabetes?
If I get pregnant will I be able to get enough nutrition for my baby?
What medications will be prescribed after the procedure?
Will I need plastic surgery after the procedure?
Do you do the operations laparoscopically?
Yes. Our surgeons have performed over 1,000 weight loss operations laparoscopically, even in patients with previous abdominal surgeries or who are extremely overweight.
What does the phrase "Roux-en-Y gastric bypass" mean?
The operation is named after a common method of using small intestines as a means to bypass (re-route) food or gastrointestinal secretions. It was first described by the frenchman, Cesar Roux (1857-1934), as a means to bypass a blocked stomach caused from severe scar tissue after peptic ulcer attacks. The “Y” comes from the vague similarity the stick figure representation of the procedure resembled the letter. The Roux-en-Y procedure has over the years been modified for use in many surgical procedures including liver transplants, pancreas operations, and cancer operations of the stomach and bile ducts. Often people simply call the procedure a gastric bypass or an RNY.
Are there important aspects of the anatomy of the stomach that help with long-term weight control?
Yes. The original size of the pouch is important - if it is too large it may enlarge substantially over time and result in becoming a “second stomach.” The most common initial size of the pouch is 20 cc, or about 1 ounce. The small pouch must also be created in such a way that it has a small outlet. This outlet is also called a “stoma”.
Some surgeons believe that changing the length of the roux limb may result in additional weight loss. The roux limb length is defined as the amount of intestine from the stomach to the hook-up (anastomosis) of the intestine. We may increase the length of the roux limb in patients whose BMI is greater than 50.
Will I be able to eat normally after the gastric bypass?
You will certainly eat differently. Patients experience significant lack of hunger after the gastric bypass. This is most significant immediately after the operation, but changes over time. Patients also become very full (satiated) after eating small amounts of food. After a gastric bypass people generally are satisfied with the foods that they eat, they generally can eat regular food (with the exception of sweets) and many of their previous cravings are gone. In the first several months of the operation, patients have to adapt suddenly to their new eating style. There is a lot of trial and error in food selection. Within a few months, eating is much easier.
Dumping usually occurs when concentrated sugar, or highly concentrated carbohydrates enter the upper intestine without being broken down by pancreatic juice and bile. Since these fluids mix with ingested food further downstream than usual after the gastric bypass, dumping generally occurs if a patient eats concentrated sweets. The syndrome typically involves 15 minutes to 1 hour of intestinal cramping, diarrhea, sweating, a fast heart rate and other side effects. Dumping can sometimes happen with other foods as well. Dumping is a good side effect that improves patient’s weight loss.
What are the expected results?
On average, after a gastric bypass, patients will loss about 70 to 80 percent of their excess weight during a two-year period. Weight loss is extremely rapid after the first six months and then tapers down. Some patients will regain five to 10 percent of their excess weight during the two to five year mark. The reason for this weight regain in some patients is complex and poorly understood. Long-term studies have consistently documented the persistent of weight loss over a 10- to 20-year follow-up. This is one of the best-studied operations for weight loss. Click here to see the expected weight loss after a gastric bypass.
What complications can occur after my procedure?
There are several potential complications possible associated with astric bypass surgery. As with any major operation, there is the risk of death. The most common cause of death is a pulmonary embolism (PE). PE’s can occur after any general anthesiai and major operation. Early mobilization and the use of blood thinners can decrease the likelihood of this serious complication. A &ldqou;leak” is when intestinal fluid spills out from where the stomach and intestines are connected. This complication can result in peritonitis. Leaks can be managed by a number of methods - sometimes requiring a re-operation. Bleeding is a complication that may require a blodd transfusion or re-operation. Nausea that lasts for more than several days is uncommon. Rarely nausea lasts for several weeks. Nausea nearly always resolves with a little time. There are numerous potential complications (some serious and some not) that can occur after any operation.
The most common late complication after a gastric bypass is iron deficiency anemia. Menstruating women will need to take a iron supplement. All other patients can have an multivitamin with iron. Osteoporosis may occur at a higher frequency in gastric bypass patients, therefore calcium supplements are recommended in some patients. Rarely, hernias can occur long after a gastric bypass. These may require operative interventions.
In the first several months after a gastric bypass, it has been found that about two percent of patients develop strictures. This is scarring between the stomach and the intestine. People notice that liquids “go down” easily, but solids tend to stick. This complication can be easily remedied by an endoscopy performed by the gastroenterologist in the office. Ulcers occur in some patients – especially smokers and patients that take NSAIDS (Motrin®, Aleve®, Advil®, Naproxen, etc.) Ulcers can cause bleeding or pain. Medications often help ulcers heal. If you smoke, stop now.
I have a severe medical problem. Am I still a candidate for surgery?
High risk patients often have the most to gain from massive weight loss. Massive weight loss improves almost every organ system. Our surgeons have successfully operated on patients who have been on the heart transplant list, who had uncontrolled diabetes and who had a number of chronic medical diseases such as multiple sclerosis, ulcerative colitis, liver disease, etc. You will need to discuss how your chronic medical condition changes the risks and benefits of the operation with your surgeon.
Is there any pain with the laparoscopic operation?
Unfortunately, there is no way to eliminate pain after this operation. Immediately after surgery, patients do experience discomfort. However, generally patients are walking and drinking the day of surgery. By the next morning, patients often say that they feel they have done too many sit-ups and are simply sore. By the time patients go home, most do not need prescription pain medications.
Can this operation be reversed?
Yes. Technically, the operation can be reversed, but in practice, that is generally not required.
What happens to the bypassed stomach?
Nothing. It has a good blood supply and produces some very important enzymes and hormones. Nothing is removed from your body during surgery – there is no need.
Will I ever be able to eat after surgery?
Of course. After a couple months, you should be able to eat almost any food that you like. You obviously will get full very quickly after eating though. After one year, you will likely be able to eat 1/3 of a “normal” entrée.
Are there any tubes used for the surgery?
Most surgeons use temporary catheters in the bladder. Some use temporary tubes that come out of the skin (called a drain). Some even use tubes that go into the nose.
Einstein Bariatrics accepts all insurance payments. However, your insurer may have specific exclusions to bariatric surgery. Einstein Bariatrics will call your insurer for you to determine your coverage and any limitations on that coverage. We can also find out your co-pays for you. More information on insurance.
How long is the hospital stay?
80 percent of patients leave the hospital after spending 1 night, the rest typically leave after spending two nights in the hospital.
I had surgery somewhere else. Elkins Park is close to home, would you follow me up for my routine care?
Einstein Bariatrics is unable to accommodate patients who have had surgery elsewhere in our program. If you have a complications of surgery performed elsewhere, we suggest you first contact that surgeon. We, of course, will take care of any patient emergencies.
I had a gastric bypass / Lap-Band® / VBG / etc., several years ago and I have had problems (weight regain, reflux, vomiting). Can I be seen for a possible revision of my surgery?
Yes. We ask that you complete the registration packet and insurance information. Also, we require that all patients who are evaluated for previous weight loss surgery obtain an Upper GI series BEFORE seeing the surgeon. Also, if possible, the surgeon would like to look at old operative records. These records can be obtained by calling your original surgeon’s office.
What about my quality of life?
A person’s quality of life is significantly improved after weight loss. Aside from the medical consequences of obesity, the social consequences are obvious to anyone who is obese. Sitting in seats on airplanes, in movie theaters and on buses is uncomfortable. Difficulties with simple acts such as tying shoes, and difficulties with basic personal hygiene, are also common. The most serious is the social stigmatization and prejudice against obesity that is everywhere throughout almost every society in the world. These consequences of obesity result in difficulties in personal relationships and at work.
In one well-done study published in the Journal of the American Medical Association, it was demonstrated that the quality of life of young patients who are severely obese is equal to a person undergoing chemotherapy for cancer. Further, after weight loss those patients’ quality of life improved to the level of the general population.
Will this operation cure my diabetes?
A major study published in the Annals of Surgery demonstrated that most patients lose enough weight that they no longer require any treatment for diabetes. Often patients who were taking more than 100 units of insulin a day are discharged home without insulin requirements. The effects of the operation in control of diabetes are very rapid – even before significant weight loss! People most likely to be completely free of insulin are those who have been diabetics for less than five years. There is a 95 percent chance of diabetes being cured after a gastric bypass if you have been diagnosed within the last five years. If your diagnosis of diabetes was more than 10 years ago, your chance of being cured after a gastric bypass is 54 percent with the remaining patients having marked improvement. On average, after a gastric bypass, diabetic patients will have normal fasting blood glucose and normal HbA1C with a very significant reduction, if not elimination of their medications.
What about my gallbladder?We take out patient’s gallbladder only when we feel the risk of complications for gallbladder removal is lower that the chance of developing significant symptoms from gallstones.
After significant weight loss, patients who did not have pre-operative gallstones have a 30 percent chance of developing stones. If you take Actigall® for six months, your risk for gallstones is only three percent.
If I get pregnant will I be able to get enough nutrition for my baby?
Many patients get pregnant after gastric bypass. In fact, several studies have demonstrated that significant weight loss can improve fertility.
We strongly discourage women of childbearing age NOT to get pregnant in the first year after the operation. This may cause significant fetal problems as your body may not have enough vitamins and proteins stores for the both of you. After the majority of weight is lost and you are nutritionally stable, pregnancy has been shown to be very safe. You should consult with your obstetrician/gynecologist before considering bariatric surgery.
What medications will be prescribed after the procedure?
Generally, patients are placed on an antacid medication for three months after there procedure to minimize the chance of developing an ulcer. Patients who take non-steroidal medications (Advil®, Aleve®, aspirin, Motrin®, Naproxen, etc.) for more than a week at a time will be required to take an antacid medication to protect the stomach. Patients who have a gallbladder will have to take Actigall® twice a day for six months in order to minimize the chance of developing gallstones. A multivitamin, iron and calcium supplement is recommended for most patients. Patients who have had the duodenal switch may be asked to take vitamins A, D and E as well.
Do patients need to be controlled by multiple dietary restrictions and rules in order to stop regaining weight?
No. Patients want to be successful with their weight control even more than we want them to be successful. This has resulted in our philosophy of forming a partnership with our patients, through education and good patient support, which will help our patients achieve their weight control goal. We are not a diet program — there is no rigid diet to adhere to after surgery. We just teach you how to you your new tool for the best results.
Being physically active, more than “exercise”, is important for maintaining the lost weight. Regular exercise is, of course, helpful in losing weight and improving your health. Becoming more active as the weight is lost will help you realize the benefits of a healthier weight and increase your long-term success. Look at increased activity as one of the rewards for being successful with weight control. Being able to walk upstairs without your knees and back hurting, and without getting severely short of breath, is a great thing - enjoy it.
Will I need plastic surgery after the procedure?
Patients who lose significant weight may require excess skin to be removed. There is not much a patient can do to prevent this excess skin from becoming a cosmetic problem. Depending on how much weight is lost, this can amount to 20 or more pounds!! We usually recommend waiting 18-24 months after surgery to have this performed if desired. We can recommend plastic surgeons that are specialized in taking care of our patients.
Temporary hair loss is expected to occur with weight loss - whether with Weight Watchers or gastric bypass. Usually hair loss starts between 6 and 8 months after surgery and then completely re-grows. Hair loss is not patchy, nor is it ever complete. Although there are a lot of remedies (biotin, protein, zinc, seleniium, etc.) that are reported – none have been proven effective in preventing hair loss.
This page last updated on 2007-09-24 11:32:50