Description

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.
• 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 into your small intestine. Because of this, 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, small intestine, and other organs.

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.

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

You will usually not have weight-loss surgery unless you cannot lose a large amount of weight and keep it off by dieting, changing your behavior, and exercising alone.

Doctors often use the body mass index (BMI) and health conditions such as type 2 diabetes and high blood pressure to determine which patients are most likely to benefit from weight-loss surgery.

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

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.

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 not start smoking again after surgery. Smoking slows recovery and increases the risks 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 make it hard for your blood 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 the same day you had surgery
• 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 belly.
• May have a catheter in your bladder to remove urine
• 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.
• May have a catheter connected to the larger part of your stomach that was bypassed. It will come out of your side and will drain fluids.
• Will wear special stockings on your legs to help prevent blood clots from forming.
• Will receive medicine through shots to prevent blood clots
• Will receive pain medicine. You will take pills for pain or receive pain medicine through an IV, a catheter that goes into your veins.

You will be able to go home when you:

• Can eat liquid or pureed food without vomiting
• Can move around without a lot of pain
• Do not need pain medicine through an IV or given by shot

Outlook (Prognosis)

Most people lose about 10 to 20 pounds a month in the first year after surgery. Weight loss will decrease over time. By sticking to your diet and exercise early on you will 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:

• Asthma
• 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.

Bypass surgery alone is not a solution for weight loss. It can train you to eat less, but you still have to do much of the work. 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.

Alternative Names

Bariatric surgery - gastric bypass; Roux-en-Y gastric bypass; Gastric bypass - Roux-en-Y

References

Leslie D, Kellogg TA, Ikramuddin S. Bariatric surgery primer for the internist: keys to the surgical consultation. Med Clin North Am. 2007; 91:353-381.

Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders; 2008.

Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery: A systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253:484-487.

Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009 Mar;122(3):248-256.e5.

Blackburn GL, Hutter M, Harvey AM, Apvian CM, Boulton HR, et al. Expert panel on weight loss surgery: executive report update. Obesity. 2009;17:842-862.

Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: A systematic review and economic evaluation. Health Technol Assess. 2009;13:1-190, 215-357.

Updated: 4/17/2012

Reviewed by: Ann Rogers, MD, Associate Professor of Surgery; Director, Penn State Surgical Weight Loss Program, Penn State Milton S. Hershey Medical Center. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.