Overview

Gastric bypass is a common bariatric surgical procedure. The surgeon bypasses a portion of the stomach and the intestine so that the food reaches the intestine faster. The surgeon makes a small pouch of your stomach and connects it to the small intestine so that less food is available in the intestine for absorption. Gastric bypass is done in obese patients to lose weight when other treatment options, such as dieting, medications, lifestyle modifications, etc., fail. This surgery is also done for patients with comorbidities such as high blood pressure, type 2 diabetes, gastroesophageal reflux disease (GERD), etc.

Alternate Name

Roux-en-Y gastric bypass

Body Location

Stomach and small intestine

How is it Performed?

Gastric bypass surgery is done under general anaesthesia. You will be asleep throughout the procedure without feeling any pain or sensation. The surgery can be open, laparoscopic, or robotic, depending on your health condition and other factors such as cost, recovery rate, etc. In robotic or laparoscopic surgery, multiple small incisions are made in the abdomen to insert surgical instruments like robotic arms, a high-definition camera, etc., depending upon the surgery type.

On the contrary, in open surgery, a large incision is made.

Robotic surgery is preferred over conventional open or laparoscopic surgeries owing to better precision, less pain, less blood loss, quick recovery time, and a similar success rate.

The procedure involves two steps:

Pouch creation: The stomach is divided into two pouches—a small one and a large one, using a stapler. The small pouch is the upper part of the stomach connected to the food pipe, and the large pouch is the bottom part connected to the small intestine. The small pouch is the size of a walnut and can hold only 25-30 g of food. You will feel abdominal fullness after eating less and lose weight.
Bypass: In the second step, the surgeon creates a bypass by connecting the small pouch through a hole to the jejunum (a small part of the small intestine). This bypass will help the food to travel directly from the small stomach pouch to the jejunum (bypassing the duodenum in the small intestine), and fewer calories will be absorbed, promoting weight loss.

The incisions will be stitched carefully under sterile conditions.

Preparation

Before deciding on the type of gastric bypass surgery, your surgeon will ensure that you are the right candidate. The surgeon will assess your medical history and current disease conditions such as diabetes, heart disease, etc.

You will undergo a pre-anaesthesia checkup (PAC), including an electrocardiogram (ECG), a chest X-ray, and certain blood tests such as CBC (complete blood count), bleeding time, clotting time, etc.

You should inform your surgeon about all the medications you take, especially blood thinners such as warfarin, aspirin, etc., as these drugs are associated with the risk of bleeding during the surgery. You might be given anti-anxiety medications to calm your nerves a few days before the surgery. You must quit smoking, tobacco use, and alcohol use at least a few weeks before the surgery to avoid complications.

You should not eat or drink anything post-midnight, the day before the surgery. You should reach the hospital at least 4-6 hours before the surgery as you will be under observation before preparing.

Procedure Type

Minimally invasive surgery (for robotic and laparoscopic) and invasive for open surgery

Follow-up

You will have regular follow-ups to ensure anticipated progress. During the first few months, you will need to take various tests such as blood work, imaging procedures (CT scan, ultrasounds, fluoroscopy, etc.), and lab tests to assess your response to the bypass surgery.

You should begin with light physical activity after the surgery, such as walking, and you can increase the distance slowly as you gain strength. Avoid strenuous activities such as cycling, running, jogging, lifting weights, etc., for at least 3-6 weeks. If your job requires heavy work, you should discuss it with your doctor. Avoid excessive bending as it will exert pressure on the abdomen.

Clean the incisions with gentle soap and water and pat dry to avoid the risk of infections.

Risks

Gastric bypass surgery has the following risks:

Incision site pain/redness/inflammation
Staple line leak though very rare in Center of Excellences
Nutritional deficiencies if supplements are not taken after the surgery

Recovery

After the surgery, you will stay in the observation room. Once your vitals have stabilized, you will be shifted to the recovery room within a few hours to a day. You will be discharged soon after. During the initial few weeks, you will only be on a liquid diet while your stomach and intestine heal to handle the solid food. You will be given multivitamins and multi-mineral supplements (a combination of iron, vitamin B12, and iron) to recover quickly and regain strength.

You will experience maximum weight loss during the initial months and may face symptoms such as weakness, hair loss. However, these symptoms will subside as you recover and return to your routine activities. Take medications as prescribed by your surgeon. Always keep an eye on warning signs of complications such as prolonged cough, pain in the abdomen, fever, diarrhoea, etc., and seek immediate medical attention if required.