WLS OVERVIEW--WHAT TO EXPECT AFTER SURGERY

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Surgery Overview

What To Expect After Surgery

Why It Is Done

How Well It Works

Risks

What To Think About

References

Gastric bypass

Surgery Overview

Gastric bypass surgery makes the stomach smaller and allows food to

bypass part of the small intestine. You will feel full more quickly

than when your stomach was its original size, which reduces the

amount of food you eat and thus the calories consumed. Bypassing

part of the intestine also results in fewer calories being absorbed.

This leads to weight loss.

The most common gastric bypass surgery is a Roux-en-Y gastric

bypass.

In normal digestion, food passes through the stomach and enters the

small intestine, where most of the nutrients and calories are

absorbed. It then passes into the large intestine (colon), and the

remaining waste is eventually excreted.

In a Roux-en-Y gastric bypass, the stomach is made smaller by

creating a small pouch at the top of the stomach using surgical

staples or a plastic band. The smaller stomach is connected directly

to the middle portion of the small intestine (jejunum), bypassing

the rest of the stomach and the upper portion of the small intestine

(duodenum).

This procedure can be done by making a large incision in the abdomen

(an open procedure) or by making a small incision and using small

instruments and a camera to guide the surgery (laparoscopic

approach).

See an illustration of a Roux-en-Y gastric bypass.

What To Expect After Surgery

This surgery usually involves a 4- to 6-day hospital stay (2 to 3

days for a laparoscopic approach). Most people can return to their

normal activities within 3 to 5 weeks.

Gastric bypass surgeries may cause dumping syndrome. This occurs

when food moves too quickly through the stomach and intestines. It

causes nausea, weakness, sweating, faintness, and possibly diarrhea

soon after eating. These symptoms are made worse by eating highly

refined, high-calorie foods (like sweets). In some cases you may

become so weak that you have to lie down until the symptoms pass.

Why It Is Done

Although guidelines vary, surgery is generally considered when your

body mass index is 40 or higher or you have a life-threatening or

disabling condition related to your weight.

Your doctor may only consider doing gastric bypass surgery if you

have not been able to lose weight with other treatments.

The following conditions may also be required or are at least

considered:

You have been obese for at least 5 years.

You do not have a history of alcohol abuse.

You do not have untreated depression or another major psychiatric

disorder.

You are between 18 and 65 years of age.

All surgeries have risk, and it is important for you and your health

professional to discuss your treatment options to decide what is

best for your situation.

How Well It Works

Most people who have gastric bypass surgery quickly begin to lose

weight and continue to lose weight for up to 12 months. One study

noted that people lost about one-third of their excess weight (the

weight above what is considered healthy) in 1 to 4 years.1 Some of

the lost weight may be regained.

The laparoscopic approach showed similar results, with 69% to 82% of

excess weight lost over 12 to 54 months.2

Risks

Risks common to all surgeries for weight loss include an infection

in the incision, a leak from the stomach into the abdominal cavity

or where the intestine is connected (resulting in an infection

called peritonitis), and a blood clot in the lung (pulmonary

embolism). About one-third of all people having surgery for obesity

develop gallstones or a nutritional deficiency condition such as

anemia or osteoporosis.3, 4

Fewer than 3 in 200 (1.5%) people die after surgery for weight loss.3

After a Roux-en-Y gastric bypass:5, 3

An iron and vitamin B12 deficiency occurs more than 30% of the time.

About 50% of those with an iron deficiency develop anemia.

The connection between the stomach and the intestines narrows

(stomal stenosis) 5% to 15% of the time, leading to nausea and

vomiting after eating.

Ulcers develop 5% to 15% of the time.

The staples may pull loose.

Hernia may develop.

The bypassed stomach may enlarge, resulting in hiccups and bloating.

What To Think About

In a gastric bypass, the part of the intestine where many minerals

and vitamins are most easily absorbed is bypassed. Because of this,

you may have a deficiency in iron, calcium, magnesium, or vitamins.

This can lead to long-term problems, such as osteoporosis. To

prevent vitamin and mineral deficiencies, you may need to work with

a dietitian to plan meals, and you may need to take nutrient

supplements and injections of vitamin B12.

Early studies of the laparoscopic approach to surgery for obesity

suggest that it reduces recovery time and postsurgery complications.2

Complete the surgery information form (PDF)(What is a PDF document?)

to help you prepare for this surgery.

References

Citations

Balsiger BM, et al. (2000). Prospective evaluation of Roux-en-Y

gastric bypass surgery as primary operation for medically

complicated obesity. Mayo Clinic Proceedings, 75(7): 673–680.

Schauer PR, Ikramuddin S (2001). Laparoscopic surgery for morbid

obesity. Surgical Clinics of North America, 81(5): 1145–1179.

American Gastroenterological Association (2002). AGA technical

review on obesity. Gastroenterology, 123(3): 882–932.

National Institute of Diabetes and Digestive and Kidney Diseases

(2001). Gastrointestinal Surgery for Severe Obesity (NIH Publication

No. 01–4006). Available online

Brolin RE (2002). Bariatric surgery and long-term control of morbid

obesity. JAMA, 288(22): 2793–2796.

Credits

Author Ellie Rodgers

Editor Geri Metzger

Associate Editor Terrina Vail

Primary Medical Reviewer Adam Husney, MD

- Family Medicine

Primary Medical Reviewer Caroline S. Rhoads, MD

- Internal Medicine

Specialist Medical Reviewer Jody Wilkinson, MD, MS

-