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During the procedure
Each type of bariatric surgery has different steps, though most share similar procedures.
General anesthesia is used for gastric bypass surgery. This means you're unconscious during the surgery.
When a Roux-en-Y gastric bypass is performed, the surgeon staples your stomach across the top, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold about an ounce of food. The pouch is physically separated from the rest of the stomach. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch.
This redirects food, bypassing most of your stomach and the first section of your small intestine, the duodenum (doo-o-DEE-num). Food enters directly into the second section of your small intestine, the jejunum (jay-JOO-num), limiting your ability to absorb calories. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to release digestive juices to mix with food in your small intestine.
Some surgeons perform this operation by using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen (laparoscopic gastric bypass). The tiny camera on the tip of the scope allows the surgeon to see inside your abdomen.
Compared with traditional "open" gastric bypass, the laparoscopic technique usually shortens your hospital stay and leads to a quicker recovery. Fewer wound-related problems also occur. Not everyone is a candidate for laparoscopic gastric bypass, however. Talk to your doctor about whether this approach is appropriate for you.
During surgery, a tube is passed through your nose into the upper stomach pouch. Occasionally, this tube stays in overnight. The tube is connected to a suction machine after surgery to keep the small stomach pouch empty so that the staple line can heal.
Gastric bypass surgery takes about four hours. After surgery, you awaken in a recovery room, where medical staff monitor you for any complications. Your hospital stay may last from three to five days.
After the procedure
You won't be allowed to eat for one to two days after the surgery so that your stomach can heal. Then, you'll follow a specific diet for about 12 weeks. The diet begins with liquids only, then ground-up or soft foods, and finally progresses to regular foods.
With your stomach pouch reduced to the size of a walnut, you'll need to eat very small meals throughout the day. In the first six months after surgery, eating too much or too fast may cause vomiting or an intense pain under your breastbone. The amount you can eat gradually increases, but you won't be able to return to your old eating habits.
You may experience one or more of the following changes as your body reacts to the rapid weight loss in the first three to six months:
- Body aches
- Feeling tired, as if you have the flu
- Feeling cold
- Dry skin
- Hair thinning and hair loss
- Mood changes
Within the first two years of surgery, you can expect to lose 50 to 60 percent of your excess weight. If you closely follow dietary and exercise recommendations, you can keep most of that weight off long term.
- American Gastroenterological Association. American Gastroenterological Association medical position statement on obesity. Gastroenterology. 2002;123:879.
- Bariatric surgery for severe obesity. National Institute on Diabetes and Digestive and Kidney Diseases. http://win.niddk.nih.gov/publications/PDFs/gasurg12.04bw.pdf. Accessed Aug. 10, 2009.
- Mun EC, et al. Surgical management of severe obesity. http://www.uptodate.com/home/index.html. Accessed Aug. 10, 2009.
- Angrisiani L, et al. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surgery for Obesity and Related Diseases. 2007;3:127.
- Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 2009;361:445.
- Suter M, et al. Results of Roux-en-Y gastric bypass in morbidly obese vs superobese patients: Similar body weight loss, correction of comorbidities, and improvement of quality of life. Archives of Surgery. 2009;144:312.
- Cottam D, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surgical Endoscopy. 2006;20:859.
- Mun EC, et al. Complications of bariatric surgery. http://www.uptodate.com/home/index.html. Accessed Aug. 10, 2009.
