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Gastric bypass surgery

Gastric bypass is a type of weight loss surgery. It works by making your stomach smaller and your digestive system shorter.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About gastric bypass surgery

A gastric bypass is an operation to make your stomach smaller and to shorten the length of small intestine that your food passes through. This allows the food you eat to bypass most of your stomach and part of your small intestine – meaning that you will only be able to eat small amounts, and some of the food that you eat won't be fully digested. Gastric bypass surgery can help you lose weight if you're very overweight (morbidly obese).

Gastric bypass surgery is sometimes called a Roux-en-Y gastric bypass (named after a surgeon called Roux). This is the most common type of gastric bypass operation carried out in the UK.

Studies show that on average, people lose between two-thirds and three-quarters of their excess weight in the two years after a gastric bypass operation.

Getting gastric bypass surgery

Your doctor will only suggest surgery if you have tried to lose weight in other ways (such as with medicines, healthy eating and exercise) for at least six months and this hasn't worked. Surgery will also usually only be considered if:

  • you're morbidly obese with a body mass index (BMI) of more than 40 or you have a BMI of over 35 and also have a medical condition, such as diabetes or high blood pressure, that would be likely to improve if you lose weight
  • you’re generally fit enough to undergo surgery
  • you’re committed to losing weight and maintaining that weight loss by combining the surgery with lifestyle changes in the future, and are prepared to attend regular follow-ups

In some areas of the UK, you may still not be eligible for the procedure even if you meet these criteria, due to the high demand for weight loss surgery. If your GP thinks weight loss surgery could be beneficial to you, he or she will refer you to a bariatric surgeon (a doctor specialising in obesity surgery) to talk about your options.

What are the alternatives?

There are other types of surgery available that can help you to lose excess weight by making your stomach smaller. These include gastric band and sleeve gastrectomy. Your surgeon will talk to you about the options available and help you to weigh up the risks and benefits of each, to decide which is best for you.

Preparing for a gastric bypass operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection, chest infection or blood clot, and slows your recovery. This is particularly important before any weight loss operation because being very overweight increases your risk of complications after surgery.

Your surgeon may ask you to follow a low-fat, low-sugar and low-carbohydrate diet with no alcohol for one to two weeks before your operation. This helps to shrink your liver and makes it more likely that your surgeon will be able to do the operation using keyhole (laparoscopic) surgery.

A gastric bypass operation is performed under general anaesthesia. This means you will be asleep during the operation.

You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice. At the hospital, your nurse will check your heart rate and blood pressure, and test your urine.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may also be given an injection of an anticlotting medicine called heparin.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a gastric bypass operation?

A gastric bypass operation usually takes between one and three hours.

The operation is usually done using keyhole surgery. Keyhole surgery is carried out by making small cuts in your abdomen (tummy) rather than one large cut. During a keyhole operation, your surgeon uses small instruments, guided by a special telescope with a camera, to perform the procedure.

If you’re very overweight or have had surgery to your abdomen before, then your surgeon may recommend having an open operation, which is done through a single, larger incision.

Using surgical staples, your surgeon will make a pouch out of the top of your stomach, separating it from the lower part of your stomach. Your surgeon will make an opening in the pouch and connect it to a section of your small intestine. This means the food you eat will bypass your old stomach and the first part of your intestine. The length of small intestine that the operation bypasses can be adjusted to make sure that when you reach the right weight for your height, you will be able to eat enough to maintain that weight. Your surgeon may insert a drain, to help remove any fluid or blood that might have collected inside your abdomen.

Your surgeon will close your cuts with stitches or small metal clips, and place a dressing over your wounds.

Gastric bypass operation

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you had open surgery, you may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes coming from the wound which drain fluid into another bag and are usually removed after a day or two.

On the first day, you may have to wear special pads attached to an intermittent compression pump on your lower legs. The pump inflates the pads and encourages blood flow in your legs, helping to prevent deep vein thrombosis (DVT). You may also need to wear compression stockings to help maintain your circulation. You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs. You may have a nasogastric tube fitted (a tube inserted into your nose that goes down to your stomach) to keep your stomach pouch empty. This is usually removed the following day.

You will have a drip put into a vein in your hand or arm to give you fluids. If you feel well enough, you can start to drink small amounts of water soon after your operation.

Two to four days after your operation, you may have an X-ray to check that the stitches and staples are healing well and that there are no leaks. You may be asked to swallow a fluid (barium) that shows up on X-ray images. If the X-ray shows that the operation has been successful, you will be able to start drinking freely, including soups and fruit juice.

You will usually be able to go home two to five days after your operation. You will need to arrange for someone to drive you home.

Your surgeon may use dissolvable stitches. The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they should usually disappear in seven to 10 days. If you have non-dissolvable stitches or clips, you will need to have them taken out. Your surgeon will tell you when and where to have them removed.

Your nurse will give you advice about caring for your healing wounds before you go home and give you a date for a follow-up appointment.

Recovering from gastric bypass surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You will need to make major changes to the foods you eat after your operation. You will only be able to eat small amounts at each meal. To start with, stick to liquids, and then move onto puréed food. You may also need to take vitamin and mineral supplements. Your surgeon and dietician will give you all the information you need about what foods to eat and how much.

You will be asked to make other changes to your lifestyle, such as becoming more active. These changes will help you to get the most from your gastric bypass operation and will help you to lose excess weight and keep it off. Being active will also help to tone your muscles and improve your posture.

You will need to have regular blood tests after your operation. These are to check that you’re getting all of the vitamins, minerals and nutrients you need to stay healthy.

It usually takes between four and six weeks to make a full recovery from a gastric bypass operation. However, this varies between individuals, so it's important to follow your surgeon's advice.

What are the risks?

As with every procedure, there are some risks associated with gastric bypass surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You're likely to have some bruising, pain and swelling of the skin around your wounds.

You may feel sick or vomit after eating, because the amount you’re able to eat is a lot less than before the operation. This should get better as you change your eating habits.

If you eat too many sugary foods, you can get an unpleasant sensation called dumping. It can make you feel sick or faint, or give you abdominal pain and diarrhoea. Eating small meals and eating little or no sugary food will help to ease these symptoms. If you feel unwell after eating sugary foods, lie down and drink fluids only until the feeling passes. See our frequently asked questions for more information about dumping.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (DVT).

Being very overweight increases your risk of complications following any operation. You’re more likely to have complications from having a general anaesthetic and are more at risk of developing blood clots. If you have other conditions linked to your weight, such as high blood pressure or diabetes, then these can also increase your risk of developing complications.

Complications specific to a gastric bypass operation are listed below.

  • An infection in your wound or a chest infection.
  • A blood clot in your lung (pulmonary embolism).
  • A leak at the place where your intestine is re-joined to your stomach. This can be very serious and you will usually have an operation to repair it straight away.
  • The opening from your stomach into your intestine can become narrowed, which makes it more difficult for food to pass through it, or your stomach can become stretched. If the opening becomes narrowed, it can usually be enlarged using a flexible telescope that you swallow called an endoscope. If you stretch the stomach pouch by overeating, this can only be repaired with surgery.
  • A lack of protein, vitamins and minerals caused by the change in the amount and type of food you’re able to eat after the operation. This can affect your general health. Vitamin and mineral supplements can help to prevent this. You may need to have injections of vitamin B12.

If you lose weight quickly, you may develop gallstones. These can be painful and you may need surgery to remove them. Your surgeon may prescribe medicine to reduce your risk of developing gallstones.

During your operation, your surgeon may come across an unexpected problem and may need to convert the keyhole operation to an open procedure. This won’t affect how well the operation works, but it may take a longer time for you to recover afterwards.

Not everyone loses enough weight after gastric bypass surgery. Inadequate weight loss is usually from not following the correct diet or taking enough exercise. If this happens, your surgeon may suggest another operation.

 

Produced by Pippa Coulter, Bupa Health Information Team, December 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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