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Gastric Bypass Surgery
 The
most common type of gastric bypass surgery is called a ‘Roux-en-Y’
gastric bypass. 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 will reduce the amount of food you eat and thus reduce the
calories consumed. Bypassing part of the intestine also results
in fewer calories being absorbed. This will lead to weight loss.
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 procedure, a small stomach pouch is created which
reduces the amount of food you can eat. The smaller stomach is connected
directly to the middle portion of the small intestine, bypassing
the rest of the stomach and the upper portion of the small intestine.
Who can have this procedure?
Although guidelines can vary, surgery is generally considered when
body mass index is 40 or greater. Also, if 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 at least considered:
• You have been obese for at least 5 years
• You do not have an ongoing problem with alcohol
• You do not have an untreated depression or another major
psychological condition
• You are between 18 and 65 years old
How is the operation performed?
Many surgeons perform this surgery laparoscopically. You will be
admitted to the hospital the morning of your surgery and the expected
length of stay is 1-3 nights post surgery. The surgeon will make
a series of small incisions in your upper abdomen, through which
he/she will pass fine laparoscopic instruments and a camera. The
expected length of surgery is between 1-3 hours. In some patients
that are very obese, or who have had previous abdominal surgery,
it is possible that they might not be a candidate for laparoscopic
surgery but may need ‘open’ surgery instead. Recovery
may take a little longer but weight loss will be just the same.
Some patients may have nausea or vomiting but medication is available
to rectify this promptly. Some discomfort and limited mobility is
also to be expected but prescribed medication is available to control
this. You can be assured of immediate care and attention at all
times. Please inform the hospital staff of your concerns and this
will be dealt with immediately and efficiently.
What to expect following surgery
Patients will be on a clear liquid diet for the first few days immediately
following gastric bypass surgery, and then advance to a pureed diet.
These foods will be very soft, so as to pass through the small,
newly formed pouch and stoma. One of the main issues during this
period will be adequate fluid intake, and dehydration can be a problem
for patients recovering from this surgery. Approximately one month
after the gastric bypass surgery, the patients can expect to advance
to a transitional diet. They begin to take more regular table foods,
but will often still go back to eating the pureed foods that they
have tolerated well. They will still be learning how to eat right,
including chewing food carefully, learning to drink most of their
liquids between rather than with meals, and learning that eating
the wrong foods, such as sweets or fatty foods, can make them ill.
Patients experience the most rapid weight loss during this period.
They are often thrilled to see the weight coming off, sometimes
at the rate of 10 kgs a month, but it is not an easy time. Patients
feel the loss of calories taken in, and are sometimes low in energy.
Their small pouch will make them uncomfortable when they eat too
much or too fast. They may have diarrhoea, which can usually be
controlled by avoiding certain foods or by taking medication. They
may experience hair loss, though the hair usually begins to grow
back within a few months.
6 months after the gastric bypass surgery, the patients will probably
be on their long-term maintenance diet, which is more or less what
and how they will eat for the rest of their lives. The maintenance
diet for the most part consists of regular table foods, but in small
portions. Most patients describe their meals as child sized, and
they often do not finish what they are served. The patients generally
become comfortable eating these small meals, and almost always say
the loss of the ability to enjoy large meals or certain foods is
more than compensated for by being able to successfully control
their weight.
Patients may expect to lose approximately 70% of their excess body
weight during the first 2 years following surgery. Sometimes a weight
regain of about 10% is seen between years 2 and 5, perhaps because
the small pouch increases several ounces in size, and perhaps because
the patients learn how to take in extra calories without making
themselves sick.
The surgical community involved in gastric bypass surgery is very
concerned about this late 10% or any other weight regain. An effort
is made in order to keep patients involved in support groups and
in follow-up with their doctors to reinforce what they had been
taught after surgery, and what had worked for them the first 2 years.
Long term success with this operation requires a team effort of
both the patients and their doctors. A monthly meeting at Dubai
Mall Medical Centre is one such support network encouraging each
other to push forward and live life to the full.
Gastric Bypass Surgery patients take in less food and absorb less
of what they take in, making them at risk for developing nutritional
deficiencies. They must also make a life- long commitment to taking
vitamin, mineral, and possibly protein supplements, and may become
very ill if they don't.
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