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Gastric bypass: Is this weight-loss surgery for you?
From MayoClinic.com
Special to CNN.com


It's always best to lose weight through a healthy diet and regular physical activity. But if you're among those who have tried and can't lose the excess weight that's causing your health problems, weight-loss (bariatric) surgery may be an option.

Gastric bypass, which changes the anatomy of your digestive system to limit the amount of food you can eat and digest, is the favored bariatric surgery in the United States. Most surgeons prefer this procedure because it's safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes.

Gastric bypass isn't for everyone with obesity, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle.


Who is gastric bypass surgery for?

Generally, gastric bypass surgery is reserved for people who are unable to achieve or maintain a healthy weight through diet and exercise, are severely overweight, and who have health problems as a result. Gastric bypass may be considered if:

Your body mass index (BMI) is 40 or higher (extreme obesity).
Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problems such as diabetes or high blood pressure.
Gastric bypass surgery doesn't replace the need for following a healthy diet and regular physical activity program. In fact, the success of the surgery depends in part on your commitment to following the guidelines given to you about diet and exercise. As you consider weight-loss surgery, make sure that you make every effort to exercise, change your eating habits and adjust any other lifestyle factors that have contributed to your excess weight.


How do you prepare for gastric bypass surgery?

Surgical candidates go through an extensive screening process. Not everyone who meets the criteria for gastric bypass is psychologically or medically ready for the surgical procedure. A team of professionals, including a physician, dietitian, psychologist and surgeon, evaluate whether the surgery is appropriate for you. This involves identifying which aspects of your health would be expected to improve after surgery and what aspects of your health may increase the risks of surgery. Surgery is recommended when the perceived benefits of surgery outweigh the recognized risks.

Your willingness and ability to follow through with the recommendations made by your health care team and to carry out prescribed changes in your diet and exercise routine help determine your readiness for surgery. The surgery may not be recommended or may be postponed if there's any sign that you aren't psychologically or medically ready for surgery.

It's important to follow your doctor's directions in preparing for gastric bypass surgery. This includes restrictions on eating, drinking, starting a program of physical activity, and limiting or stopping the use nicotine products.


How is gastric bypass surgery done?

In gastric bypass (Roux-en-Y gastric bypass) the surgeon creates a small pouch at the top of your stomach and adds a bypass around a segment of your small intestine.



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 secrete 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.


What can you expect during the surgery?

Gastric bypass surgery is performed under a general anesthesia. This means you inhale analgesics as a gas or receive them through an intravenous (IV) line so that you're asleep during the surgery.

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.

You may have another tube in the bypassed stomach. This tube would come out of the side of your abdomen and is removed four to six weeks after surgery. Some skin irritation may develop around this tube.

Gastric bypass surgery takes about four hours. After surgery, you wake up in a recovery room, where medical staff monitor you for any complications. Your hospital stay may last from three to five days.


What can you expect after gastric bypass surgery?

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 dietary progression for about 12 weeks. This begins with liquids only, proceeds to pureed and soft foods, and finally 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 ever 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 percent 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.



Gastric bypass diet: Nutritional needs after weight-loss surgery

What are the benefits of gastric bypass surgery?

In addition to dramatic weight loss, gastric bypass surgery may improve or resolve the following conditions associated with obesity:

Type 2 diabetes
High blood cholesterol
High blood pressure
Obstructive sleep apnea
Gastroesophageal reflux disease (GERD)
Gastric bypass surgery has also shown to improve mobility and quality of life for people who are severely overweight.


What are the risks of gastric bypass surgery?

As with any major surgery, gastric bypass carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Possible risks specific to this surgery include:

Death. A risk of death has been associated with gastric bypass surgery. The risk varies depending on age, general health and other medical conditions. Talk to your doctor about the exact level of risk gastric bypass surgery may pose for you.
Blood clots in the legs. Blood clots in the legs are more likely to occur in very overweight people. Blood clots can be dangerous. In some cases, they travel to the lungs and lodge in the lungs' arteries causing a pulmonary embolism — a serious condition that damages lung tissue and can lead to death. Walking and using leg wraps that apply intermittent pressure to the leg can help reduce this risk of blood clots in the legs.
Leaking at one of the staple lines in the stomach. This severe postoperative problem would be treated with antibiotics. Most cases heal with time. Sometimes, the leak can be serious enough to require emergency surgery.
Pneumonia. Excess weight places extra stress on the chest cavity and lungs. This means a higher risk of developing pneumonia after the surgery.
Narrowing of the opening between the stomach and small intestine. This rare complication may require either an outpatient procedure to pass a tube through your mouth to widen (dilate) the narrowed opening or corrective surgery.
Gastric bypass can also cause dumping syndrome, a condition where stomach contents move too quickly through the small intestine causing nausea, vomiting, diarrhea, dizziness and sweating. Other common complications of gastric bypass surgery include:

Vitamin and mineral deficiency
Dehydration
Gallstones
Bleeding stomach ulcer
Hernia at the incision site
Intolerance to certain foods

What are other weight-loss surgery options?

Though it's the most commonly used, gastric bypass is just one kind of weight-loss surgery. Other types include:

Adjustable gastric banding. The surgeon uses an inflatable band to partition the stomach into two parts. He or she then wraps the band around the upper part of your stomach and pulls it tight, like a belt, creating a tiny channel between the two pouches. The band keeps the opening from expanding and is designed to stay in place indefinitely. But it can be adjusted or surgically removed if necessary. Most surgeons perform this operation using a laparoscope.
Vertical banded gastroplasty. This operation divides the stomach into two parts — limiting space for food and forcing you to eat less. There is no bypass. Using a surgical stapler, the surgeon divides your stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch — the rest of your stomach. Partly because it doesn't lead to adequate long-term weight loss, surgeons use it less commonly than gastric bypass.
Biliopancreatic diversion. In this procedure, a portion of your stomach is removed. The remaining pouch is connected directly to your small intestine, but completely bypasses your duodenum and jejunum where most nutrient absorption takes place. This weight-loss surgery offers sustained weight loss, but it presents a greater risk of malnutrition and vitamin deficiencies and requires close monitoring.

Looking ahead

Surgery for weight reduction isn't a miracle procedure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after gastric bypass surgery depends on your commitment to making lifelong changes in your eating and exercise habits. But the feeling of accomplishment as you lose weight and your improved health are significant benefits and are well worth your efforts.

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There's also a special Gastric Bypass Diet that follows.......

Gastric bypass diet: Nutritional needs after weight-loss surgery
From MayoClinic.com
Special to CNN.com


What you eat, how you eat and how much you eat changes after gastric bypass surgery — surgery that alters the anatomy of your digestive system to promote weight loss.

With your stomach pouch reduced to the size of a walnut, you'll need to follow a gastric bypass diet. This diet — which your doctor or dietitian creates for you — tells you what type and how much food to eat with each meal and the required consistency and texture of the food. The gastric bypass diet helps you maintain good nutrition while losing weight.


After surgery: The first three months

You won't be allowed to eat for one to two days after the surgery. Then you consume specific foods according to a diet progression. The purpose of the diet progression is to allow your stomach time to adapt to processing food and to allow you to lose weight while maintaining good nutrition.

The following are common phases in the gastric bypass diet progression:

Liquids. Foods and fluids that are liquid or semiliquid at room temperature and contain mostly water, such as broth, juice, milk and cooked cereal. In most cases, you stay on a liquid diet for two to three days.
Pureed foods. Foods with a consistency of a smooth paste or a thick liquid. Pureed foods contain no distinct pieces. You usually eat pureed foods for three to four weeks so that your stomach has time to fully heal.
Soft foods. Foods that are tender and easy to chew, such as ground or finely diced meats, canned or soft, fresh fruit, and cooked vegetables. You usually eat soft foods for eight weeks before progressing to regular-textured foods, as recommended by your dietitian or doctor.
During the diet progression, you eat many small meals a day and sip water frequently. You might first start with six small meals a day, then progress to four meals and finally, when eating regular foods, decrease to three meals a day. Typically, each meal includes protein-rich foods, such as lean meat, yogurt and eggs. Protein is important for maintaining and repairing your body after surgery.

How quickly you move from one step to the next depends on how fast your body adjusts to the change in eating patterns and the texture and consistency of food. In most cases, people start eating regular foods three months after surgery.



Gastric bypass: Is this weight-loss surgery for you?

Lifelong changes: New eating habits

After three months, expect to eat three small meals and three small, healthy snacks a day. Your meals typically include lean sources of protein (such as poultry without skin or low-fat cottage cheese) fruits, vegetables and whole grains. Limit or avoid high-sugar, high-fat foods, which provide many calories but few nutrients.

The changes in your digestive system restrict how much you can eat and drink with each meal. To avoid problems and to ensure you're getting all the nutrients you need, closely follow these guidelines:

Eat small amounts. Just after surgery, your stomach holds only about 1 ounce of food. Though your stomach stretches over time to hold more food, you won't be able to eat more than 1 to 1 1/2 cups of food with each meal. Eating too much food adds extra calories and can cause pain, nausea, vomiting and abdominal cramps. Make sure you eat only the recommended amounts and stop eating before you feel full.
Eat and drink slowly. Eating or drinking too quickly, especially high-sugar foods such as soda or ice cream, can cause dumping syndrome — when foods and liquids enter your small intestine rapidly and in larger amounts than normal, causing nausea, vomiting, diarrhea, dizziness and sweating. To prevent dumping syndrome, eat your food and sip your beverages slowly. Take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup of liquid.
Chew food thoroughly. The new opening that leads from your stomach into your intestine is very small and large pieces of food can easily block the opening. Blockages prevent food from leaving your stomach and could cause vomiting. Take small bites of food and chew them to a pureed consistency. If you can't chew the food thoroughly, don't swallow it.
Drink most of your fluids between meals. Drinking beverages with your meals may cause pain, nausea and vomiting as well as dumping syndrome. Also, too many liquids at mealtime may leave you feeling overly full and prevent you from eating enough nutrient-rich foods. Expect to drink about 6 to 8 cups of fluids a day to prevent dehydration.
Try new foods one at a time. After surgery, certain foods may cause nausea, pain, vomiting or may block the opening of the stomach. To find out which foods are OK to eat and which cause you trouble, try one new food at a time. Foods that commonly cause trouble include dry tough meats, bread, raw vegetables and carbonated beverages.
Take recommended vitamin and mineral supplements. After surgery, your body has difficulty absorbing certain nutrients because most of your stomach and the first part of your small intestine are bypassed. To prevent a vitamin or mineral deficiency, take vitamin and mineral supplements regularly. These may include a multivitamin-multimineral, calcium, vitamin B-12 and possibly an iron supplement.

Weight loss and weight gain

Within the first two years following surgery, you can expect to lose 50 percent to 60 percent of your excess weight, if you follow the dietary and exercise recommendations. If you continue to follow these recommendations, you can keep most of that weight off long-term.

However, if you return to your old eating habits, you may gain back any weight you've lost. People who regain weight after gastric bypass surgery usually are consuming too many high-calorie foods and beverages and don't exercise enough. And rather than eating three meals a day and small snacks, some people graze — eat food all day long. This eating pattern often leads to consuming too many calories, which causes weight gain.

If you aren't losing weight or are regaining weight after surgery, see your doctor. Your health care team can help reassess your eating and exercise habits and help you confront and overcome any weight-loss obstacles.

Though weight-loss surgery helps you shed the pounds, its success depends on your willingness to adopt lifelong healthy-eating and exercise habits. What you eat and how you eat changes after surgery, but the benefits of weight loss and your improved health are well worth these efforts.


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