A Guide to Gastric Bypass Surgery

Dr. Christopher McGowan
September 14, 2020

If you are reading this article, there is a chance you or someone you know is overweight. In fact, as harsh as it may sound, you may have heard the term “morbidly obese.” This is not a sensational term. The negative health effects of being severely overweight are a genuine threat to your life. Especially as you age, carrying large amounts of excess weight will significantly increase your chances of dying early. This is to say nothing of the diminished quality of life you may experience from any of a number of diseases to which severe obesity contributes.

With this rather blunt intro it will likely not surprise you that gastric bypass is not just a cosmetic option or a quick ticket to losing pounds the easy way. Gastric bypass surgery is a serious medical procedure, and though it is done to help improve your quality of life, the side effects of this surgery can themselves turn deadly.

What is Roux-en-y Gastric Bypass Surgery?

Gastric bypass surgery is a weight loss surgery where the size of the stomach is reduced to prevent you from eating as much as you were before surgery. In a gastric bypass, the top portion of your stomach is cut and turned into a small pouch only a fraction the size of your normal stomach. Gastric bypass is usually only considered for people who have a body mass index (BMI) over 40 who cannot lose weight by other methods. There are many kinds of bariatric surgery, but the roux-en-y gastric bypass has historically been regarded as the most successful. 

During a gastric bypass surgery, a surgeon cuts through the stomach near the top and seals off the larger bottom portion of the stomach. The remaining top portion of the stomach is then sewn together into a small pouch that is connected directly to a portion of your small intestine that has been cut and re-routed from its original position. The result is the amount of food you can eat is drastically reduced. Due to the severe restriction on how many calories you can take in, you are very likely to lose the majority of your excess body weight after a gastric bypass surgery. 

Gastric bypass surgery is a serious surgery that carries life-long consequences. If you are a candidate for surgery, you will need to prepare for weeks or even months ahead of time. You will consult with a team of doctors and dietitians who will not only help you prepare for surgery, but will also work with you long after you are out of the operating room. 

After you have bariatric surgery, your life, and certainly your diet, will never be the same. It is very likely you will lose 60-70% of your excess body weight in the first several months after your surgery. For the rest of your life you will need to be conscious of what you are eating to ensure you do not stretch or damage your new smaller stomach. You will also need to maintain a strict regimen of vitamins and mineral supplements to ensure you get enough nutrients to keep your body healthy. 

Who is a Candidate for Gastric Bypass Surgery?

There are many surgeries and procedures available today to change the way your body looks. An entire branch of medicine exists to help people sculpt and shape their bodies into the shape they desire when a few pounds prove hard to lose. Gastric bypass is a different matter altogether. 

Morbid obesity, a condition identified as having a BMI over 40, is the main prerequisite for being a candidate for gastric bypass surgery. Being overweight to this extent has been proven to have serious detrimental effects on your health. The list is quite long of ways being overweight can affect you, but a few of the headliners are as follows:

  • sleep apnea
  • heart disease
  • type 2 diabetes
  • high blood pressure
  • stroke 
  • high cholesterol

How is Gastric Bypass Performed?

No matter how you slice it, gastric bypass surgery is a major surgery that requires a hospital stay and has potential health problems of its own. Anytime surgery is performed, there is the possibility of infection, and the chance for blood clots to form, to say nothing of the possibility of complications with the anesthesia. 

There are two main ways gastric bypass surgery is performed. The first is through traditional open surgery where large incisions are made in your abdomen. The second option is to perform the surgery laparoscopically through a series of small incisions that allow doctors to remotely perform surgery with specialized instruments. 

Open surgery is rapidly becoming a less favored option by doctors due to the higher likelihood of potential side effects. Your recovery time for open abdominal surgery is longer, and the complication rates are higher. 

Laparoscopic surgery is far easier on the body. Though it is difficult to perform, and requires specialized equipment, the overall trauma and damage to the body are significantly less than in a traditional surgery. This means your recovery time will be lowered, something that is very important after bariatric surgery. Your body takes nutrients to heal itself, and after reducing your stomach to a small pouch, it will be difficult for you to take in enough nutrients to heal quickly. 

Regardless of how it is performed, the mechanics of roux-en-y gastric bypass are the same. A portion of the top of your stomach is cut away and stitched together to create a small stomach pouch. This new stomach is then attached to a part of the small intestine to create a smaller pathway for your food. 

The small intestine that is left in place after the surgery now has two channels … one containing your duodenum coming from your new stomach and the other from the part of the stomach that was sealed off during surgery. This is to allow the gastric juices secreted by the gallbladder and pancreas to pass through the common bile duct and mix with the food in your small intestine. This is crucial to ensure you can digest your food properly. Without these gastric juices, you would be at an even greater risk of health problems stemming from the malabsorption of the fewer calories you are now able to consume. 

Recovering from Gastric Bypass Surgery

Regardless of the surgical procedure performed, the results of gastric bypass surgery will be life-long. The most dramatic of these effects will be seen in the first few months after surgery. 

As your new stomach heals, it is important to protect it by radically changing your diet. At first, you will only be able to take in liquids. Slowly your doctor will allow you to begin eating soft foods as your stomach continues to heal. As time moves on, you will be allowed to introduce more and more solid foods into your diet. There is no exact timeline for this, and it will depend on what your body can tolerate. 

The short term weight loss following bariatric surgery is typically dramatic. During this period you will continue to be under observation by your doctor as there are some other potential health hazards to losing weight so quickly. You will be at a higher risk for:

  • gallstones
  • hair thinning or hair loss
  • mood changes
  • flu-like symptoms
  • fatigue

In the following months, you will begin to establish your new diet. As your body begins to adjust to living on fewer calories, you will need to establish new dietary habits. Your caloric intake will now be so restricted that every bite will need to be planned out in advance. Getting the nutrients you need will mean intentionally consuming the right amount of fats, protein, and carbs to give your body the fuel you need to survive. This will mean regular follow-up visits with your doctor and a nutritionist to ensure you are staying on track to keep losing weight while keeping your body fueled.

Diet After Gastric Bypass

Everyone is different, but it is very likely you will need to take dietary supplements for the rest of your life after bariatric surgery. One reason a gastric bypass is not seen as a silver bullet against weight gain is the significant amount of work you will need to do for the rest of your life to keep things on the rails from a nutritional perspective. Your diet will always need to be supplemented with vitamins and minerals to keep you healthy. 

Not only do you need to start counting every last calorie, but you will also need to pay attention to how easy your food is to digest. Not all proteins and fats are created equal, and the bioavailability, or how easy a food is for your body to digest, will matter immensely. 

Hydration is another, often overlooked, aspect of life after a gastric bypass. Your new, smaller stomach pouch will not be large enough to take in very much liquid at one time. This means you will need to be careful about how much water you need to take in and how much you lose. This can be a particular challenge if you live in a hot climate or are attempting to exercise as a part of your overall attempt to keep weight off and get healthy.

These two problems of water-loss and digestion can come together in ways some people may not expect. Some artificial sweeteners, for example, are not easily processed by the body, which means they  add zero calories to your diet. This may sound like a good thing, but it turns out digesting some of these sweeteners, such as sorbitol and xylitol, will draw water into the intestines as your body tries to process these compounds. This can result in a potentially dangerous cycle of dehydration and diarrhea. If you have developed a habit of drinking diet sodas that contain these sugars, the very beverages you are drinking are causing you to become more dehydrated. 

Other Bariatric Procedures

For years, gastric bypass surgery was considered the gold standard in weight loss surgery. New techniques and procedures are constantly being developed, though, and now there are many new options if you are considering a surgical solution to fight chronic weight gain. 

Sleeve gastrectomy, or endoscopic sleeve gastrectomy (ESG), is one of the more promising procedures that closely matches the overall effect of gastric bypass, but in a manner that is far less invasive and damaging to the body. Rather than rerouting your stomach and intestines to limit your digestive capacity, an ESG involves creating a small stomach pouch by stitching part of your stomach together with a device that can be inserted through your mouth and down your esophagus with an endoscope. One of the advantages of ESG is that it does not involve cutting into your intestines at all, leaving the duodenum and jejunum intact below the stomach. 

If preventing you from eating too many calories is the objective, shrinking the size of your stomach is one option. Taking up the available space is another. This can be accomplished through a procedure known as the ORBERA® Managed Weight Loss System. This procedure involves using an endoscope to place a deflated balloon into your stomach that is then inflated to roughly the size of a grapefruit. Just like a traditional bariatric surgery, ORBERA® leaves you with a smaller available volume in your stomach. The difference is, the balloon can be easily removed later, making this procedure completely reversible. 

Dangers of Bariatric Surgery

The dangers that can follow bariatric surgery only serve to underscore how dangerous it can be to carry significant amounts of excess weight. It is possible you could have serious complications from your weight loss surgery, but the risks for life-threatening complications of morbid obesity are just as real. 

Malnutrition may not be something we think about often in the United States, but if you have undergone bariatric surgery, it is a very real and dangerous possibility. Your new digestive tract gives your body less time to absorb nutrients from your food, and you can eat far less food than you used to. 

Malnutrition may not look like you think after a gastric bypass. The raw quantity of food we eat as Americans usually masks the poor quality of the food we consume. Since you will no longer be able to eat as much food, your team of doctors and nutritionists will develop a special formulation of vitamins and minerals for you to help supplement the small amount of calories you can get through your diet. Many vitamins, such as vitamin b12 and others derived from fatty acids, are going to be difficult to get if you are cutting down the calories, especially from fat. 

Dumping syndrome is a particularly dangerous condition that can strike if your digestive system is too far out of balance. If this happens, food that has not been properly digested is moved too quickly into your small intestine. This can lead to diarrhea, short-term drops in blood sugar, dehydration, abdominal bloating, changes in blood pressure, and a host of other symptoms. Beyond these short-term symptoms, the bottom line is you are not getting the nutrients you need from your food.  

Knowing your Options

There are relatively few people who reach a point where gastric bypass surgery is an option. In most cases, you must have a BMI over 40 and other serious health concerns—while still being in good enough health that you are not at risk from the potential complications of surgery and the radical changes it brings to your diet and lifestyle. 

Other, less-invasive options such as ESG exist that can deliver similar results as gastric bypass while carrying fewer complications. Some of these are even reversible, should there be a need later in your life to explore other options in managing your weight. 

Another of these options that is gaining popularity is something called medical nutrition therapy. Rather than a surgery, this is a program that puts you in direct, ongoing contact with a team of doctors, nutritionists, and dietitians who can provide you ongoing feedback and guidance to help you lose weight at a healthy pace. Lying somewhere between the drastic measures of bariatric surgery and being left on your own to manage a diet, medical nutrition therapy is an answer that can provide a path for those who need help setting and achieving reasonable weight loss goals. 

At True You Weight Loss, we do not perform gastric bypass surgery. The alternative weight loss procedures we do perform and the help we provide through our medical assisted nutrition program can provide powerful, life-changing results with far less serious consequences to your health, and at a much lower cost, than gastric bypass surgery. 

Providing these procedures is what led us to start the nation’s first and only physician-founded weight loss center specifically focused on offering these solutions to individuals needing to find freedom from the challenges and dangers of significant excess body weight. Request a consultation today to learn more about the services we provide and what your options are if you are considering gastric bypass. 

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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