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Gastric Bypass

at Cedars-Sinai Marina del Rey Hospital

Guide from the Marina Weight Management Center

Today, gastric bypass surgery is one of the most commonly performed bariatric procedures, along with sleeve gastrectomy and lap band surgery. Over 216,000 bariatric surgeries were carried out in the U.S. during 2016, out of which nearly 19% gastric bypasses. At Cedars-Sinai Marina del Rey Hospital, whose weight management center is renowned throughout Los Angeles, our bariatric surgeons have vast experience in providing high-quality treatment to patients suffering from obesity who are willing to make a commitment to improving their eating habits and, at the same time, their quality of life. Following a thorough evaluation, we will determine whether you are a suitable candidate for gastric bypass surgery and, in the event you are, proceed with the preoperative care.

If gastric bypass surgery proves to entail considerable risks for your health, our bariatric team will either help you prepare for it by recommending you a personalized diet or by coming up with other surgical solutions you can choose from so that you can benefit from the procedure you will undergo to the fullest, without worrying for your safety. We will also provide you with superior postoperative care and ensure you only leave the hospital when you are entirely ready to take care of yourself.

Also known as Roux-en-Y, gastric bypass surgery is a bariatric procedure whose aim is to reduce the size of the stomach so that the patient will be prevented from ingesting large amounts of food at once. It also entails re-routing a portion of the digestive system, which will impede the body from absorbing as many calories and nutrients from food. Thus, the individual will gradually lose excess weight and develop healthy eating habits. Gastric bypass surgery is suitable for people whose BMI (body mass index) exceeds 40, as well as for those who have a BMI of over 35 accompanied by serious health issues stemming from obesity.

While Route-en-Y is the most widespread gastric bypass procedure, there are other techniques by which this surgery can be carried out, one of which being extensive gastric bypass, medically known as biliopancreatic diversion. This surgery involves a more radical re-routing of the digestive system. However, although efficient for weight loss, it is rarely performed, since it implies numerous risks and has a high rate of complications.

At Cedars-Sinai Marina del Rey Hospital, we perform gastric bypass surgery with the aid of a minimally invasive technique, namely the laparoscope, which promotes faster recovery and shorter hospitalization. Furthermore, postoperative risks and complications are also fewer with laparoscopic surgery, which our proficient bariatric surgeons specialize in and have been performing for years.

In order to determine your eligibility for gastric bypass surgery, our bariatric specialists will order a series of tests and medical exams for you, which may include:

  • blood tests: a complete blood count, blood urea nitrogen, cortisol, creatinine, electrolytes, prolactin, and thyroid-stimulating hormone
  • EKG (electrocardiogram)
  • chest X-ray
  • ultrasonography of the gallbladder
  • pulmonary function tests
  • upper endoscopy
  • echocardiogram
  • abdominal ultrasound
  • sleep studies
  • pH monitoring studies
  • stress test
  • liver function tests
  • thyroid function tests
  • urinalysis

Should you be deemed a good candidate for gastric bypass surgery, the date of the procedure will be set up and your bariatric surgeon will instruct you regarding how to correctly prepare for it. For one or two weeks prior to your surgery, you should only eat protein shakes or meal replacement shakes, soup broth with no solid pieces of food, one or two daily servings of lean meat, as well as give up all caffeinated and carbonated drinks. The purpose of the preoperative diet is to reduce the amount of fat around your liver and spleen. It is extremely important to follow the meal plan your specialist compiles for you, as your surgery will otherwise be canceled due to the increased risks it entails.

If you are a smoker, it is strongly advised to quit several weeks before the surgery, as it increases the risk of blood clots. Similarly, if you regularly take any medication, ask your physician about it, as you may need to cease doing so prior to gastric bypass surgery. In general, the following drugs should not be taken one week prior to the surgery:

  • steroids
  • birth control
  • Aspirin, Celebrex, Advil, as well as any other NSAIDs
  • replacement hormones
  • Coumadin
  • anti-coagulation medication

Your stomach should be empty during the surgery, so you need to refrain from eating anything at least 12 hours beforehand.

On the day of your gastric bypass surgery, you will first be put under general anesthesia. After it takes effect, a bariatric nurse will permanently monitor your vital signs. The surgery consists of two steps – during the former, the surgeon will reduce the size of your stomach, whereas, during the latter, they will create the bypass using your small intestine. 4 to 6 small incisions will be made in your abdomen, through which the laparoscope and other medical instruments will subsequently be introduced. With the aid of a staple, the bariatric surgeon will divide your stomach into a tiny upper part, where the food you ingest will go, and a larger lower portion. Your new stomach will only be able to hold one ounce of food, which facilitates quick weight loss.

Following the division of your stomach, the surgeon will construct the bypass by taking between 31 and 59 inches of your small intestine and re-arranging it into a Y-shape near the newly created small pouch. It will be connected to your new stomach so that the food you consume will travel directly into the bypass to prevent your body from absorbing too many calories. The rest of your small intestine will henceforth remain inactive. Additionally, this anatomical configuration will cause changes in the hormones which promote satiety. As a result, you will feel less hungry and your risk of developing type 2 diabetes will also decrease while you lose weight. Gastric bypass surgery usually takes between 2 and 4 hours to complete.

As for extensive gastric bypass surgery, it is performed in a similar manner to the regular one, the only difference being that the surgeon removes the lower portion of your stomach and subsequently attaches the lower part of the small intestine to your new stomach. However, since it implies a high risk of depriving your body of vital nutrients, it is rarely performed.

The diet you follow after the surgery is essential. Your bariatric doctor will provide you with a complete, individualized meal plan upon leaving the hospital and it is crucial to comply with it to a T. In general, you are forbidden from eating any food during the first week post-surgery, as only liquids such as water, fat-free broth, and sugar-free jello are allowed. Within the next two weeks, you are encouraged to include protein shakes and pureed foods into your diet. Some examples are non-fat cottage cheese, egg whites, and non-fat soft cheese. Consuming beverages, which contain caffeine is still forbidden and so are carbonated drinks and alcohol.

During the fourth and fifth weeks after the surgery, you can consume soft foods, as long as you make sure to eat slowly and thoroughly chew every bite. The following are generally allowed, but you should always consult with your bariatric doctor if you are not sure with regard to the safety of eating a certain food:

  • lean turkey and chicken
  • non-fat cheese
  • fish
  • tofu
  • potatoes
  • tomatoes
  • avocados
  • bananas
  • squash
  • green beans

Finally, when six weeks have passed after your gastric bypass surgery, you can resume eating solid foods. Nonetheless, it is recommended to take into consideration the following pieces of advice every time you have a meal:

  • Do not drink water and eat food simultaneously. You should let at least 30 minutes elapse between having a glass of water and consuming solid food.
  • Proteins should be eaten first, vegetables second, and carbohydrates last.
  • Each bite of food should be chewed for approximately 15 seconds.
  • Introduce new food in your diet gradually so as to be able to observe how your body reacts to each.

In addition to facilitating safe and significant weight loss (between 60% and 80% of excess weight), gastric bypass surgery also entails the following benefits for patients who choose to undergo it:

  • improves or completely cures conditions, which stem from obesity, such as high blood pressure, obstructive sleep apnea, and diabetes
  • increases life quality and expectancy
  • helps maintain a weight loss of approximately 50%  in the long run
  • inhibits appetite and promotes satiety by interfering with the hormones responsible for food cravings
  • enhances respiratory function
  • decreases the risk of hernia
  • alleviates depression
  • improves fertility

Hospitalization following gastric bypass surgery usually lasts for 1 to 3 days, provided no complications arise. Only 10% of patients experience minor complications after the procedure, whereas just 5% face serious postoperative health problems. Depending on how your recovery is going, you can return to work within 1 to 3 weeks. You will be encouraged to walk as soon as you are able to in order to prevent the forming of blood clots.

Even though gastric bypass surgery is a very effective and safe treatment for obesity, with a survival rate of 99.8%, it remains a surgical procedure which – as every surgical procedure – implies a series of risks. Some of the immediate postoperative risks associated with gastric bypass surgery are:

  • bleeding
  • wound infection
  • constipation
  • leaks in your gastrointestinal system
  • blood clots
  • pulmonary problems

In the long run, the following complications may appear:

  • vitamin and mineral deficiencies (B12, iron, calcium, etc.)
  • gallstones
  • ulcers
  • breakdown of staple lines
  • malnutrition
  • low blood sugar
  • pouch stretching
  • bowel obstruction
  • stomal stenosis
  • malnutrition
  • stomach perforation

Nevertheless, if you follow the instructions and advice of your bariatric surgeon and go to every follow-up appointment, the risk of experiencing serious complications as a consequence of gastric bypass surgery is very low.

It is worthy of note that dumping syndrome, which refers to food traveling to the small intestine before it is properly broken down, is quite common among people who underwent gastric bypass surgery. This often happens when you eat sweet or high-fat food very fast or in large amounts. The symptoms of dumping syndrome, which typically alleviate within one or two hours, include:

  • sweating
  • nausea
  • vomiting
  • cramping
  • diarrhea
  • increased heart rate

To avoid experiencing dumping syndrome, you should keep in mind the advice above and also refrain from eating the following foods, as they are very difficult to digest:

  • grapes
  • whole grains
  • beef
  • nuts
  • shellfish
  • corn
  • beans