Gastric Bypass Surgery

What is gastric bypass surgery?

Gastric bypass surgery is a type of bariatric surgery. It changes the size and shape of your stomach and small intestine. Gastric bypass surgery is a common treatment for obesity. The surgery divides your stomach into two sections. One is smaller than the other. This small section is called a stomach pouch. The stomach pouch is then connected to your small intestine. The new connection takes the form of a Y. This is why healthcare providers may use the French term Roux-en-Y gastric bypass surgery. Roux-en-Y means “in the shape of a Y.”

Obesity is a disease that increases your risk for serious health issues. Gastric bypass surgery can help you lose weight and improve your health. This surgery can change your life, but it’s only part of that transformation. You need to be ready and able to commit to lifelong lifestyle changes. That’s how you lose weight and keep it off to improve your health.

How does gastric bypass surgery change my body?

The surgery changes how much food your stomach holds. Right after surgery, the small stomach pouch (your “new” stomach) will hold about 1 ounce of food. The average adult stomach can hold about 32 ounces of food. Eventually, the small pouch will be able to hold 8 ounces of food.

Gastric bypass surgery also affects how food moves through your small intestine. Food typically travels through 22 feet of small intestine to reach your large intestine. The surgery creates a shortcut so that food skips the first part of your small intestine and goes straight to the middle part. That shortens the digestion period. Your poop will look and smell different because it contains partially undigested food.

The surgery also makes lasting changes to your metabolism. Your metabolism is how your body turns food into energy. Gastric bypass surgery changes your metabolism by boosting certain hormones. Hormones are chemical messengers that control different functions in your body. Gastric bypass surgery appears to boost activity in some hormones. These hormones include:

• Ghrelin: This is a hunger hormone that controls your appetite.
• GLP-1 (glucagon-like peptide): This hormone manages your blood sugar. It sends messages to the area of your brain that processes hunger and satiety (feeling full after you eat).
• PYY (peptide YY): This hormone also controls appetite.

How much weight can you lose with gastric bypass surgery?

Everyone’s situation is a bit different. Research shows people lose about 30% of their baseline weight after surgery. Baseline weight is how much you weigh before surgery. So, if you weigh 300 pounds before surgery, you’d lose about 90 pounds.

How should I prepare for this procedure?

The first step is talking to a healthcare provider if you have concerns about your weight and your health. Your healthcare provider may refer you to a bariatric specialist to talk about surgery if your situation meets certain guidelines. The guidelines are based on body mass index (BMI). BMI estimates the amount of body fat you have based on your height and weight. There are different BMI classes. Providers consider surgeries like the gastric bypass for people who are:

• Adults with a body mass index (BMI) of 35 or higher (class 2 obesity or higher)
• Adults with a BMI of 30 to 35 (class 1 obesity) who also have Type 2 diabetes and other medical problems related to obesity
• Adults with a BMI of 30 to 35 who’ve tried to lose weight through other means, like changing what they eat and being more active
• Children and adolescents with a BMI of 40 or higher (class 3 obesity)
• Children and adolescents with a BMI of 35 or higher (class 2 obesity) who have a major obesity-related condition (Type 2 diabetes and high blood pressure are examples of a major obesity-related condition)

There are other factors to consider. Gastric bypass surgery is major surgery. Your providers in the bariatric program you join will do tests to confirm you’re physically strong and healthy enough for surgery. They’ll discuss the lifestyle changes that you’ll follow after surgery. For example, you may need to avoid certain foods and be more active.

You and your providers will talk about these factors. If gastric bypass surgery is a good fit for you, your provider will explain the steps leading up to your surgery.

Final surgery preparation

Your final preparations may begin about two weeks before your surgery. You’ll start a liquid diet of protein shakes and clear liquids. You’ll continue the liquid diet up until midnight on the day of your surgery. You can have clear liquids up to two hours before you arrive at the hospital.

What happens during Roux-en-Y bypass surgery?

You receive general anesthesia for this surgery so you’re asleep the entire time. You’ll have a breathing tube during the surgery. Your surgery team will remove it before you wake up. Steps in gastric bypass surgery are:

1. Your surgeon will make a small cut (incision) in your belly to insert a tube that contains carbon dioxide gas. They use the gas to inflate your belly (abdominal cavity). The gas creates space between your skin and organs so your surgeon can do the procedure.
2. They’ll place a tiny video camera (laparoscope) through the small cut. The laparoscope projects images of the inside of your belly onto a video screen.
3. Your surgeon makes a few more cuts to place more instruments so they can get to your stomach and small intestine.
4. They use surgical staplers to divide your stomach into two sections. One section is a small pouch that makes your “new” stomach. Your new stomach is about the size of an egg. The rest of your stomach is separated from the pouch. After surgery, what you eat won’t end up in this part of your stomach.
5. Your surgeon makes a cut to divide your small intestine into two parts. They bring the lower part up and connect it to your new stomach.
6. They reconnect the upper branch or bypassed part of your small intestine. Now, your small intestine has two branches. One leads to your stomach pouch. The other leads from the remainder of your stomach.
7. Your surgeon closes the incisions in your abdomen after they connect your new stomach to your small intestine.

How long does this procedure take?

The procedure itself takes about two to three hours. Afterward, you’ll probably remain in the hospital for two days. You won’t be able to eat solid foods yet.

What are the potential benefits and risks of gastric bypass surgery?

Gastric bypass surgery works when other weight loss programs aren’t successful. It makes it easier for you to manage your blood sugar, blood pressure and hunger pangs. The surgery may ease or reduce your risk of conditions like:

• Diabetes
• Heart disease
• Gastroesophageal reflux
• High blood sugar
• High blood pressure
• High cholesterol
• Metabolically-dysfunctional-associated steatotic liver disease (MASLD)
• Osteoarthrosis
• Sleep apnea

There are potential short-term and long-term risks with gastric bypass surgery. Short-term risks may include:

• Anastomotic leak (a leak at the connections between your stomach pouch and small intestine)
• Excessive bleeding
• Incisional hernia
• Reaction to anesthesia
• Surgical wound infection
• Small bowel (small intestine) obstruction

Potential longer-term complications are:

• Painful sores called ulcers at the spot where your new stomach and small intestine connect
• Bile reflux
• Dumping syndrome
• Gallstones
• Inability to absorb nutrition from food and malnutrition
• Regaining weight

How long will it take for me to recover from surgery?

Recovery takes time. For example, you may need to avoid strenuous activities for two to four weeks after your surgery. Ask your care team to explain which activities you should avoid and what you can do as you recover.

What can I eat after I have gastric bypass surgery?

Gastric bypass surgery changes what you eat and how much you eat:

• You’ll be on a liquid diet for two weeks after surgery.
• Next comes soft foods that are easy for your body to digest. You’ll eat soft foods for the next two to three months, avoiding carbs and sugars and even raw vegetables.

Your healthcare team will help you get ready when it’s time to start eating solid food. They’ll share detailed information about what you should eat. In general, you should try to:

• Eat at least 100 grams of protein a day: Filling your plate with high-protein foods will prevent muscle loss. It also helps you get mileage out of the calories you consume.
• Drink up: Shoot for 64 ounces of fluids a day. Getting your fill of fluids will help prevent constipation and nausea.
• Avoid sugary food: What you eat is on a fast track from your stomach pouch to your small intestine. You may have fast blood sugar changes when sugary food hits your small intestine.
• Take your microsupplements: These are small amounts of vitamins and minerals. Surgery may change your body’s ability to absorb nutrients that it needs. Microsupplements help to replace those nutrients.

Life after gastric bypass surgery

Your body will go through a lot of changes in the weeks and months after your surgery. Here are some suggestions that may help you to manage them:

• Get your rest: You’re consuming fewer calories than you were before. Calories are how your body gets energy. You may feel more tired than usual until your body gets used to receiving fewer calories.
• Amp up activity: Losing weight after surgery may give you more energy and interest in being more active. But talk to your care team before starting a new routine.
• Follow up with your care team: Obesity is a chronic disease. You’ll need ongoing medical support. Your care team will help you maintain your weight loss. For example, they may recommend food plans and exercise programs. They may help you connect with support groups. And they may prescribe medication.

When should I call my healthcare provider?

Contact your surgeon if you have symptoms that could mean you have a surgical wound infection or bowel obstruction. The following symptoms are reasons to call your surgeon:

• Chills
• Fever (greater than 101 degrees Fahrenheit or 38.4 degrees Celsius)
• Thick, cloudy, white- or cream-colored discharge from the incision
• Redness or color changes in your skin that go beyond the edge of the incision
• Pain when you touch the wound or the area around the wound
• Nausea and vomiting when you eat or drink
• Bloated stomach
• Severe stomach pain
• Not passing gas or pooping

What is the success rate of gastric bypass surgery?

Success rates vary. But a 2021 study shows 92% of people had significant and long-term weight loss after surgery.

Can you live a normal life after gastric bypass surgery?

You’ll have a new normal after surgery. For example, you’ll feel full more quickly. That may change how and when you eat. You may have new limits on what you can eat. You might have to avoid sugary foods, too. But your new normal may also include being more active. It may mean you feel more comfortable in your body.

Why would someone not be able to have gastric bypass surgery?

This surgery isn’t an option for everyone. You may not be able to have this surgery if:

• You’re pregnant
• You have severe illnesses, like heart or lung disease
• You have substance use disorder
• You have active cancer or uncontrolled health conditions