What Is Gastric Bypass Surgery?
Gastric bypass surgery, also known as Roux-en-Y, is a weight loss procedure designed to reduce the size of your stomach and restrict calorie absorption. During surgery, a surgeon divides your stomach into two portions and creates an egg-sized gastric pouch. Your small intestine is also separated into two parts, allowing your surgeon to connect the lower part of your small intestine directly to the newly-created gastric pouch. By doing this, food travels directly from your esophagus to the small stomach pouch and on to the small intestine, bypassing most of the stomach as well as the duodenum (the first portion of the small intestine where nutrients, minerals, and vitamins are absorbed). In this way, this technique excludes the majority of the stomach and re-routes part of the lower intestine to yield significant weight loss. Although there are several types of bariatric surgery, this procedure has been performed for several decades and is traditionally considered the “gold-standard” in weight loss surgery.
Gastric bypass surgery isn’t for patients who are looking to shed a few pounds; it’s geared towards those who need to dramatically decrease their body mass index (BMI) and who are suffering from obesity-related health concerns.
What Are the Pros and Cons of Gastric Bypass?
While this bariatric method offers numerous benefits for the right candidate, it’s not appropriate for everyone. Some of the advantages of gastric bypass surgery include:
- Produces significant long-term weight loss for most patients
- Restricts the amount of food that can be consumed
- Decreases the sensation of hunger for better appetite control
- Produces favorable changes in gut hormones that reduce appetite, enhance satiety, and improve diabetes, hypertension, sleep apnea, hyperlipidemia, and joint pain, among other conditions
It’s also important to recognize certain drawbacks that could affect your progress or results, including:
- Technically a more complex operation than adjustable gastric banding (AGB) or laparoscopic sleeve gastrectomy (LSG), and has a higher rate of early and late complications compared with sleeve gastrectomy
- Can lead to long-term vitamin/mineral deficiencies, particularly deficits in vitamin B12, iron, calcium, and folate
- Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance
- More strict restrictions related to medications, such as extended-release formulations of your medications, use of NSAIDs, and oral steroids
A detailed review of surgery, post-op requirements, and review of risks and benefits will be covered during your consultation.
Is Gastric Bypass Right for You?
Gastric bypass surgery is one of the most effective weight loss options available today. For patients who struggle with being overweight or who have tried dozens of alternatives and failed, gastric bypass surgery is often a solution that works to achieve significant weight loss and improved overall health. That said, not everyone is a good candidate for this surgery.
There are certain medical, physical, and even emotional criteria that should be considered if you’re thinking of gastric bypass surgery. In general, good candidates for gastric bypass surgery should know the procedure will involve:
A Commitment to Losing Weight with Lifestyle Changes
One common misconception about gastric bypass surgery is that a patient will lose weight and keep it off no matter what. The reality of gastric bypass surgery is a little different. If you aren’t fully committed to the idea of losing weight for one reason or another, even with gastric bypass surgery, you could gain weight in the future if you do not commit to proper eating habits and routine physical activity.
The way that gastric bypass surgery works is by stapling the top part of the stomach and creating a small gastric pouch (the size of a walnut or egg) and excluding the remainder of the stomach. Next, the small intestine is disconnected and reconnected to the gastric pouch. This allows restriction from the small stomach pouch. and a small amount of malabsorption of fats and protein, by bypassing a portion of the small intestine before food encounters the bile stream from the liver and digestive enzymes from the pancreas. One of the biggest factors that leads to weight loss, satiety, and improved insulin metabolism is the gut physiology and hormonal changes a gastric bypass causes in the body.
Reasonable Health to Tolerate Anesthesia and Surgery
Obesity by itself is a very unhealthy state, as such patients are typically designated as an ASA 3 classification for anesthesia. Historically, operations on obese patients were avoided due to risk of anesthesia and surgery itself. However, improvements in anesthetic gases and techniques, combined with peri-operative monitoring and decreased trauma from laparoscopic surgery, have dramatically decreased the risk of surgery in the obese population.
A typical pre-operative work-up can include a cardiac evaluation and clearance, a sleep study, labs, nutrition education, psychological assessment, and evaluation of gastrointestinal symptoms, if required.
Potential Coverage By Medical Insurance
If you are a good candidate for gastric bypass surgery, your medical insurance company may cover the cost based on your physician’s professional recommendation. If you are considering gastric bypass surgery, review your medical policy or speak to an insurance representative to make sure it would be covered. Be advised that most bariatric surgeons do not accept Medicaid. you can call our office to discuss your medical insurance policy and perform an “insurance verification” of benefits to see if your plan will cover the cost of surgery.
Consideration of Other Weight Loss Methods First
Gastric bypass surgery is a serious surgery that you should only consider if all else has failed. Before resorting to any weight loss surgery, speak to your bariatric physician to find out if there are other noninvasive weight loss options available to you. Chances are, your doctor will be able to suggest at least one that you might not have tried yet.
If you suffer from being overweight, gastric bypass surgery may be a viable option, but considering the factors that make a good candidate first is a wise move. For more information about gastric bypass surgery cost, contact us today.
What Should I Expect During the Gastric Bypass Procedure?
Gastric bypass surgeries are performed in a hospital under general anesthesia, which means you’ll be unconscious during the procedure. While some operations are performed using traditional large incisions in your abdomen, Dr. Bagshahi typically performs the procedure laparoscopically, which is much less invasive and offers a quicker healing time.
Laparoscopic techniques have dramatically decreased complications related to open surgery and lead to shorter recovery time and length of time required to return to work. After gastric bypass surgery, you will be up and walking as soon as anesthesia wears off the same evening. You will stay in the hospital overnight for monitoring during your recovery and typically be discharged the day after surgery, once you can tolerate oral liquids, walk, have well-controlled pain and nausea, and experience no issues related to surgery. Most patients return to work in four to seven days depending on their activity levels and job requirements, some patients may need more time before returning to work.
What Happens During Gastric Bypass Recovery?
Following surgery and discharge from the hospital, you will follow a recovery diet plan that includes two weeks of liquids, two weeks of pureed food, then slowly introduce soft foods and eventually solid food. You will receive a post-surgery guide booklet to outline the diet recovery plan, types of protein supplements, meal examples, and detailed multivitamin regimen required for long-term success. You will slowly increase your physical activity and exercise levels, and you will work on developing a lifelong habit of exercise and increased physical activity for physical and mental health as well as to keep the weight off long term.
Are There Any Gastric Bypass Side Effects?
Obesity can cause a number of health-related issues, including type 2 diabetes, hypertension, stroke, and heart disease. While gastric bypass surgery can provide long-term weight loss, like any surgical procedure, risks are involved. Gastric bypass surgery changes the way your body handles food, so it’s vital that you incorporate healthy lifestyle changes to ensure your body gets all its required nutrients. In some cases, patients may experience certain effects as a result of the procedure, particularly if they eat beyond the capacity of the stomach pouch, indulge in foods that are not recommended, or otherwise disregard the optimal diet. Aside form risks immediately related to surgery such as bleeding, infection, leaks, (otherwise covered in your surgical consent at the time of pre-op) these effects can include:
- Dumping syndrome (mainly caused by high sugar or high fat foods, things that a bypass patient is instructed to avoid)
- Development of gallstones
- Nutritional deficiencies (follow multivitamin and dietary instructions and maintain long term follow up to avoid these, or treat them if they arise)
- Bowel obstruction (intense abdominal pain after gastric bypass should not be ignored as this could be related to an internal hernia, which can be life-threatening)
Our goal is to provide proper pre-op education in your decision to find the procedure that suits you, prepare you to have surgery, and develop a long-term relationship that establishes continued long-term aftercare. This is designed to ensure you are losing weight in a healthy, effective manner and to address any “alarm symptoms” that may arise post-op.
Is There a Gastric Bypass Diet to Follow?
Pre-Op Gastric Bypass Diet
You will receive a post-surgery guide booklet to outline pre-op and post op diet plan. Prior to surgery we review eating behaviors, habits, teach mindful eating, work on avoiding poor food choices, and reduce calorie intake in general. Dr. Bagshahi encourages patients to start taking a multivitamin, a probiotic, and fiber supplements, as these are important factors in the gut microbiome and are related to healthy metabolism, bowel habits, and overall improved GI health.
In the weeks before surgery, you will go on a liquid diet to decrease the liver size and intra-abdominal fat, which will create more space to work during surgery and also help manage eating behavior immediately after surgery. This makes it possible to avoid diet-related complications with staple lines as the stomach and bowel is healing.
Post-Op Gastric Bypass Diet
In general, your diet will be limited by stomach-size restriction and malabsorption, and your body will gradually adapt to the changes. With a smaller stomach, you simply cannot take in as much food as you did previously, and with malabsorption of macro and micronutrients, absorption will be different between the various procedures. So, it’s important to prioritize your nutritional requirements and follow dietary and supplement recommendations to achieve successful healthy weight loss.
Your skin, bones, muscles, and vital organs all depend on protein, and you should first of all ensure that you take in an adequate supply. In the immediate days and weeks after gastric bypass surgery, this may need to be in predominantly liquid form, using protein supplements outlined in your surgery guide booklet.
Long term It’s also important to maintain an adequate intake of complex carbohydrates. Avoid refined and simple carbohydrates with a high glycemic index. Complex carbohydrates will minimize spikes in blood sugar and insulin levels, preventing the craving for sugary snacks and refined carbohydrates, which can easily derail your efforts to maintain your new healthy weight. Unrefined carbohydrates and vegetables are also a great source of essential vitamins and minerals.
The amount of these solid foods your body can absorb will increase over time, but in the early days you need to focus on liquid and soft foods and a high protein diet. You should always take in plenty of water and other fluids, but this intake should be spread throughout the day.
The ideal gastric bypass surgery diet is not very different from the best diet for anyone. Surgery is used as a tool to help control appetite through volume restriction and appetite suppression. These approaches can achieve significant weight loss, and they can help patients work on developing a healthy lifestyle by choosing more nutritious foods and developing healthy activity levels through increased mobility at a lower weight.
How Much Does Gastric Bypass Cost?
The price of gastric bypass surgery may be covered by your medical insurance. We can provide insurance verification, if needed; simply contact our office. Please note most bariatrics surgeons do not accept Medicare. Price should not be the only determinant of where you receive surgery and who performs the procedure, as this could have unintended and serious consequences. It’s important to consider your safety, the quality and training of a potential bariatric surgeon, and facility accreditation when choosing a weight loss surgeon and practice. We cannot discuss other patients’ treatment plans and costs; however, we will review the price of your program with you in full during your initial consultation. Everyone deserves access to good health, and we will work with you to find weight loss financing and other payment options to best suit your needs.
Are There Any Gastric Bypass Alternatives?
Gastric bypass surgery is one of the most successful and heavily researched weight loss procedures, but it is not the only treatment option available to help you begin living a healthier quality of life. If you have a BMI over 50, duodenal switch can also be an effective procedure to help you achieve and maintain long-term weight loss results. This technique is completed in two stages, both of which take place during the same operation: first, part of the stomach is removed to restrict the amount of food intake possible. After reducing the stomach size, the small intestine is re-routed so that a large segment of bowel is excluded from contact with food, thereby limiting calorie absorption. As a result of this two-part procedure, duodenal switch surgery often achieves greater weight loss than the gastric bypass method. It is often the recommended bariatric treatment for patients who have diabetes or high blood cholesterol.
Another potential weight loss option is an endoscopic sleeve gastroplasty, which may be suitable for patients who have a BMI of 30 to 35. This non-surgical procedure narrows and shortens the length of the stomach, reducing the overall stomach volume and allowing patients to feel full for longer periods of time. An endoscopic sleeve gastrectomy essentially suppresses the appetite and—when combined with an effective dietary and exercise program—can lead to a 20 to 25 percent decrease in your total weight over 18 months. It’s important to note that this procedure should not be seen as a “substitute” for gastric bypass and may not be the best long-term solution for certain patients. In any case, Dr. Bagshahi is committed to learning your weight loss goals and recommending the appropriate bariatric techniques based on a thorough review of your medical history.
What Is Gastric Bypass Revision?
For a number of reasons, gastric bypass revision surgery may be recommended if your initial procedure didn’t achieve the results you expected, or if there were medical complications during your recovery. While we will always utilize conservative treatments to address issues before recommending another procedure, revision bariatric surgery may be an appropriate solution for patients who have experienced gastric bypass failure. In assessing whether your results could be improved by gastric bypass revision, Dr. Bagshahi will evaluate the size of your pouch or stoma as well as your esophagus. An endoscopy will be performed and our team will try to identify the reason for your gastric bypass failure. Based on their evaluation, four possible revision techniques can be performed to improve your results: sclerotherapy, LAP-BAND® surgery, roux limb lengthening, or a duodenal switch conversion. Our team will review all of these options with you in person to determine the best course of action. Some of the most common reasons why patients may have regained their weight—or may have not lost enough weight in the first place—include metabolic issues, medical complications, or poor food consumption.
Choosing a Bariatric Surgeon
Taking the steps to live a healthier lifestyle can be a huge decision that seems intimidating for some patients. That said, the process may be much smoother than expected with the help of a compassionate and experienced weight loss surgeon. You deserve the highest degree of care and support during your weight loss journey, which is why it’s important to select a bariatric surgeon who:
- Has completed an extensive breadth of bariatric surgery training: Seeking out surgeons who are board certified, fellowship trained, or belonging to professional organizations like the American Society for Metabolic and Bariatric Surgery can help you narrow down your options for a qualified weight loss provider.
- Is well-known for his/her results and patient success stories: Be sure to read online patient reviews, explore testimonials, and view all available media to both learn about a surgeon’s reputation and to get an idea of what can be expected at a given weight loss practice.
- Offers a continuum of patient care: While a bariatric procedure can be an essential step towards reclaiming your health, your weight loss journey continues long after you recover from surgery. Therefore, it’s important to select a bariatric surgeon who can provide you with additional resources to support your weight loss goals, such as access to a nutritionist, medical team, plastic surgeon, etc.
- Provides a wide array of treatment options: No two patients are the same, and selecting a surgeon who offers minimally invasive, endoscopic, and robotic-assisted procedure options on top of the more traditional bariatric surgeries is key to finding the most effective weight loss method for your needs.
After listening to your needs and weight loss goals during a consultation, Dr. Bagshahi can work with you to assess whether the gastric bypass procedure or another treatment option would be most effective in helping you improve your weight and/or health concerns.
Additional Gastric Bypass FAQs
How long is gastric bypass surgery?
When performed laparoscopically, which means the procedure is completed with the assistance of a video scope and tiny surgical instruments, gastric bypass surgery usually takes two to three hours.
When can I return to work after gastric bypass surgery?
How soon you’re able to resume working after your procedure depends on the nature of your work and your own unique rate of healing. Most patients take one to two weeks off from work to allow themselves ample time to recover before returning to their normal routines.
What is the BMI requirement for gastric bypass surgery?
Gastric bypass surgery is generally an effective weight loss option for patients who have a BMI equal to or greater than 40, or individuals who have a BMI of 35 to 40 and contend with severe health complications, such as diabetes, pulmonary hypertension, cardiovascular disease, or uncontrolled GERD, among other potentially serious conditions.
When will I see weight loss after the procedure?
Weight loss typically occurs rapidly during the first few months after gastric bypass surgery, although each person’s rate of progress will depend on their ability to follow the proper dietary guidelines. Many patients lose 5 to 15 pounds per week during the initial 30 days of their recovery. By the six-month mark post-surgery, most gastric bypass patients have lost approximately 50 percent of their excess weight.
Are there any things you can’t do after gastric bypass surgery?
For the first six weeks after your procedure, strenuous activity and lifting anything heavier than 10 pounds are prohibited. You will also be asked to avoid doing anything that requires pushing and pulling motions, such as vacuuming.
The best way to determine if this procedure is right for you is to discuss your concerns, goals, and medical needs with a qualified bariatric surgeon. Contact us today to schedule your initial consultation.