Laparoscopic Gastric Bypass

This is an operation where some of the stomach and part of the small intestines are bypassed. In a gastric bypass the stomach is stapled to leave a smaller pouch and then a section of the small intestine (about 100 cm down from the stomach) is attached (usually by staples) to the small stomach pouch that has been created. In effect only small volumes of food can be consumed, due to the small pouch, and then this food ‘misses out’ on the first 100 cm of small intestine which leads to the release of various gut hormones causing early fullness.

The gastric bypass is done as a laparoscopic (keyhole) surgery procedure while you sleep under a general anaesthetic. The procedure will change how and what you eat.

• You will not able to eat as much as before because after a gastric bypass, patients generally feel more satisfied after a meal and have less desire to eat.
• You may not tolerate foods containing fat, sugar and starch as well as you used to. If you eat too much of these types of foods you may actually start to feel ill, but this ‘side effect’ in itself could help you make dietary and lifestyle changes to achieve long term weight loss.
  Gastric bypass surgery is recommended for patients with a body mass index (BMI) over 35. On average, patients tend to lose 1/3 of their total body weight during treatment.

With a gastric bypass you will feel less hunger and feel full quicker and for longer than usual. Greater and faster weight loss is usually achieved than with the gastric band. An immediate remission of diabetes and improvement in blood pressure within days of having the operation is also seen.

As with any operation, there are risks associated with having a general anaesthetic. Specific to this operation, there is a small risk of wound infection, chest infection, deep vein thrombosis (DVT, or blood clots in the legs), pulmonary emboli (blood clot on the lungs). Most people will not experience any serious complications from their surgery. The risks increase for people who already have other medical conditions, such as heart disease or high blood pressure. However, any problems that do arise can be rapidly assessed and appropriate action taken. Other complications include leakage from one of the joins in the bowel, narrowing of one of the joins or ulceration of the gastric pouch may occur in 1% of patients. A second operation may be required to correct this. Internationally reported figures indicate there is a 1 in 500 (0.16%) risk of death and a 2-5% risk of adverse effects as listed above caused by having this treatment, but here at The London Weight Clinic our morbidity rate is 0% and our leak rate is 0%.

A few weeks before your operation, we will ask you to attend the Pre-admission Assessment Clinic. This appointment is an opportunity to check that you are fully prepared for your admission, treatment and discharge home. You may also have routine investigations such as blood tests, ECG (recording of your heart) or a chest x-ray done at this time to check your fitness for surgery. An anaesthetist will also see you at this appointment.

Please follow the pre-operative diet sheet for bariatric surgery before your operation.

Make sure you go for a 30 minute walk every day, as this is good cardiovascular exercise. This will help reduce the risk of post-operative complications, as well as help you lose some weight prior to surgery. If you smoke, try your best to stop six weeks before your planned surgery date.

You should also do deep breathing exercises whilst you are having your 30 minute walk each day.

Please do not have anything to eat (not even sweets or chewing gum) six hours before surgery, and nothing to drink two hours before surgery.

• If you regularly take medicines in the morning, you should take them before 7.00 am, with a small sip of water if necessary.
• If you are diabetic, you must not take your insulin or diabetic tablets on the morning of your operation.
• If you take blood-thinning medications (such as warfarin or aspirin) and/or are allergic to any medications, please contact us well in advance before your surgery.

You will be admitted to the ward on the day of your operation. Your temperature, blood pressure, respiration rate, height, weight and urine will be measured to give the nurses a baseline (normal reading) from which to work. We will measure you for special stockings (sometimes known as ‘TEDS’) to prevent blood clots (known as ‘DVT’ or ‘deep vein thrombosis’) from forming in your legs following surgery. We may also start you on anti-coagulant (blood-thinning) injections to help minimise this risk. The surgeon will explain the procedure to you in detail before asking you to sign a consent form. This is to make sure that you understand the risks and benefits of having the operation.

All make-up, nail varnish, jewellery (except wedding rings, which can be taped into place), body piercings and dentures must be removed. One of the nurses will then come and prepare you for the operating theatre.

You will wake up in the recovery room before you are taken back to the ward.

Please tell us if you are in pain or feel sick. We have tablets/ injections that we can give you, as and when required, so that you remain comfortable and pain free.

You may feel light-headed or sleepy after the operation. This is due to the anaesthetic and may continue until the next morning. It is also common to have a sore throat for 2 or 3 days after having a general anaesthetic. This sometimes happens because the anaesthetist (specialist doctor) has to pass a tube down your windpipe to give you the anaesthetic gases that keep you asleep during the operation.

Four hours after your operation we will ask you to stand up and start moving around.

Please make sure that you do your breathing exercises 10 times every two hours (between 8.00 am and 10.00 pm) and walk around for 10 minutes every two hours. You can combine doing your breathing exercise with walking around as you did before your operation.

Your wound may have been closed with clips that will be removed in clinic 7–10 days after surgery.

You will be allowed to start slowly sipping unlimited amounts of water, tea, coffee, milk, squash, Ribena, soups or Bovril on the day of surgery.

Provided you are well enough, you should be able to go home 1 – 2 days after your operation. We will give you a 1 week supply of medication to take home with you.

If possible please arrange for someone to come and collect you by car on the day of your discharge home as you will not be able to drive yourself or travel on public transport.

You should continue to go for a minimum of a 30 minute walk every day as this is good cardiovascular exercise. It will also reduce the risk of post-operative complications. Your breathing exercises should be continued 3 times a day for the next 6 weeks.

You may feel different sensations in your wound such as tingling, itching or numbness. This is normal and is part of the healing process.

However, if you experience a high temperature or fever, swelling, pain, discharge or excessive redness around the wound site, please contact us.

If you are unable to swallow or are having difficulties in swallowing please contact us using the numbers given to you before you go home.

You will be given a diet plan to follow by the dietician prior to surgery, but in brief you will be expected to follow the basic diet structure as outlined below:

• Days 2–6 after surgery, you will be on a liquid diet
• Days 7–13 after surgery, you will be on a puréed diet
• Weeks 2–4 after surgery, you will be on a soft diet
• After 4 weeks you can return to a regular diet

1 Week after surgery

You may still have some abdominal discomfort which can be caused by your wound or the reduced size of your stomach. You can take painkillers for this if necessary. You should be able to return to work. However, you should avoid doing any heavy lifting for the next six weeks. Make sure that you continue to walk for 30 minutes each day, as well as do your breathing exercises 3 times a day using your inspirometer. Continue following a predominantly liquid diet as instructed by your dietician. See your diet sheet for ideas and meal plans.

2 – 4 Weeks after surgery

You should now be able to start on a diet of puréed foods (see diet sheet for examples of meal plans). You may experience symptoms of ‘dumping syndrome’. This is where you may feel sweaty, light headed and have diarrhoea after eating refined carbohydrates such as sucrose (table sugar) or fructose (fruit sugar). You may also notice intolerance to milk based products; if this occurs, switch to non-dairy soya based alternatives.

Make sure that you continue to walk for 30 minutes each day, as well as do your breathing exercises 3 times a day using your inspirometer.

4 – 8 Weeks after surgery

You can now start eating a diet of predominantly soft foods. Make sure that you continue to walk for 30 minutes each day, as well as do your breathing exercises 3 times a day using your inspirometer.

8 Weeks after surgery

You can start eating ‘normal’ food (solids), but be careful with any food that does not crumble in the hand, such as bread or broccoli because these can swell in the stomach causing bloating. Make sure that you continue to walk for 30 minutes each day, as well as do your breathing exercises 3 times a day using your inspirometer.

3 Months after surgery

You will have your third post-operative outpatient appointment to see the doctor. Blood tests will be taken at this appointment.

1 Year after surgery

You will have your fourth post-operative outpatient appointment to see the doctor. Blood tests will be taken at this appointment.

After the first year

We would like to see you on a yearly basis. Blood tests will be taken at this appointment.