Laparoscopic Gastric Bypass
Laparoscopic Roux-en–Y Gastric Bypass Surgery
Laparoscopic roux-en-y gastric bypass (simplified to gastric bypass) is an operation that creates a small stomach out of your existing stomach and through rejoining the small bowel it bypasses the remainder of your stomach, duodenum, and approximately 1.2 meters of small bowel (jejunum).
How does it work?
Like the sleeve Gastrectomy the gastric bypass works by restriction, vagus nerve stimulation, and gut hormones (particularly protein YY and Ghrelin) making background hunger less and enhancing the sensation of fullness after eating. In addition there is a small component of malabsorption. The gastric pouch is very small at the start and as time goes on it slowly enlarges allowing to eat larger meals. This provides for significant weight loss at the start with eventual plateau of the weight loss by 12-18months. It never becomes as big as your whole stomach currently is though it is important to remember this operation provides you with a tool for weight loss and using the tool correctly by combining with good eating habits, a healthy diet, and healthy lifestyle remains essential for life.
Perioperative care pathway
The pre-operative preparation for gastric bypass is identical to that of the sleeve Gastrectomy with education sessions with our Dietitian, Nurse specialist, and Anaesthetist. There is a three-week Optifast diet leading up to your surgery date.
The operation is performed under a general anaesthetic. Laparoscopic approach is successful in most patients though like the sleeve Gastrectomy occasionally conversion to open is required. There are generally five small incisions made for the instruments (same as for sleeve Gastrectomy). The operation takes approximately 1.5 to 2 hours (slightly longer than the sleeve Gastrectomy).
Recovery is pretty much identical to that of the sleeve Gastrectomy with two nights in hospital, a progressive diet over six to eight weeks, and the recommended two weeks off work. Physical activity is encouraged immediately after surgery though should be light (short walks) but increased over time. By two weeks most light activities should be easily performed. We recommend waiting four weeks for heavy lifting and strenuous activities. Follow-up appointments are as per the sleeve Gastrectomy.
- Wound infection
- Significant internal bleeding (1%)
- Leak from one of the joins (2%)
- Ulcer or stricture (narrowing) within the gastric pouch
- Internal herniation (1% per annum, generally needs emergency surgery)
- Major nutritional deficiency (if you stop taking your multivitamins)
- Dumping syndrome
- Medical complications such as blood clots, pneumonia, heart problems, kidney problems (1-2%)
Other rarer complications include reaction to medications given, injury to other structures within the abdomen, and developing an incisional hernia.
Note: Smoking significantly increases the risk of complications such as a leak from one of the joins, wound infection, blood clots, (which can travel to the lung) and ulcer formation. Vaping of nicotine products is also thought to increase complication risks though is less well studied. All patients are expected to be smoke and vape-free for a minimum of six weeks before surgery.
Following gastric bypass you may experience an intolerance to certain types of food They fall into two categories:
- Fatty greasy foods and dairy products
- Highly processed carbohydrates such as cakes and sugars/ sweets.
Fatty foods cause their effect by going through undigested. Simple carbohydrates have a more complex effect on insulin and adrenaline-like hormone controls. These cause unpleasant symptoms similar to sea sickness such as sweating, nausea, shaking, abdominal pain as well as diarrhoea. Symptoms may last a few minutes to an hour. This is known as “dumping” syndrome.
Will I get dumping syndrome?
Most people will get some dumping syndrome as a result of gastric bypass surgery though for most it is very mild and only occasional. The best way to avoid it is to stick to good eating habits and a healthy diet.
Other common side effects:
Hair loss: This is related to inadequate protein intake and is most noticeable during the first six months after surgery. It is mostly reversible as your dietary intake of protein increases
Gallstones: Morbid obesity is an independent risk factor for developing gallstones though so is rapid weight loss such as after weight loss surgery. Most people who have gallstones are asymptomatic so currently there is no recommendation to screen you for gallstones or preventatively remove the gallbladder at the time of surgery unless you have symptoms.
At present, we do not have a fixed fee for laparoscopic gastric bypass though estimate it to be equal to the cost of the sleeve Gastrectomy with an allowance of up to $2000 extra for additional operating time and consumables.
Yes, it is possible, most people will lose some weight initially but it is possible to stop losing weight early and put all the weight loss back on. The three main causes of weight loss failure and weight regain are snacking, force-feeding, and liquid calories (energy-rich drinks). Bariatric surgery is a tool to help weight loss and does not work on its own. We provide education sessions so that you may better learn how to use your operation and get a great outcome that is durable over many years.