Answers to Questions About Gastric Bypass Surgery
Before you have any consultation with a surgeon about any bariatric surgery, you should gather as much information as possible about the various options. The list of FAQ's below is meant to address common issues. Please read them carefully. They might help you think of other questions that you need to ask during your visit.
About the operation
Q: What is the Roux-en-Y Gastric Bypass operation?
See “How I do the Surgery” for pictures and further description.
During this surgical procedure, the stomach is divided into two compartments. The upper part of the stomach, called a pouch, receives the food that you eat. This new pouch is approximately 15 cubic centimeters (or the size of a golf ball). While the surgery reduces the capacity of the stomach by 90-95 percent, no part of the stomach is removed.
Next, an outlet, called a stoma, is created in the small stomach pouch. This outlet is about 12 millimeters in diameter – about the size of an “M&M”. The food a person eats must be able to pass through this opening, which is why it must be chewed very well. The upper small intestine is then divided and joined to the new stoma. Food bypasses the lower part of the stomach and a very small part of the small intestine (which is why the surgical procedure is also known as the “gastric bypass”). Digestion occurs in the remainder of the intestine.
Q: What happens to the larger stomach portion that is no longer used?
The larger, lower part of your stomach no longer receives food, but its gastric juices from this part of the stomach pass into the intestine and mix with food as they did before surgery. This mixing of the stomach juices and food allows digestion to occur in the small intestine. This piece of stomach is a very important part of your digestive tract, because of the fluid that it makes, so it's important to keep it in place. (Note: the Sleeve Gastrectomy removes 80+% of this part of the stomach, which may lead to serious problems with nutrition after the Sleeve operation!)
Q: Is the Gastric Bypass reversible?
Yes, the gastric bypass IS reversible. Reversals are extremely rare, however, so you don't tend to hear about them being performed very often.
Q: Can the stoma (pouch outlet) narrow down and cause vomiting?
Patients heal at different rates and scar differently. In a few patients, scarring at the pouch’s outlet can cause their outlet to narrow. This is called stomal stenosis, or stricture, and is usually managed by endoscopic dilatation by a gastroenterologist. If this is going to occur it usually happens within the first three months after surgery. Those patients who are smokers, or exposed to second hand smoke, are prone to this occuring to a more severe degree and on a long term basis.
Q: Why are staples used in surgery?
Staplers have been used in abdominal surgery for the past 30 years, and there are few gastrointestinal operations done without them. They make a more precise connection than suturing alone. In the Roux-en-Y gastric bypass, a special type of cutting stapler is used when the stomach is completely divided to create the stomach pouch. It is also used to divide the small intestine. Compared to old-fashioned methods, the use of the cutting stapler allows fast, clean and precise division of the stomach and intestine.
As healing progresses over the three to four week period after your surgery, tissue grows over the staples. They are there permanently and will show up on an x-ray, but they play no significant role in the long-term outcome of the operation, nor are they associated with significant ill effects. (This is not to be confused with the “vertical banded gastroplasty,” commonly called “stomach stapling”, which uses staples in a far different manner. )
Q: Will the staples set off the metal detector or the security alarm at the airport?
It is highly unlikely that the internal staples described above will set off a metal detector at the airport. It is recommended, however, that if you ever require a test called magnetic resonance imaging (MRI), you tell the people performing the test that you have internal staples. It is generally safe to undergo MRI scanning although most radiologists recommend waiting at least 2-3 months after surgery to do so.
Q: How long will it take me to recover from surgery?
Most people go back to desk-type jobs about a week after surgery. It generally takes about six weeks before the fatigue of anesthesia fully wears off and it is important to exercise and eat and drink properly from the very beginning so you have lots of energy when the six week mark arrives. You are not allowed to lift anything more than 10 pounds for one month after laparoscopic surgery and for six weeks following open surgery.
Q: How much food will my new stomach hold?
When your new stomach pouch has healed, an average meal will be about ½ to 1 cup of food, however, different foods move through at different rates, depending on the consistency. The amount of food a person can eat 9-12 months after surgery varies between individuals, but most people are able to eat a couple of cups of food at a sitting, like most thin people do.
Q: What kind of nutrition program will I have after surgery?
You will be on a special eating program designed to allow your stomach to heal, while you receive the protein, vitamins and minerals you need. You will begin with liquids for about a week and then progress to soft and, finally, solid foods in about two weeks. You will be taught by the nutritionist, the nursing staff and of course, by me. I will help guide your eating plan throughout your recovery and will teach you about your new eating program as time passes. If you want details, I recommend that you take a look at The Toolkit, and read the section on “What to Eat After Surgery”.
Q: Can I be healthy eating the recommended amounts of food and fewer calories?
Absolutely. Family members may voice concern about the small amounts of food and fewer calories that patients eat after Bariatric surgery. However, this low-volume, low fat and low sugar-eating program is designed to meet your body’s nutritional needs. We will teach you all about your body’s nutritional needs and how to meet these needs after surgery. You will learn how to keep protein in your eating plan and about the multivitamins you will need to take. A well-balanced nutrition program is very important after surgery because your stomach will be smaller and hold less.
Q: Are there any foods that I will never be able to eat after Gastric Bypass Surgery?
Food tolerance is very individual. Most people eat almost everything they ate before surgery that is low in fat and sugar. However, they chew more carefully and eat smaller portions.
Occasionally, patients find there are a few foods they do not tolerate well after surgery. This usually happens as they reintroduce solid foods into their eating program. Foods that can provide difficulty include red fibrous meat, doughy bread, rice and pasta. Some patients find that starches, carbohydrates and sugars make them feel unwell after surgery and they are happy to not be able to eat them.
Q: How will surgery change my eating habits?
The surgery will help you change the way you eat and will reinforce a new eating plan. Because your new stomach is smaller, you will feel full after eating less food. Your new stomach pouch will not be able to grind food as it once did, so you will need to eat small bites and chew food very, very well.
You may choose not to eat certain foods because they may no longer taste good to you. In addition, foods high in fat and sugar may not be tolerated well and can cause a reaction called the “dumping syndrome”.
Q: What is the “Dumping Syndrome”?
After gastric bypass, your body may be less able to tolerate “refined” sugars or high amounts of fats. When these foods are eaten, your pancreas is signaled to secrete insulin and cause fluids to be drawn into the intestine. This causes a reaction called the “dumping syndrome”. Common symptoms include sweating, nausea, dizziness, tiredness, cramps and diarrhea. These symptoms typically last about 30-90 minutes, depending on what and how much the person has eaten. The symptoms can mimic the flu. It is not fatal, but it can be quite uncomfortable.
Q: Will the stomach pouch stretch so that the lost weight is gained?
If the surgery is performed correctly, the pouch will not stretch significantly. It is more important to concern yourself with stretching the stoma of the new stomach by persistently overeating, or by not chewing food well enough. This does not occur easily, but occurs only by persistently overeating over a long period. The surgery is a tool to help you achieve weight loss, but you must follow the nutritional recommendations for long-term success.
Q: Why do I need to drink 64 ounces of water daily?
Drinking water keeps you from becoming dehydrated. This is particularly important after gastric bypass surgery. Drinking plenty of water allows the body to be effective and efficient in ridding itself of the excess fat and also reduces food cravings. Staying hydrated and exercising are also the two best ways to reduce the amount of excess skin that you have after the weight loss is complete!
Since you will not be able to drink water quickly as your stomach heals from surgery, you will need to sip small amounts of water throughout the day. Carry a water bottle for convenience and to remind you to keep sipping. The water bottle should become a familiar sight in and out of your home. If you do not like your tap water, treat yourself to bottled water. A slice of lemon can add flavor.
Q: Can I drink coffee and soft drinks for my fluid requirements?
It is not recommended to drink soda, tea or coffee, as they dehydrate your body by acting as a diuretic and they stimulate your appetite. Also, avoid carbonated beverages during the first six months or so after your surgery. Carbonation does not stretch out your stomach, but it can cause gas that may be painful.
Avoid the use of straws. With a straw, you can drink large amounts of fluid without realizing it and overfill your stomach pouch. In addition, you can swallow air that can cause discomfort.
Q: Can a person drink alcohol after gastric bypass surgery?
Alcohol is basically a type of sugar and it slows down a patient’s weight loss and may cause dumping syndrome. It contains lots of calories and is not nutritional. After surgery, alcohol enters the blood stream more quickly than before surgery. The intoxicating effects of alcohol occur sooner than before surgery and after smaller amounts are ingested. A patient who has had gastric bypass surgery absorbs FOUR times as much alcohol from a given drink versus before surgery. It is best to avoid drinking alcohol for at least six months after surgery, since it can be irritating to the stomach pouch and cause ulcers. You may choose to drink alcohol after the six month mark, but only do so on special, rare occasions, and NEVER drive within 24 hours of having an alcoholic beverage.
Q: Can I smoke after surgery?
Absolutely not. Smoking stimulates gastric secretions that can irritate the lining of the stomach. This irritation can cause chronic gastritis and ulcers in the stomach and small intestine. It can also lead to dangerous strictures of the stomach. The same applies to second hand smoke.
Q: Why do I need to take vitamins on a regular basis?
Since you are eating less food, smaller amounts of vitamins and minerals are entering your system.The body also requires more vitamins during the stress of weight loss and you need special vitamins for life due to differences in the way your body aborbs vitamins from food after surgery. It is important to follow your bariatric surgeon's advice about vitamins and get your labs checked by your surgeon every year, for life. Do not prescribe vitamin supplements yourself. Many are toxic in larger amounts. For details on the required vitamins, see “The Toolkit” and the section on vitamins.
Q: I have already had my surgery, and I do not seem to be hungry. Why?
Patients report different reactions to food after surgery. Some find that they are not hungry for the first several weeks or months and have to “force” themselves to eat the meals. Remember, the size of your stomach is smaller after surgery, so it will take less food to make you feel full.
Your first nutritional goals are to drink 64 ounces of fluid daily and meet your daily goal of 60 grams of protein. Remember too, that some fluids can be good sources of protein.
Q: What if I am feeling hungry?
The feeling of hunger immediately after surgery can indicate that the liquids are not remaining in your stomach long enough for you to feel “full”. However, it is important that you follow the nutritional guidelines that allow your pouch to heal from the surgical procedure.
If you are hungry once you are on more solid foods, it could mean that you are not getting enough water between meals, as the body frequently cannot tell the difference between hunger and thirst.
Q: Why do I think about the high fat and high sugar foods that will not be a part of my new eating program?
A craving for a particular food is usually triggered by an emotional or hormonal desire. Sometimes after surgery, patients grieve over losing the freedom of food choice that they had before surgery. It can be difficult emotionally to have a restriction on the kind and amount of food you can eat. Feelings of loss must be dealt with as part of the healing process in your path to recovery.
To prevent a thirst-triggered craving, make sure you drink enough water. If you are bored, distract yourself with some exercise or activity. When you increase your activity level, glucose is released into your system and often may end your craving. In addition, participating in an activity you enjoy may distract your craving. If you wish to learn new coping and problem solving skills, referral to a therapist can be arranged. You also may find participation in a support group helpful after your surgery.
Q: When should I weigh and measure myself?
We recommend that you weigh once a day. Plan to weigh and measure yourself on a regular schedule, at the same time of day and in similar clothing.
Q: Will my weight loss ever hit a plateau?
During the period of weight loss, you may hit a plateau when you notice you are not losing pounds. Your body needs time to adjust to the chemical and biological changes that occur during weight loss.
If plateaus continue for more than a few weeks, review your nutrition plan and activity level. Are you following the nutrition guidelines for portions, protein and fluid intake and limiting fats and sugars in your food selections? Decreasing your activity level can also contribute to a weight plateau. Review your activity level and see if your level of physical activity can be increased. If you are weight training, remember that muscle weighs more than fat, and while you are building muscle, you are still losing inches even though you are not losing pounds. Please never hesitate to contact my office with these issues! I am here to help you through these times!
Q: Why is Activity so important for me after surgery?
Exercise maximizes weight loss and helps to maintain a healthy body. When you are losing weight rapidly, you must protect your muscles from breakdown and exercise does just this. If you do not exercise properly, you may have significant muscle wasting and weakness. So after surgery, you not only need good nutrition, you need to take the time for regular activity. You can build exercise into your daily schedule, and it even helps to walk to do your errands. Here are some reasons why physical activity is important to you:
- Exercise increases your metabolic rate, which can help you lose weight faster.
- Exercise is fat burning.
- Exercise improves your mood and feeling of well being by secreting endorphins (pleasure-chemicals) into your body.
- Exercise causes a person to feel less hungry.
- Exercise increases muscle tissue, which, unlike fat, constantly burns calories (even when the body is resting).
- Exercise will decrease muscle breakdown while losing weight.
- Exercise helps to alleviate constipation.
- Exercise can improve sexual activity.
There are many more reasons for exercise. Why not consider the benefits of joining a fitness program? Use your increasing energy to discover (or rediscover) some new, active interests.
Q: What will my rate of weight loss be after surgery?
Patients do not lose pounds and inches at the same pace from week to week. Weight loss is greatest in the first three months after surgery. A person usually loses at least 20 percent of his/her excess body weight within the first two months, and 50-100 percent at one year, depending on how well they adhere to the program. As you begin to near your weight loss goal, weight loss will slow to approximately one to three pounds per week. Remember that men generally lose weight faster than women.
Q: How does a menstrual cycle affect a woman’s weight loss?
Women should consider their normal menstrual cycle when they weigh themselves. If you typically gained weight during your period before surgery, you will probably continue this pattern after surgery. Remember that water weighs more than fat. This fluctuation of water in your body due to your menstrual cycle may result in a temporary temporary "plateau" in your weight loss, or even a slight weight gain.
Q: Will surgery affect a woman’s chances of pregnancy?
Women who are overweight sometimes have reduced fertility, and losing the weight increases the fertility. We recommend that women avoid pregnancy for the first year to 18 months after surgery. After that period, a woman should have a normal pregnancy. It is essential to discuss any plans for pregnancy with your surgeon, as well as an obstetrician, before surgery.
Q: I have heard that some people experience hair thinning or loss after gastric byass surgery. Will this happen to me?
Major surgery, rapid weight loss and changes in eating behavior and activity level can produce stress on the body. Hair loss may be a reaction to this stress. Patients who experience some hair loss usually notice it occurs three to six months after surgery. This is temporary, and you will not lose all of your hair. It will grow back, although some men report that it doesn’t return to 100% fullness.
Q: How often will I follow up after surgery?
My patients have their first appointment with me several days after their discharge from the hospital. After that time, I either meet face to face or have a telephone follow-up with each of my patients on a monthly basis for the first year. Most patients reach their maximum weight loss by a year, but if you have more than 150 pounds to lose, it may take longer. I will be available to work on a monthly basis with you until you achieve your goal. We then decide together how to proceed, but follow-ups are done at least on a yearly basis thereafter, FOR LIFE.
Q: How often do I follow up with my therapist?
If you were receiving treatment from a therapist before surgery, we advise you to continue keeping your appointments after your hospitalization.
Q: Can I take my antidepressant or antianxiety medication?
If you were taking an antidepressant or other psychopharmacological medication before your surgery, we recommend you resume use in consultation with myself and your prescribing doctor. You may need to adjust the dosage of some medications as your needs change.