Gastric bypass surgery is one of the most common weight-loss surgeries out there. It's a procedure that reduces the size of your stomach so you can't eat as much food at once, which causes you to feel full more quickly and lose weight.
The cost for this type of surgery varies quite a bit depending on where it's being done, but it typically ranges from $25,000-$35,000.
Gastric bypass, also called Roux-en-Y (roo-en-wy) gastric bypass, is a weight-loss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine.
After gastric bypass, swallowed food will go into this small pouch of the stomach and then directly into the small intestine, thereby bypassing most of your stomach and the first section of your small intestine.
Gastric bypass is one of the most commonly performed types of bariatric surgery. Gastric bypass is done when diet and exercise haven't worked or serious health problems because of your weight. Check out this here to know more about the cost of gastric bypass surgery.
Symptoms of Anastomotic Leaking
Anastomotic leaks happen in 1.5% to 6% of bypass procedures, depending on the type of surgery. A leak may happen up to several weeks later. Most develop within 3 days after surgery. Symptoms of an anastomotic leak include:
- Rapid heart rate
- Stomach pain
- Drainage from a surgical wound
- Nausea and vomiting
- Pain in the left shoulder area
- Low blood pressure
- Decreased urine output
The more obese you are, the more at risk you are for an anastomotic leak. Other risk factors include:
- Being male.
- Having other medical problems besides obesity.
- Having a history of previous abdominal surgery.
Diagnosis and Treatment of Anastomotic Leaking
A diagnostic test used to look for anastomotic leaking is an upper GI or a CT scan. Both involve swallowing some liquid contrast dye and then taking X-rays to see if the dye is leaking through the anastomosis. Even if you have a negative exam but still have symptoms, your healthcare provider may recommend an emergency operation to look for a leak.
The medical team treating an anastomotic leak will likely take these steps:
- Give you antibiotics through an intravenous line (IV).
- Drain any infection caused by the leak, repair the leak, or make a new anastomosis by operating again.
- Use an upper endoscopy to place a temporary stent across the leaking area, from the inside of the gastric pouch or the small intestine.
- Stop all oral feedings. You may be fed through a tube that goes directly into your intestine until the leak has healed.
Risks of Anastomotic Leaking
A leaking anastomosis may cause bleeding and infection until it is treated. These leaks are serious and can be life-threatening. Long-term complications may include ulcers, scarring, and narrowing of the anastomosis (where the intestine is connected to the gastric pouch), a stricture.
A drainage tract through the skin called a fistula might also develop. A fistula could develop between the gastric pouch and the bypassed stomach. Pneumonia is another dangerous complication because digestive juices can spill into the lungs.
If you are considering gastric bypass surgery for obesity, discuss the procedure carefully with your healthcare provider. The overall risk of serious complications should be weighed against the risk of continued obesity. Also, remember that gastric bypass surgery works best when combined with long-term, healthy lifestyle choices. These involve good nutritional eating habits and regular exercise.
Things to Anticipate
You will have some belly pain and may need pain medicine for the first week or so after surgery. In addition, the cut that the doctor makes (incision) may be tender and sore.
Most people need 2 to 4 weeks before they are ready to get back to their usual routine.
Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly and lead to dumping syndrome. This can cause diarrhea and make you feel faint, shaky, and nauseous. It also can make it hard for your body to get enough nutrition.
Your doctor will give you specific instructions about what to eat after the surgery. First, you'll start with only small amounts of soft foods and liquids. Then, bit by bit, you will be able to add solid foods back into your diet.
This surgery bypasses the part of the intestine where many minerals and vitamins are most easily absorbed. Because of this, you may not get enough iron, calcium, magnesium, or vitamins. So it's important to make sure you get enough nutrients in your daily meals to prevent vitamin and mineral deficiencies. You may need to work with a dietitian to plan meals. And you may need to take extra vitamin B12.
Depending on how the surgery was done (open or laparoscopic), you'll have to watch your activity during recovery. If you had open surgery, make sure to avoid heavy lifting or strenuous exercise while you are recovering so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks. The surgery is most often done as a laparoscopic procedure. This means the recovery time is faster.
Things to Prepare Yourself For
Life after weight loss surgery isn't always what people expect. In addition to changes in your appetite, you may experience unexpected alterations in your lifestyle, social life, relationships, and emotions. The changes often come as a surprise to people who hoped that the surgery might offer an easy way out of their weight loss predicament.
Weight loss surgery isn't an alternative to diet and exercise—it is an addition to diet and exercise. Good eating habits and regular exercise become even more important after bariatric surgery.
To optimize the results of your surgery, you will need to spend each day practising healthy behaviour. In addition, you have to journal your food intake and measure quantities and types of food you eat to ensure the appropriate dietary and nutritional intake. For some, the commitment is more than anticipated.
New Social Habits
As you begin to build a new relationship with food, you may not partake in social situations that revolve around food. Instead, you would learn to schedule social outings around physical activity, which some of your friends may not be keen about.
Loss of Relationships
Your changing social habits may frustrate and even alienate the friends you had before surgery. You will need to work with your family and friends to accept the new behaviours, and that may be a challenge because most people prefer to keep their life the way it was. That includes any bad habits that may have caused weight gain in the first place.
People who undergo bariatric surgery will often build entirely new social circles with friends who practise healthier behaviours to stay on track. Unfortunately, this can sometimes result in the loss of old friendships, which can be painful.
If you expect weight loss surgery to solve social or emotional problems and make life better, you may end up disappointed. Some people who gain weight use food for emotional comfort. This isn't a problem that surgery can solve. If emotional issues are present before surgery, they are likely to be present after surgery as well.
Your weight loss may provide positive results on the scale, but you still may not like what you see in the mirror. Excess skin is a problem for bariatric patients who lose weight. For some, the sight of loose skin is just as bad (or even worse) than excessive weight.
Solutions for reducing excess skin include exercise and various surgeries such as a lower-body lift (belly, buttocks, hips, and thighs), upper-body lift (breast and back), Brachioplasty (upper arms), and medial thigh lift (inner and outer thighs).
Multiple surgeries are sometimes needed. Moreover, the cost of surgery can often be exorbitant, with a lower-body lift costing anywhere from $7,000 to $25,000.
Alcohol Use Disorder
Some patients who undergo surgery, particularly gastric bypass and sleeve gastrectomy, experience alcohol use disorders years after surgery. There is speculation that the procedures alter the way alcohol is processed in the body.
Because of this, some patients may be at higher risk for alcohol use disorder. Male sex, younger age, tobacco use, and drinking patterns before bariatric surgery are associated with increased risk.8
While the success rates for weight loss surgery continue to improve, some weight regains after bariatric surgery are very common.
What You Can Expect
Gastric bypass surgery is done in the hospital. Depending on your recovery, your hospital stay is typically one to two days but may last longer.
During the Procedure
You will be given general anesthesia before your surgery begins. Anesthesia is a medicine that keeps you asleep and comfortable during surgery.
The specifics of your gastric bypass depend on your situation and the doctor's practices. Some surgeries are done with traditional large (open) incisions in your abdomen. However, most are performed laparoscopically, which involves inserting instruments through multiple small incisions in the abdomen.
After making the incisions with the open or laparoscopic technique, the surgeon cuts across the top of your stomach, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Normally, your stomach can hold about 3 pints of food.
Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. Food then goes into this small pouch of the stomach and then directly into the small intestine sewn to it. Thus, food bypasses most of your stomach and the first section of your small intestine and instead enters directly into the middle part of your small intestine.
Surgery usually takes a few hours. After surgery, you awaken in a recovery room, where the medical staff monitors you for any complications.
After the Procedure
Immediately after gastric bypass surgery, you may have liquids, but no solid food as your stomach and intestines begin to heal. You'll then follow a special diet plan that changes slowly from liquids to pureed foods. After that, you can eat soft foods, then move on to firmer foods as your body can tolerate them.
You may have many restrictions or limits on how much and what you can eat and drink. Your doctor will recommend you take vitamin and mineral supplements after surgery, including a multivitamin with iron, calcium and vitamin B-12.
You'll also have frequent medical checkups to monitor your health in the first several months after weight-loss surgery. In addition, you may need laboratory testing, bloodwork and various exams.
Gastric Bypass Surgery FAQs
Some bariatric surgery risks include:
- Acid reflux
- Anesthesia-related risks
- Chronic nausea and vomiting
- Dilation of esophagus
- Inability to eat certain foods
- Obstruction of stomach
- Weight gain or failure to lose weight
Bariatric Surgery Long-Term Risks
Bariatric surgery carries some long-term risks for patients, including:
- Dumping syndrome, a condition that can lead to symptoms like nausea and dizziness
- Low blood sugar
- Bowel obstruction
Overview of Bariatric Surgery Risks and Complications by Procedure
Risks and side effects vary by bariatric procedure. Therefore, the following list is not all-inclusive but briefly outlines the risks of gastric bypass and gastric sleeve.
Your bariatric surgeon will make sure you understand the risks and complications of your specific procedure.
Risks of Gastric Bypass:
- Dumping syndrome
- Gallstones (risk increases with rapid or
- substantial weight loss)
- Internal bleeding or profuse bleeding of the
- surgical wound
- Perforation of stomach or intestines
- Pouch/anastomotic obstruction or bowel obstruction
- Protein or calorie malnutrition
- Pulmonary and cardiac problems
- Skin separation
- Spleen or another organ injury
- Stomach or intestine ulceration
- Vitamin or iron deficiency
Beverages to Avoid After Bariatric Surgery
Some drinks may irritate your healing stomach and should be avoided after bariatric surgery, including:
- Caffeine for at least 3 months after surgery
- Carbonated beverages for at least 3 months after surgery
- Alcoholic drinks for at least 6 months after surgery
Even after your stomach heals, you may find that there are certain beverages that you can't tolerate, and they may need to be removed from your diet indefinitely.
Foods to Avoid After Bariatric Surgery
You may also experience food intolerances that you didn't have before surgery. They may include the following:
- Red meat that's tough or dry
- Greasy, high-fat foods
- Heavily seasoned or spicy foods
- Sugar alcohols, such as erythritol, glycerol, mannitol, sorbitol and xylitol
- Foods reheated in the microwave
Pain is a subjective matter. However, whether you have gastric bypass, gastric sleeve or Lap-Band surgery, there will be a pain, and it can be significant.
It would be nice to say gastric bypass surgery produces an 8 out of 10 on the pain scale. Gastric sleeve surgery produces 7 out of 10 on the pain scale, and Lap-Band surgery is a 5 out of 10. However, we can't do that because there are just too many differences in the way people feel and rate pain.
Most weight-loss surgeries are performed laparoscopically, so this article pertains specifically to laparoscopic surgery. With an open procedure, there is considerably more pain, and a longer hospital stay.
Anecdotally, laparoscopic gastric bypass and gastric sleeve surgery (sleeve gastrectomy) produce a similar amount of pain. Typically, more pain is experienced at the incision site that the surgeon removed the stomach from. This is usually the upper left quadrant (under your rib cage on your left side).
This makes sense because the incision needs to be widened and often stretched to remove the stomach during a gastric sleeve procedure. Muscle fibres tear and are often bruised as a result.
During gastric bypass surgery, the anastomosis (the connection of the intestines to the new stomach) is often made with a circular stapler. These staplers are large and typically require enlarging the incision in the upper left quadrant. In addition, the insertion and removal of this stapler can stretch the muscle and sometimes cause bruising.
Because of the larger incisions with gastric bypass and gastric sleeve surgery, these two procedures may lead to slightly more pain than Lap-Band surgery.
Overall, pain is not a huge concern after surgery. It can be managed well with pain medication. Most patients are off all pain medications in a few days and back to work within a week. With that said, bending over, getting up from a seated position and twisting your torso can cause sharp pain for a few weeks after surgery. This goes away with time.
The key point to remember about pain is that there are very few, if any, patients that would not have the surgery again if they could go back in time. So while you can expect some pain, rest assured, it will be worth it in the long run. Our article about gastric sleeve recovery goes into detail on pain and recovery.