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Gastric bypass surgery for obesity

Published by Bupa's health information team, December 2006.

This factsheet is for people who are having or thinking of having a gastric bypass operation. Your care may differ from what is described here because it is adapted to meet your individual needs, so it's important to follow your surgeon's advice.

What's involved?

Gastric bypass is a type of weight loss surgery that works by making your stomach smaller and removing part of your bowel to make your digestive system shorter. This means that you can only eat small meals and your body will take up less calories from the food you eat.

The operation is done under general anaesthesia. This means you will be asleep during the procedure. For more information, please see the separate BUPA health factsheet, General anaesthesia.

Depending on the surgical technique used, you will need to stay in hospital about three to five days.

Your surgeon will explain the benefits and risks of having a gastric bypass, and will also discuss the alternatives to the procedure.

Preparing for your operation

The hospital will send you a pre-admission questionnaire. Your answers help hospital staff to plan your care by taking into account your medical history and any previous experience of hospital treatment. You will be asked to fill in this questionnaire and return it within three days.

Two or three weeks before your operation you will be asked to attend a pre-admission clinic for a blood pressure check and routine blood and urine tests.

If you normally take medication (eg tablets for blood pressure), continue to take this as usual, unless your surgeon specifically tells you not to. If you are unsure about taking your medication, please contact the hospital.

Before you come into hospital, you will be asked to follow some instructions.

• Have a bath or shower at home on the day of your admission.
• Remove any make-up, nail varnish and jewellery. Rings and earrings that you prefer not to remove can usually be covered with sticky tape.
• Follow the fasting instructions in your admission letter. Typically, you must not eat or drink for six hours before general anaesthesia.

When you arrive at the hospital, your nurse will do some simple tests such as checking your heart rate and blood pressure, and testing your urine.

You may be asked to wear compression stockings to help maintain circulation and prevent blood clots forming in the veins of your legs (deep vein thrombosis, DVT). You may also be given an injection of a blood thinning drug called heparin before surgery. For more information please see the separate BUPA health factsheets, Deep vein thrombosis and Compression stockings.

Your surgeon and anaesthetist will visit you before the operation. This is a good time to ask any unanswered questions.

About the operation

Your surgeon will use surgical staples to create a pouch from the upper part of the stomach. A section of your small intestine is then cut out, making it shorter. It is re-connected to the pouch so that food bypasses part of your digestive system and is absorbed less easily by the body. Gastric bypass can be done using keyhole (laparoscopic) or open surgery. The operation may take two to three hours.

Keyhole surgery

About five small cuts (one to two centimetres long) are made on your abdomen and chest. Your surgeon will insert a tube-like telescopic camera into a cut, and view the area either by looking directly through this, or at pictures it sends to a video screen. The operation is done using specially designed surgical instruments. Afterwards, the skin cuts are closed with two or three stitches.

Open surgery

A single cut (about 30cm long) is made on your upper abdomen. The cut is closed using stitches and staples.

You will be given antibiotics during the operation to reduce the chance of getting an infection from the bacteria that are naturally present in your bowel.

After your operation

You will be taken from the operating theatre to the high dependency unit where you will be closely monitored. You will be connected to machines that monitor the activity of your heart and other body systems. Once the medical team is happy with your progress, you will be taken back to your room.

Back on the ward

A nurse will assess the operation site and monitor your heart rate and blood pressure at regular intervals.

You may have a tube passing through your nose to your stomach for the first day or two. This drains air and fluid from your stomach to stop you feeling sick and bloated.

For the first 24 hours you will only be allowed to drink clear fluids. After this your surgeon or dietitian may start you on a liquid diet. While you are unable to drink you will have a drip in your arm to keep you hydrated.

You may have a catheter to drain urine from your bladder into a bag beside your bed. You may also have a tube running out of a small hole in your abdomen. This drains fluid into a bag.

Your surgeon will visit you to assess your progress and answer any questions you have about the operation. You will usually have an X-ray taken to check the gastric bypass is working and there are no leaks. You may be asked to swallow fluid that shows up on X-ray images. Ask your surgeon for further details.

You may have an intermittent compression pump attached to special pads on your lower legs. By inflating the pads, the pump encourages healthy blood flow and helps to prevent DVT.

You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs. You may have daily injections of heparin for a week or two. You may be shown how to inject this yourself at home.

You will need to make lifelong changes and follow a strict diet after the bypass operation. You will need to have liquidised or pureed food for the first few weeks, so that the new joins in your digestive system have chance to heal properly. Your dietitian or surgeon will give you more advice.

Going home

Before you go home, your nurse will give you advice about caring for the healing wound(s), hygiene and bathing. For more information, please see the separate BUPA health factsheet, Caring for surgical wounds.

Your nurse will also give you a telephone number for the hospital, in case you need to ask for further advice, and a date for a follow-up appointment.

After you return home

If you need them, continue taking painkillers as advised by the hospital. Any medication you are prescribed should be dissolvable.

Your stitches are usually removed before you leave hospital. The skin staples are usually taken out 12 to 14 days after surgery. Please contact the hospital if you have any concerns.

Deciding on having a gastric bypass

A gastric bypass is a major operation that changes the way the digestive system works. For most people, the benefits in terms of losing excess weight are much greater than any disadvantages. However, the operation carries an element of risk. In order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful treatment. Afterwards, you are likely to have some bruising, pain and swelling of the skin around the healing wound(s) for a few days.

You may feel or be sick after eating, especially if you try to eat too much. If you eat sugary foods it can make you feel faint and sweaty. This is called "dumping" syndrome. You will usually need to take vitamin supplements due to the restricted diet, and your bowel absorbs less well than before surgery.

Complications are when problems occur during or after the operation. Most people are not affected. The possible complications of any surgery include an unexpected reaction to the anaesthesia or excessive bleeding during or soon after surgery. A blood transfusion may be required to replace the lost blood.

Some of the complications specific to a gastric bypass are listed here.

• Wound infection. Antibiotics are given during surgery to help prevent this.
• For up to six weeks after the operation, it is possible to develop a blood clot (DVT) in the veins in the leg. This clot can break off and cause a blockage in the lungs. In most cases this is treatable, but it can be a life-threatening condition. Compression stockings, intermittent compression pumps and blood-thinning injections are used to help prevent DVT.
• During the operation other organs in the abdomen may be accidentally damaged. The points at which the intestine is re-joined could leak in the first few days. These complications are rare, but may need further surgery.
• There is a small risk of death during or soon after this operation.
• It is possible you may fail to lose sufficient weight or regain weight, and the operation may need to be repeated.
• If you lose weight rapidly, there is a risk of developing gallstones in your gallbladder. These can be painful. Your surgeon may remove your gallbladder during surgery.

Ask your surgeon to explain how these risks apply to you. The exact risks will differ for every person. This is one of the reasons why we have not included statistics here.

Further information

• British Obesity Surgery Patients Association (BOSPA)
  08456 02 04 46
  www.bospa.org
• Association for the Study of Obesity (ASO)
  020 8503 2042
  www.aso.org.uk

Sources

• Gastric bypass. British Obesity Surgery Patient Association.
  www.bospa.org
  accessed 6 December 2006

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