Gastric bypass
Gastric Bypass
The gastric bypass best suits people with a BMI >40. If your diet contains refined sugar (sweet foods) this procedure is often preferred. Like the gastric band the bypass places a restriction on the quantity of food that can be consumed by reducing the size of your stomach. It also effects the digestion and absorption of food and therefore creates a larger degree of weight loss.
The Procedure
The bypass is a more invasive procedure than gastric banding. It is carried out laproscopically under general anaesthetic and usually takes between 2-4hours. You will generally be discharged from hospital 2-3 days following your operation.
As with the band the bypass restricts the quantity of food by creating a small stomach pouch at the top end of the stomach. The major difference is that food does not enter the lower half of the stomach because the operation bypasses this area and rejoins the bowels at the jejunum. The bypass of this area means less nutrients are absorbed by the body and this also means weight loss is more rapid. It is important to note that although less absorption occurs, the body can still receive adequate nutrition.
As the body adjusts to the gastric bypass, dietary intake involves progression from a:
Fluid diet 1-2 days
Liquidised diet 1-3 weeks
Soft diet 4-5 weeks
Normal diet(Solid) + 6 weeks
The length of time at each stage differs from person to person. The aim is to get you back to a healthy diet of a solid consistency by 6weeks (see dietary intake post gastric bypass).
Initially there is a need to restrict the consistency and type of foods that can be consumed. This is due to the presence of swelling between the opening of the new stomach pouch and the intestine. Initially only liquidised foods should be consumed. A few teaspoons will make you feel full.
The new stomach pouch is much smaller and subsequently has a decreased holding capacity to store the food that you eat. This means you won’t be able to eat large volumes of food. You will feel full very quickly and your appetite will be decreased. As the body adjusts there will be some give allowing for more solid food to be consumed.
Due to dietary restrictions it is important to protect against nutritional deficiencies. Following surgery you should have a multivitamin, calcium and iron supplement which will protect against the risks of osteoporosis and anaemia. Occasionally a zinc deficiency may occur and you may be prescribed a tablet called Zincomed. An anti acid tablet will help reduce stomach acid and prevent the formation of ulcers.
Initially post surgery is the time when the stomach adjusts to its new environment. The body is healing post surgery, so it is important that you still consume adequate calories and protein to help promote recovery.
Constipation
This is due to drinking insufficient fluids, or drinking too much fluid that contains diuretics such as tea, coffee or alcohol. The solution is to drink more fluids and avoid diuretics rather than to take laxatives.
Diarrhoea
Bowels normally return to normal after the operation, although diarrhoea is not uncommon to start with. This usually settles as you restart solids.
If it does not settle or it returns, look carefully at what you are eating. The most common reason is eating foods high in sugar such as sweets, chocolates, sweet drinks or sugar added to food, or food that is high in fat such as crisps, snack foods, chips, fried foods, cheese and fatty meals. Make sure you drink extra fluid if you do have diarrhoea until it settles, but avoid sugary drinks. If your bowel motions become fatty, yellow and difficult to flush, this is always due to eating too much fat, which has exceeded the body’s ability to absorb it. It will settle if your diet is adjusted.
Dumping Syndrome
The bypass can lead to a condition called dumping. This is a term used to describe a number of symptoms including; sweating, faintness, palpitations, diarrhoea, nausea and abdominal distension. It occurs when food rapidly enters the jejunum. The main cause of dumping is sugar and sugary foods and they must therefore be avoided. Ensuring small, frequent meals with carbohydrate can also help reduce symptoms if they occur. You will still be able to consume a small quantity of chocolate, biscuits, fruit juices, sweet desserts but they must be consumed in moderation.
Vomiting
Your body will tell you if it is unhappy with the consistency and type of food that you have consumed. Vomiting may be caused by eating too fast, too much, or food that is too solid. If it contains blood (which is extremely rare), immediately call your G.P.
Generally if you revert back to the consistency of food that you could previously tolerate, and then retry a more solid consistency a few days later.
i.e. I you have been having solid food, try soft food.
If you are at the soft stage, try the liquidised stage.
Medications on discharge
Whilst in hospital, you will commence on some tablets, which you will go home on and which you need to keep taking. These consist of anti-acid tablet called FasTab (lansoprazole 30 mg) that dissolves in the mouth and which reduces the amount of stomach acid that you make. This is essential to prevent ulcers at the joint between the stomach and the intestine as the intestine is rather sensitive to the acid. You’ll also be given a pain-killer in solution form, and may need to take that for a week or two. Paracetamol is often sufficient after 1-2 weeks. You will be given a short supply of the medications from the hospital when you are discharged and you will need to arrange for a repeat prescription from you GP.
Your doctor will be sent a list of the medications that you are now on, and will be asked to start you on calcium, iron and multivitamin supplements after 2-3 weeks from the operation. Occasionally patients notice some hair loss after the surgery, and this seems to be due to a possible selenium and zinc deficiency. If this occurs, you can buy selenium supplements over the counter in most chemists, either as capsules or chewable or request from your GP. Zincomed Take two standard strength tablets twice daily as well as selenium (2 tablets, twice daily. Alternatively your doctor can prescribe you a zinc supplement (prescription name Zincomed, 2 tablets twice daily).
If you have a under active thyroid and take a medication called levothyroxine it is advised that you allow a minimum of two hours between drug administration. Thyroxin can bind to iron supplements and reduce absorption therefore taking these drugs individually and on an empty stomach will prevent any problems.
If you have diabetes then close monitoring of your blood sugar levels is essential. Food intake will be minimal over the first few weeks and it is likely that medication will need to be adjusted accordingly.
The wound
The skin wound will have been closed with absorbable sutures that dissolve. The sutures will have been placed under the skin and don’t need to be removed. You’ll have water proof dressings on so that you may have a shower or a bath any time after the surgery. All you’ll need to do is to peel the dressings off a week after the operation.
If the wound gets red and swollen, or discharges fluid, this might suggest a wound infection and you should see your doctor. This is not a common problem. It is very rare to have a wound hernia after keyhole surgery.
Exercise
It is important to stay mobile when you first get home, and gentle exercise is encouraged. After 2-3 weeks you should get into the habit of taking regular exercise such as swimming, brisk walking or jogging, or visiting a gymnasium; aim for at least 30 minutes a day, 3 times a week. It is safe to use toning tables after 6 weeks. You will notice that your ability to exercise improves very rapidly after the surgery. Apart from speeding up the weight loss by burning off more calories, exercise reduces blood pressure and blood cholesterol and improves muscle tone, which reduces the problems of sagging skin. Most people are able to return to work after 2-3 weeks. You may resume driving after 2 weeks from surgery.
