Gastric Bypass

Gastric bypass surgery is a method in the field of bariatric surgery where the amount of food taken in is limited. A considerable weight loss follows gastric bypass 6 months after surgery. Most of the excess weight is lost 18 to 24 months after surgery and usually the patients lose about 70 to 80% of their excess weight.

We have a Specialist Bariatric Nurse Judith Jobling in the United Kingdom calling our patients regularly in the first month after surgery to monitor their recovery. Judith gives professional support and advice to each patient and since she has had bariatric surgery herself, she can be of true help and counsel.


Surgeon	Dr. Rein Adamson / Dr. Martin Adamson
Required body mass index	BMI starting from 30 (depending on the comorbidities)
Anesthesia	General
Surgery duration	1-2 hours
Nights at hospital	3
Sick leave	2 weeks
Expected weight loss	70%-80% of overweight
Pros	* Biggest weight loss * Very good diabetes control * No foreign elements left into the body
Cons	* Possible nutritional deficiencies * Dumping syndrome
Operation reversible	YES
Price	€6150 (all-inclusive package, including a support person in the UK)
Medical loan	starting from €167 per month. Apply here.
	Ask for more information

What is gastric bypass?

The gastric bypass procedure is a type of bariatric surgery or weight loss surgery designed to reduce your food intake if you have tried and failed to lose weight through diet and exercise.

However, gastric bypass isn’t for everyone with obesity. It’s a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle. Before deciding to go forward with the surgery, it’s important to understand what’s involved and what lifestyle changes you must make. Largely, the success of the surgery is up to you.

Why might gastric bypass surgery be necessary?

Gastric bypass can greatly improve the quality of life, not only because of an improvement in appearance and an increased mobility, but also because it can reduce the number and severity of health problems that overweight people are prone to suffer. Through bariatric surgery a person can be potentially be cured of numerous obesity related medical diseases (called comorbidities) including:

Diabetes (a disease characterized by abnormally high glucose levels in blood)
Hypertension (persistent high blood pressure)
High cholesterol
Sleep apnoea (temporary suspension of breathing occurring during sleep)
Chronic headaches
Venous stasis disease (discoloration around ankles and lower legs)
Urinary incontinence (loss of bladder control)
Liver disease (accumulation of fat in the liver cells resulting inflammation)
Arthritis (joint disorder featuring inflammation)

Expected weight loss results

Following gastric bypass surgery, weight loss occurs rapidly within the first 6 months. A person usually settles at a final weight about 18 to 24 months after surgery. During this time, the average weight loss surgery patient can expect to lose 60% to 70% of his or her excess weight.

Studies have shown that it is possible to lose up to 80% of excess body weight. Although most gastric bypass patients do gain some weight back after the initial weight loss; if you continue to follow the dietary and exercise guidelines, it is possible to keep most of the weight off in the long term.

Are you a candidate for gastric bypass surgery?

Gastric bypass surgery is considered for people who are obese, defined as having a BMI of 30 or higher with other serious health conditions taken into account that are associated with obesity.

Measure your BMI

About the procedure

Gastric bypass is a complex procedure performed under general anaesthesia- you sleep through it. Time in surgery is approximately 1-3 hours, followed by a four-night stay in the hospital.

Roux-en-Y-gastric bypass (traditional and laparoscopic)

This operation is the most common gastric bypass surgery performed in the world. Firstly, a small stomach pouch is created by stapling part of the stomach together or by vertical banding. This limits how much food you can eat.

The next step is when a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum as well as the first portion of the jejunum. This causes reduced calorie and nutrient absorption.

This procedure can now be done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen) in some people. This involves using small incisions and generally has a more rapid recovery time.

Risks of gastric bypass surgery

People who undergo gastric bypass surgery are at risk for:

Pouch stretching (stomach gets bigger overtime, stretching back to its size before surgery).
Band erosion (the band closing off part of the stomach disintegrates).
Breakdown of staple lines (band and staples fall apart, reversing procedure).
Leakage of stomach contents into the abdomen (this is dangerous because the acid can eat away other organs).
Nutritional deficiencies causing health problems.

Gastric bypass surgery may also cause “dumping syndrome” whereby stomach contents move too rapidly through the small intestine. The symptoms include nausea, weakness, sweating, faintness and occasionally diarrhea after eating; as well as the inability to eat sweets without becoming extremely weak. Gallstones can occur in response to rapid weight loss.

Complications from nutritional deficiencies

The limited absorption of vitamin B12 and iron can cause anemia. The lack of calcium absorption can cause osteoporosis and metabolic bone disease. People who undergo this procedure are required to take nutritional supplements that usually prevent these deficiencies.

The more extensive the gastric bypass surgery, the greater is the risk for complications and nutritional deficiencies. People who undergo extensive bypasses of the normal digestive process require not only close monitoring but also lifelong use of special foods and medications.

Life after gastric bypass surgery- recovery diet

Gastric bypass surgery alone will not help one lose weight, but it is a very effective tool to help one achieve significant and permanent weight loss. Overall weight loss success will depend on a total commitment to lifestyle changes including eating smaller portions of healthy food and exercising regularly.

Following gastric bypass surgery, you will be able to eat limited types of food straight after. The recovery diet will progress from liquids to pureed foods to soft foods over the first three months before you start eating solid foods. The slow food progression is necessary for proper healing after surgery, especially whilst recovering in hospital, and to allow your body to get used to new the new eating habits.

The first few days will be limited to drinking small amounts of fluids. This will be liquids such as water, broth, juice and milk. After a few days, pureed foods will slowly be added to the diet. Pureed food items might include clear broths and soups, low-fat yogurt, jello, and any foods that are blended and do not contain any distinct pieces of food. A pureed diet is generally recommended for at least a few weeks.

After that your body should be ready to progress to soft foods. This light diet will include foods that are tender and easy to chew such as canned or soft fresh fruit without skins, well-cooked and tender vegetables, scrambled eggs, ground or finely diced meat. Patients are usually on a soft diet for about 8 weeks before their doctor gives the okay to begin eating regular meals.

Recovery time

The amount of time it takes to resume pre-surgery levels of activity after gastric bypass surgery will vary based on a patient’s physical condition, nature of the activity, and the type of gastric procedure performed. Many patients recover within 6 to 8 weeks of their operation, whereas it may only be a few weeks for patients who had a less invasive procedure.

Pregnancy

Pregnancy places added demands on your body and there is the potential for fetal damage if pregnancy occurs too soon after weight loss surgery. It is strongly advised that women avoid getting pregnant and to use the most effective forms of birth control for the first two years after weight loss surgery if they are of childbearing age and sexually active.

Exercise

Exercise will be an important part of your weight loss programme after gastric bypass surgery. As soon as possible after surgery, you should be up and walking. You will start out slowly with your exercising and then gradually increase the amount and intensity of your workouts.

Exercise not only helps to burn calories but it also builds and preserves muscle tissue. Because you will be on a reduced diet and losing weight rapidly, your body will turn to energy reserves in the body for the fuel it needs to function.

Unless you exercise, the body will first burn through muscle tissue rather than fat tissue to function. Exercise will protect your muscle tissue and help burn fat tissue. Also, if you don’t exercise you will have to eat less and less food over time.

Gastric bypass surgery diet

The surgery will require you to adopt a whole new attitude about eating. Overall, the success of gastric bypass surgery will depend on your effort and commitment to making these dietary changes. Although specific dietary guidelines may vary, there are some general guidelines that apply to most weight loss surgery patients:

Eat small amounts

Your new smaller stomach will not be capable of holding any more than a very small amount of food. Immediately after surgery the stomach will only hold about one ounce of food. The stomach will stretch somewhat over time; however, and by after 3 months you will be able to eat about 1 to 1,5 cups of food.

Since you will only be eating a small amount, it will be especially important to choose nutritious foods so that your body gets the necessary protein and nutrients it needs to function.

Chew food thoroughly

You will need to take small bites of food and then chew the food into a pureed consistency before swallowing. If you don’t, the pieces of food can get stuck in the opening between your new stomach and intestine.

When the opening gets blocked and food cannot leave the stomach, it can cause vomiting, nausea and abdominal pain. Some doctors will also advise against chewing gum for this reason- if you accidently swallow the gum it can block the opening.

Eat meals slowly

It is important to eat your food slowly so that it does not enter the intestines too quickly. If too much food enters the intestines too rapidly, it can cause dumping syndrome. It should take about 30 minutes to eat a meal if you are eating at the right pace.

Drinking liquids

To keep yourself from becoming dehydrated, you will need to drink plenty of liquids. You should try to drink at least 6 to 8 cups of liquids a day. Water is a good choice, but other options include sugar-free and calorie-free flavored drinks, tea, or some sports drinks.

You will need to drink slowly (30 to 60 minutes for one cup of liquid) in order to prevent dumping syndrome. Although you should be sipping liquids throughout the day, you should not drink with your meal or within 30 minutes of a meal (before or after) as your stomach does not have space for both liquids and food.

Foods to eat

Since you will be able to eat only a small amount of food at any one time, it is important that the food you eat is healthy and nutritious. For the first 1-2 years, which is when most of the weight loss occurs, you will be eating about 800 calories per day.

After that, you will be eating about 1000-1200 calories per day to maintain your weight loss. Meals will primarily consist of protein-rich foods including lean meat, low-fat dairy products (yogurt, cottage cheese etc), eggs and soy products. The body needs protein to recover after surgery and to maintain normal body functions. You will also want to eat nutrient-rich fruits and vegetables.

Foods to avoid

After gastric bypass surgery, there are certain foods that should be avoided. Some foods will cause discomfort and are not well tolerated by the body. Some of the foods that can cause problems are foods that are dry, sticky or fibrous such as tough meat, bread, pasta, rice, raw vegetables and skins of fruits and vegetable. You should not drink carbonated beverages as they can cause bloating.

There are also foods that should not be eaten because they are not nutritious, high in fat, high in sugar, and high in calories. You should not eat desserts and other foods with sugar listed as one of the first three ingredients.

You should not have high-calorie liquids such as milk shakes, regular soda, fruit drinks, and meal replacement drinks. Alcohol should be avoided because of the high calories as well as the risk of addiction. High-calorie foods and beverages will not satisfy your hunger and will ruin your weight loss efforts.

Gallery with before/after pictures

The gastric bypass surgery is performed by a specialist Dr. Rein Adamson or Dr. Martin Adamson, who are the leading bariatric team in Estonia. Ask for more information.