Gastric Bypass Surgery - Before and After Surgery -

Gastric Bypass Surgery has been consider the gold standard for weight loss surgery for many years. Gastric bypass surgery has been performed worldwide for over 30 years. In recent years with the boom of laparoscopic surgery or minimally invasive techniques, the gastric bypass surgery outcomes have significantly improved. Laparoscopic gastric bypass surgery offers the patient faster recovery, less pain, shorter hospital stay, lower risk of wound complications (infection and hernias) and many other advantages.

Dr Angel Caban is Fellowship Trained in Advanced Laparoscopy and Bariatric Surgery. If you are in the Ocala, Gainesville and North Central Florida area and you are looking for surgeons to undergo gastric bypass surgery look no further. Dr Angel Caban has the best outcomes in this region, with years of experience and hundreds of cases performed with no mortality and no leaks. In this article we will address some of the steps to go through surgery and what to expect before, during and after surgery.

Want to know if you qualify for surgery, Click Here to see the requirements.

What to Know Before Gastric Bypass Surgery:

The Gastric bypass is also known as a Roux en Y gastric bypass. It gets this name because of the two components that promote weight loss. The first component is restriction of the amount of food that you can eat by creating a small stomach. The new stomach is approximately 30 ml or the size of an egg. The second component is a malabsortion component or the bypass portion of the surgery. The Roux limb is approximately 150 cm long, creating malabsortion of some of the nutrients and calories that are consumed.

Patients should expect to lose between 70-80% of the Excess Body Weight (EBW) within 1-2 years after surgery. So if you are 100 lbs overweight you should lose between 70-80 lbs, for a 200 lbs overweight patient, the estimated weight loss is 140-160 lbs. In average most patients lose between 50-70 lbs in the first 3 months after surgery. At the 6 months mark you should lose another 25-35 lbs or half of what you lost the first trimester. As time goes by the weight loss will taper until you hit your max weight loss. Our patients are always encourage to lose as much weight as possible the first 3 months because that will determine your overall success in most cases.

Once you known if you meet the criteria for surgery the next step is to call your insurance and see if you have bariatric surgery coverage. The next step will be to contact us and make an appointment. During this visit we will go over your medical history and we will determined what procedure is best for you.

You will receive a check list with the next steps. In most cases this will include a nutritionist evaluation, a psychological evaluation, a pre operative class, plus or minus other test depending on your age and/or medical conditions.

You will be on a liquid diet for 2 weeks prior to surgery, we do this for several reasons and I will explained those in another post. Trust me is not as bad as you think and most patients lose between 10-20 lbs during this 2 weeks.

Time for the Gastric Bypass Surgery:

In my hands the gastric bypass surgery is done laparoscopically in 99.9% of the time. Surgery takes between 2-3 hours in average. It is done under general anesthesia. I use five small incisions, the largest one is 12 mm in size and is the one that hurts the most after surgery.

A urinary catheter will be placed before surgery and will stay in after surgery for 24 hours to monitor your urine output. You WILL NOT have any drains, tubes or any other catheters as long as everything goes smoothly. Some surgeons will place temporary feeding tubes, I do not do that routinely.

The first step in my hands is to form the roux limb or the small bowel work. The connection is done using a combination of staples and sutures. The creation of the small gastric pouch and the gastro-jenunal connection follows. Again I use staples and sutures to do this connection as well.

By using a combination of sutures and a linear stapler I gave that connection the best chance to heal without complications. My leak rate is 0% and I wanted to stay that way.

The largest incision will be close with a suture to hold the muscle together to prevent hernias after surgery. That is the reason why the incision hurts more than the others. The suture will dissolved in severeal weeks, but you wont hurt all this time, the pain will go away as soon as the suture starts to lose strength.

What About After Gastric Bypass Surgery:

The usual hospital stay is 2 days, so if you have surgery on a Monday, you should expect to be discharged on Wednesday. The first 24 hours are the worst in terms of pain, you will get IV pain medication to control your pain. The second most common complaint in the first 24 hours is nausea, this is usually controlled with IV medications as well, most of the nausea is gone within 24 hours.

You will be encourage to get up and out of the bed immediately after surgery to prevent blood clot in your legs. Morbid obese patients are high risk for deep venous thrombosis (DVT) and the most effective preventive treatment is early ambulation. Early ambulation is also helpful in preventing pneumonia. An incentive spirometer will be given to you to prevent respiratory complications after general anesthesia.

Immediately after surgery you will be completely NPO (nothing by mouth). The first day after surgery you will be doing sips of water only (30 ml every hour). On day number two you will graduate to protein drinks. You will get 60 ml of protein drink (Carnation Instant Breakfast) every other hour and 30 ml of water in between. After discharge you will start the high protein liquid diet for 2 weeks. I will explained the liquid diet in more detail in another post.

Most patients should expect 2-3 weeks off work to fully recover. If you do heavy lifting or high intensity work you might need 4-6 weeks in order to performed all you working duties. You can start exercising 2-3 weeks after surgery but you need to start slowly and stay hydrated. I usually tell my patients to limit the lifting to 15-20 pounds for 6 weeks, after this period most patients are clear to do any type of activities. Every patient is different so use your commonsense, if you are doing something and is causing pain then you are not ready for that activity yet.

Most patients will see me in the office 2 weeks after surgery, then at 3 months, 6 months, 9 months and 12 months. After the first year I will see you on a yearly basis. Some patients see me more often depending on the weight loss, knowledge of the diet and overall success. I want you to succeed so if you need to come see me more often, then that will be your follow up plan.

Vitamin supplementation is a most after gastric bypass surgery. You will need to take a multivitamin daily. You will also need Vitamin B12 supplementation for life. I will explained Vitamin B12 in another post but in a nutshell you need either a sublingual, nasal or injection dose of vitamin B12 either daily or every six months depending on the route.

You will have to take an anti-acid medication (PPI) for 12 months after surgery even if you don’t have acid reflux or heartburn. This is to prevent any ulcers after surgery. Marginal ulcer or an ulcer in the connection between the stomach and the small bowel is a known occurrence after a gastric bypass. I have a very low ulcer rate after surgery and to some degree I attributed that low rate to the one year therapy with PPI’s.

Most likely your medications will have to be adjusted after surgery, most patients require only half of the diabetes medications after surgery. This will be discussed with you prior to discharge from the hospital. You will get a prescription for pain medication, anti-acid and anti-nausea medication. You will have to crush tablets or open the capsules while you are on the liquid diet. Once you advance the post op diet to regular diet you can take your medications without crushing them.

Conclusion:

A gastric bypass is a great option for many individuals, but you still need to put work into it…

Weight loss surgery is like anything else in life, the more work you put into it the better the reward. In the Ocala/Gainesville/North Central Florida nobody has better outcomes in bariatric surgery than I do. My 30 day mortality is 0%, readmission rate is less than 1% and leak rate is 0%.

If you are one of our patients reading this post, I want to Thank You for your trust in me and my staff. Thank you for selecting our program to regain control of your life.

If you are new to the weight loss surgery process, Thank you for taking the time to read this post and we will be happy to see you in the office and help you regain control of your life. We will help you win the fight against obesity.