Roux-en-Y gastric bypass
What is a Roux en Y gastric bypass and how does it work?
This is an operation where some of the stomach and part of the
small intestines are bypassed. The stomach is stapled to leave a
smaller pouch and then a section of the small intestine is attached
(usually by staples) to the small stomach pouch that has been
created. The operation is normally carried out as a laparoscopic
(‘keyhole’ surgery) procedure under a general anaesthetic. The
procedure will change how and what you eat:
- You will not able to eat as much as before because after this
type of surgery, patients generally feel more satisfied after a
meal and have less desire to eat
- You may also absorb fewer nutrients and calories from your food
as a result of the shortening of your small intestine
- You may not tolerate foods containing fat, sugar and starch as
well as you used to. If you eat too much of these types of foods
you may actually start to feel ill, but this ‘side effect’ in
itself could help you make dietary and lifestyle changes to achieve
long-term weight loss.
This method of surgery is recommended for patients with
a body mass index ranging 40–55. On average, patients
tend to lose 30% of their total body weight during treatment and
70% of excess weight (fat).
What are the advantages of having a gastric bypass?
- Feeling less hunger and feeling full quicker and for longer
than usual
- Greater and faster weight loss than with the gastric band
- An immediate remission of diabetes and improvement in blood
pressure within days of having the operation.
Are there any risks associated with this operation?
As with any operation, there are risks associated with having a
general anaesthetic. Specific to this operation, there is a small
risk of wound infection, chest infection, deep vein thrombosis
(‘DVT’ or blood clots in the legs), pulmonary emboli (blood clot on
the lungs). Most people will not experience any serious
complications from their surgery. The risks increase for people who
already have other medical conditions, such as heart disease or
high blood pressure. However, any problems that do arise can be
rapidly assessed and appropriate action taken. Other complications
include leakage from one of the joins in the bowel, narrowing of
one of the joins or ulceration of the gastric pouch may occur in
2-5% of patients. A second operation may be required to correct
this. There is a 1 in 300 (0.3%) risk of death and a 2-5% risk of
adverse effects as listed above caused by having this
treatment.
What are the alternatives to this operation?
What happens before the operation?
A few weeks before your operation, we will ask you to attend the
Pre-admission Assessment Clinic. This appointment is an opportunity
to check that you are fully prepared for your admission, treatment
and discharge home. You may also have routine investigations such
as blood tests, ECG (recording of your heart) or a chest x-ray done
at this time to check your fitness for surgery. An anaesthetist
will also see you at this appointment.
Is there anything I should do to prepare for my operation?
Please follow the pre-operative diet sheet for bariatic surgery
for two weeks before your operation.
Make sure you go for a 30-minute walk every day, as this is good
cardiovascular exercise. This will reduce the risk of
post-operative complications, as well as help you lose some weight
prior to surgery. You should also do your breathing exercises each
day using your inspirometer as instructed by your clinical nurse
specialist. Please do not have anything to eat (not even sweets or
chewing gum) or drink after midnight on the night before your
operation. If you regularly take medicines in the morning, you
should take them before 7.00am, with a small sip of water if
necessary. If you are diabetic, you must not take your insulin
or diabetic tablets on the morning of your operation. If you
take blood-thinning medications (such as Warfarin
or aspirin) and or you are allergic to any medications, please
contact the ward for advice before you come in to hospital.
What happens on the day of my operation?
You will be admitted to the ward on the day of your operation.
Your temperature, blood pressure, respiration rate, height, weight
and urine will be measured to give the nurses a baseline (normal
reading) from which to work. We will measure you for special
stockings (sometimes known as ‘TEDS’) to prevent blood clots (known
as ‘DVT’ or ‘deep vein thrombosis’) from forming in your legs
following surgery. We may also start you on anti-coagulant
(blood-thinning) injections to help minimise this risk.
The surgeon will explain the procedure to you in detail before
asking you to sign a consent form. This is to make sure that you
understand the risks and benefits of having the operation.
All make-up, nail varnish, jewellery (except wedding rings,
which can be taped into place), body piercings and dentures must be
removed. One of the nurses will then come and prepare you for the
operating theatre.
What happens after the operation?
You will wake up in the recovery room before you are taken back
to the ward.
Please tell us if you are in pain or feel sick. We have tablets/
injections that we can give you as and when required, so that you
remain comfortable and pain free.
You may feel light-headed or sleepy after the operation. This is
due to the anaesthetic and may continue until the next morning. It
is also common to have a sore throat for two or three
days after having a general anaesthetic. This sometimes happens
because the anaesthetist has to pass a tube down your windpipe
to give you the anaesthetic gases that keep you asleep during the
operation.
Four hours after your operation we will ask you to stand up and
start moving around. It is important that you move about as much as
possible, as this will reduce the risk of any complications and
speed up your recovery.
Please make sure that you do your breathing exercises 10 times
every two hours (between 8.00am and 10.00pm) and walk around for 10
minutes every two hours every day that you are in hospital.
Your wound will have been closed with absorbable sutures
(stitches) that will dissolve within seven to 10 days after
surgery. We will remove the dressing covering your wound after 24
hours.
For the remainder of your stay, the nurses will take your
temperature, pulse and blood pressure at regular intervals to check
your recovery and it will sometimes be necessary to wake you up to
do this. It is very important that we monitor your progress after
your operation, so please be patient with the nursing staff during
this time. Your doctor will also visit every day to check on your
recovery.
You may also have a drain (tube) inside your wound. This is so
that any blood or fluid that collects in the area can drain away
safely and will help prevent swelling. The tube will be removed
when it is no longer collecting fluid, usually on the
day you go home (two days after surgery).
A ‘drip’ will also be attached to a needle in your arm or neck
to provide you with fluids and prevent dehydration.
When can I start eating and drinking again?
You will be allowed to start slowly sipping unlimited amounts of
water, tea, coffee, milk, squash, Ribena or Bovril the day after
surgery.
- Days 2–7 after surgery, you will be on a liquid diet
- Week 1 –5 after surgery, you will be on a puréed diet
- Weeks 5–12 after surgery, you will be a soft diet
- After 12 weeks, you can return to a healthy diet
(lifestyle)
For further details, please see the diet plan given to you
before surgery by the dietician.
When can I go home?
Provided you are well enough, you should be able to go
home two days after your operation. We will give you a
two-week supply of medication to take home with you. Any further
medication will need to be prescribed by your GP. Please make sure
that you arrange this before the two-week supply runs out. If
possible, please arrange for someone to come and collect you by car
on the day of your discharge home, as you will not be able to drive
yourself or travel on public transport. It is important that you
make the necessary plans as you will be expected to make your own
arrangements for going home unless your doctor feels that there are
special reasons why you need hospital transport.
You should continue to walk for 30 minutes every day, as this is
good cardiovascular exercise. It will also reduce the risk of
post-operative complications. You should also do your breathing
exercises three times each day for the next six weeks,
using your inspirometer as instructed by your clinical nurse
specialist
Is there anything I need to watch out for at home?
You may feel different sensations in your wound such as
tingling, itching or numbness. This is normal and is part of the
healing process. However, if you experience a high temperature or
fever, swelling, pain, discharge or excessive redness around the
wound site, please contact us as you may have an
infection.
What happens next?
1 week after surgery
You may still have some abdominal discomfort, which can be
caused by your wound or the reduced size of your stomach. You can
take painkillers for this if necessary. You should be able to
return to work. However, you should avoid doing any heavy lifting
for the next six weeks. Make sure that you continue to walk for 30
minutes each day, as well as do your breathing exercises three
times a day using your inspirometer. Continue following a
predominantly liquid diet as instructed by your dietician. See your
diet sheet for ideas and meal plans. You will have your first
post-operative outpatient appointment to see your surgeon. We will
send you blood tests to be taken prior to this appointment.
2-5 weeks after surgery
You should now be able to start on a diet of puréed foods (see
diet sheet for examples of meal plans). You may experience symptoms
of ‘dumping syndrome’. This is where you may feel sweaty, light
headed and have diarrhoea after eating refined carbohydrates such
as sucrose (table sugar) or fructose (fruit sugar). Make sure that
you continue to walk for 30 minutes each day, as well as do your
breathing exercises threetimes a day using your inspirometer.
5-12 weeks after surgery
You can now start eating a diet of predominantly soft foods.
Make sure that you continue to walk for 30 minutes each day, as
well as do your breathing exercises three times a day using
your inspirometer.
12 weeks after surgery
You can start eating ‘normal’ food (solids), but be careful with
any food that does not crumble in the hand, such as bread or
broccoli because these can swell in the stomach causing bloating.
Make sure that you continue to walk for 30 minutes each day, as
well as do your breathing exercises three times a day using
your inspirometer. You will have your second post-operative
outpatient appointment to see the doctor or nurse practitioner. We
will send you blood tests to be taken prior to this
appointment.
Six months after surgery
You will have your third post-operative outpatient appointment
to see the doctor or nurse practitioner. We will send you blood
tests to be taken prior to this appointment.
1 year after surgery
You will have your fourth post-operative outpatient appointment
to see the doctor or nurse practitioner. We will send you
blood tests to be taken prior to this appointment
After the first year
We would like to see you on a yearly basis to
make sure you are happy and we will send you for blood
tests before this appointment.