Laparoscopic Roux-en-Y Gastric Bypass

Introduction

Gastric bypass surgery assists the patient in losing weight because they eat less and their body absorbs less of what has been eaten. Fewer calories absorbed means a greater weight loss to the patient.

If you do eat too much at mealtimes you may feel uncomfortably full and even vomit. It will not take long before you learn the capacity of your new stomach. You will find that following this surgery you will be unable to tolerate certain foods. These are normally fatty or greasy foods, dairy products and sweets.

Gastric bypass surgery offers extensive and prolonged weight loss results. Most patients experience a lower risk of hypertension, heart disease, diabetes and other health conditions associated with obesity.

Preoperative Instructions

After your first initial consultation with Dr Daoud, he will advise you to have a blood test and to speak with a dietitian to be informed about the specific pre-operativeand post-operative diet. After you have had your blood test and spoken with a dietitian, you will be required to attend a second consultation with Dr Daoud.

Procedure

A small pouch is created at the top of the stomach to make it smaller. This is done via stapling or a plastic band. This new smaller part of the stomach is then connected into the middle part of the small intestine. The procedure bypasses the majority of the stomach and the upper part of the small intestine. As the stomach is now smaller the patient will fill full with a much smaller quantity of food. The intestine, which has been bypassed, is where food nutrients and calories would normally be absorbed.

This procedure is done via a laparoscope. It involves making several small incisions where the surgeon will then insert the laparoscope to perform the surgery. A small pouch will be created to enable the restriction of food intake. A “Y” shaped section of the small intestine is then attached to this new pouch to allow food to bypass the lower part of the stomach, duodenum and the first part of the jejunum.

Postoperative Instructions

If you are on any medications, it is imperative that you advise Dr Daoud before your surgery is performed. Following surgery, it is recommended that if you are taking tablets it is advisable to crush them.

It is important to remember that all patients are individuals and recovery after surgery will be different for each patient. Your post-operative recovery will depend on many factors: - your current health problems, whether you were suffering from depression prior to your procedure and on your return home will you have support? Patients who have a positive outlook and are on their feet quickly after surgery have been found to recover much quicker than those who rest too much.

It is imperative that you remember that you have undergone major abdominal surgery. Your muscle and tissue will need time to recover from the surgery. Laparoscopic surgery indicates that there is less incisional or cutting of the body and normally your recovery time will be quicker because of the minimal number of incisions made.

Following laparoscopic surgery, you may feel some pain in the shoulder region. This is quite normal and is caused by the collection of gas in the upper chest area. It is important to remember that gas in the abdominal cavity from the laparoscopic procedure is always endeavored to be removed, but there can sometimes be small amounts left in the abdominal cavity. This will place pressure under the diaphragm, near the phrenic nerve, and this in turn causes irritation and referred pain to the shoulder. During the procedure the liver is retracted and this can cause some swelling around the liver and this in turn puts pressure on the phrenic nerve. This gas pain can take between 24 and 48 hours to disappear. If the pain persists, please call our rooms on 07 3397 8499.

Constipation is reasonably common post-operatively, because of several factors including the anaesthesia and fasting. Do not be overly concerned. It is important to remember that after surgery your diet will be just fluid and with no bulk (fibre) it is normal to suffer from a degree of constipation. Make sure you are drinking at least 2 liters of water per day. You could try apple or prune juice. Try to maintain a good level of activity. You can also try medications such as Metamucil, Agarol etc. Please notify the office if you are still constipated after 4 to 5 days following the procedure. As much as constipation is a problem so too is diarrhea.

You will probably be advised to commence a programmed vitamins and mineral supplements. Because of the reduction in your food intake and the variety of foods ingested during the first 8 to 10 weeks following the surgery it is important to maintain sufficient nutrients. Once you are past the fluid stage you may need to eat small meals at more frequent times. Normally three meals and two snacks per day should give you the required nutrients for maintaining a healthy body. It is suggested that you chew your food thoroughly and eat slower to avoid regurgitation after meals.

It is now very important to start some form of gentle exercise. Start with something as simple as a short walk to your letterbox or walk around the house. As time progresses it is important to extend your level of activity. This can at times be uncomfortable but this is normal due to the repair of muscle in the wound area. Only you will know how far you can stretch yourself with your exercise level. Use your own common sense as to how much you can achieve each day.

If at any time your wound site becomes red, hot to touch or inflamed please contact the office as soon as possible as this can be a sign of infection.

Risks

  • Sepsis
  • Anastomotic leak
  • Suture line leak
  • Peritonitis
  • Multiple surgeries
  • Stricture
  • Obstruction
  • DVT
  • PE
  • Death

If you have any questions regarding this information, please contact our rooms on 07 3397 8499 to arrange an appointment to discuss this further. Our office is open from 8:30am-5:00pm Monday-Friday.