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Gastric bypass surgery refers to a surgical procedure in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both. A gastric bypass operation usually takes between one and three hours
Before and After Weight Loss Surgery
The operation is usually done using keyhole surgery. During a keyhole operation, your surgeon uses small instruments, guided by a special telescope with a camera.
If you're very overweight or have had surgery to your abdomen before, then your surgeon may recommend having an open operation, which is done through a single, larger incision.
Using surgical staples, your surgeon will make a pouch out of the top of your stomach, separating it from the lower part of your stomach. Your surgeon will make an opening in the pouch and connect it to a section of your small intestine. This means the food you eat will bypass your old stomach and the first part of your intestine.
The length of small intestine that the operation bypasses can be adjusted to make sure that when you reach the right weight for your height, you will be able to eat enough to maintain that weight.
Your surgeon may insert a drain, to help remove any fluid or blood that might have collected inside your abdomen.
It's much more easily understood by watching a video:
Variations of the gastric bypass
Gastric bypass, Roux en-Y (proximal)
Gastric bypass, Roux en-Y (distal)
Mini-gastric bypass (MGB)
Guidelines to qualify for gastric bypass surgery:
In general, gastric bypass and other weight-loss surgery could be an option for you if:
Efforts to lose weight with diet and exercise have been unsuccessful.
Your body mass index (BMI) is 40 or higher (extreme obesity)
Your BMI is 35 to 39.9 (obesity) and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea
In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.
Indians are considered to have lesser muscle mass per kg body weight compared to the western population. Hence the standards of BMI and Obesity along with the values for potentially life threatening obesity varies in the Indian population. Your doctor is the best judge to suggest if you fall in the potentially dangerous bracket.
For more details you can watch:
Evaluating if you're ready for gastric bypass surgery:
A team of health professionals usually including a doctor, dietitian, psychologist and surgeon evaluate whether gastric bypass or one of the other forms of weight-loss surgery is appropriate for you.
Health benefits of the surgery outweigh the potentially serious risks?
Are you psychologically and medically ready to undergo the procedure?
When conducting an evaluation for gastric bypass surgery, the health team considers:
Your nutrition and weight history. The team reviews your weight trends, diet attempts, eating habits, exercise regimen, stress level, time constraints, motivation and other factors.
Your medical condition. Some health problems increase the risks associated with having surgery.
Your psychological status. Certain mental health conditions may contribute to obesity or make it more difficult for you to maintain the health benefits of gastric bypass surgery.
Your motivation. The team will also assess your willingness and ability to follow through with recommendations made by your health care team and to carry out prescribed changes in your diet and exercise routine.
Your age. Although there's no specific age limit for gastric bypass surgery, the risks increase as you get older.
Preparing for a gastric bypass operation:
If you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection, chest infection or blood clot, and slows your recovery.
Your surgeon may ask you to follow a low-fat, low-sugar and low-carbohydrate diet with no alcohol for one to two weeks before your operation.
A gastric bypass operation is performed under general anesthesia.
You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may also be given an injection of an anticlotting medicine called heparin.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
You will only be able to eat small amounts at each meal. To start with, stick to liquids, and then move onto pured food. You may also need to take vitamin and mineral supplements. Your surgeon and dietician will give you all the information you need about what foods to eat and how much.
It usually takes between four and six weeks to make a full recovery from a gastric bypass operation. However, this varies between individuals, so it's important to follow your surgeon's advice.
Do's and Don'ts after bariatric surgery:
Do not eat and drink at the same time. Drink fluids 30 minutes after you eat food. Drink slowly.
Take a short walk. Do not lift any heavy things.
Do not wear tight clothing that rubs against your incisions while they heal.
Keep your dressing (bandage) on your wound clean and dry.
Do not shower until your doctor tells you to do so.
Take medicines as prescribed.
Things to expect at home:
You will lose weight quickly over the first 3 to 6 months. During this time, you may have body aches, feel tired and cold, have dry skin, mood changes, and hair loss or hair thinning. These problems should go away as your body gets used to your weight loss and your weight becomes stable. You will need to be careful that you get all of the nutrition and vitamins you need as you recover.
Side-effects are the unwanted but mostly temporary affects you may get after having the procedure. You're likely to have some bruising, pain and swelling of the skin around your wounds.
You may feel sick or vomit after eating, because the amount you're able to eat is a lot less than before the operation. This should get better as you change your eating habits.
If you eat too many sugary foods, you can get an unpleasant sensation called dumping. It can make you feel sick or faint, or give you abdominal pain and diarrhea.
By the time you leave the hospital, you will likely have a follow-up appointment scheduled with your surgeon within a few weeks. You will see your surgeon several more times in the first year after your surgery.
You may also have appointments with:
A nutritionist or dietician, who will teach you how to eat correctly with your smaller stomach. You will also learn about what foods and drinks you should have after surgery.
A psychologist, who can help you follow your eating and exercise guidelines and deal with the feelings or concerns, you may have after surgery.
You will need blood tests for the rest of your life to make sure that your body is getting enough important vitamins and minerals from food after your surgery.(4)
Schedule for Consultations/Diagnostic tests:
Medical Instructions: As per doctor's instructions.
It is important to modify the diets post bariatric surgery. Since your stomach size has been reduced, the natural urge to eat and drink will also get reduced. Regular meals cannot be consumed for almost 2 months post-surgery, but it is extremely important to remain well-hydrated.
1.Sip 1 Cup of regular, plain water or unsweetened, non-carbonated fluid over one hour.
2.Consume about 2 litres of water/fluid in one day.
3.Don't drink any fluids 30 minutes prior to meals and 60 minutes post meals.
4.CHEW every bite for about 30 seconds or more before swallowing it.
5.Don't use a straw as unwanted air can get filled into the stomach.
6.No chewing gum.
7.Be sure to eat at least 55-70 grams of protein daily. Protein powders per meal should not exceed 25 grams.
8.Supplementation is crucial post-surgery -Multivitamin, Calcium citrate, Vitamin B12, Vitamin D
9.Restrict fiber rich foods such as fruits and vegetables for the Stages I and II.
10.Once you are in Stage III, avoid refined, sugary, high fat and processed foods. Include whole grains, poly and mono-unsaturated fats and gradually reintroduce fruits and vegetables. Make healthy, balanced and nutritious food choices.
For more details you can watch:
Stage I Full liquid diet (1-2 weeks post-surgery)
Whey protein shake ORvanilla
flavoured protein powder made with water or Skim milk
Jell-O OR Ice Lolly
Cup strained Dal water ORstrained,
clear vegetable /chicken soup
Cup strained coconut water OR
Stage II Pureed diet (3-6 weeks post-surgery)
Egg (Soft boiled) OR1 Cup
Oatmeal made with skim milk
Cup Sweet potatoes (boiled)
Cup Coconut water
Cup boiled Toor/Masoor/Moong dal
frozen lemonade OR decaffeinated
well-cooked and pureed vegetables (carrots, beans, cauliflower, pumpkin) ORpaneer mixed with pureed
Cup Skim milk
Stage III Regular diet (2 months post-surgery)
egg omelette made with soft vegetables ORMoong dal dosa
Cup Potatoes/Sweet potatoes (boiled) OR1/2
Cup well blended Badam kheer made with skim milk
Cup Coconut water
Cup Toor/Masoor/Moong/Chana dal
Cup Brown rice
Cup Decaffeinated tea
Ragi Crackers OR1/2 Cup
or 2 Roti
Cup Vegetable curry
Cup Paneer curry
Cup Skim milk
Life Long Instructions
Bariatric surgery is a big one to go through, but to have long lasting effects one needs to adapt a healthy lifestyle. After your doctor approves of a regular diet, eat balanced and nutritious diets. Eat foods that are low in saturated fats and cholesterol. Avoid refined, sugary, high fat and processed foods. Increase protein sources and keep yourself well hydrated. Stay away from caffeinated, carbonated and alcoholic beverages. Follow an exercise routine and make sure you never gain those kilos again. Do not smoke.
Eat Right and Exercise your way to a Healthy Body.