More information on gastric bypass

What is a Roux-en-Y gastric bypass and how does it work?

This information sheet has been provided to help answer some of the questions you, your family and friends may have about ROUX-EN-Y GASTRIC BYPASS.

All the health care professionals involved in your care will also be happy to answer any questions you may have about your operation and your care after surgery.

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 done as a laparoscopic (‘keyhole’ surgery) procedure while you sleep under a general anaesthetic.

If you have access to the internet, there is a very good video about this operation and other types of weight loss surgery at www.mayoclinic/health/gastricbypass/ MM00703

The procedure will change how and what you eat.

• You will not be 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, starch and sometimes milk, 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 BMI (body mass index) of 40 – 55. On average, patients tend to lose 30% of their total body weight during treatment and 70% of excess weight (fat).

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 2 – 5% risk of

• leakage from one of the joins in the bowel or narrowing of one of the joins or ulceration of the gastric pouch. A second operation may be required to correct these

• stomach ulceration

• deep vein thrombosis (‘DVT’ or blood clots in the legs)

• pulmonary embolism (blood clot on the lungs)

• bleeding

• wound, chest or urine infection.

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.

Please note that there is a 1 in 300 risk of death caused by having this treatment.

Are there any alternatives to this operation?

• Lifestyle management

• Drug treatment

• Gastric banding surgery

• Sleeve gastrectomy surgery

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 bariatric surgery for two weeks before your operation. This is to shrink the size of your liver. If you have not lost any weight in the two weeks prior to surgery, your operation may have to be abandoned.

• Make sure you go for a 30 minute walk every day, as this is good cardiovascular exercise. This will reduce the risk of postoperative 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.

• If you take blood-thinning medications (such as warfarin or aspirin) and/ or you are allergic to any medications, please contact the ward or us for advice before you come in to hospital.

• If you are a smoker, you must stop smoking at least 6 weeks before your operation. This will reduce the risk of chest troubles, as smoking makes your lungs more sensitive to the anaesthetic. If you stop smoking, it improves your chances of a good result. It will also improve wound healing.

• All infections (such as coughs and colds) must be cleared up before you have your operation.

• Please do not have anything to eat or drink (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.

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. It also gives you the opportunity to ask any remaining questions you may have.

All make-up, nail varnish, jewellery (expect 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 2 or 3 days after having a general anaesthetic. This sometimes happens because the anaesthetist (specialist doctor) has to pass a tube down your windpipe to give you the anaesthetic gases that keep you asleep during the operation.

We will ask you to stand up and start moving around 4 hours after your operation. 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 using the inspirometer 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 surgical clips, which we will remove when you return for your first follow-up clinic appointment 7 – 10 days after surgery. You can remove the dressing covering your wound 24 hours after your operation and have a shower the following day.

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. Our team will also visit you every day to check on your recovery.

You may 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 2 – 3 days after surgery. In some cases, the tube may be left in and removed at your first follow-up appointment 7 – 10 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.

• From Day 2 after surgery until your first follow-up visit, you will be on a liquid diet.

• Weeks 2 – 5 after surgery, you will be on a puréed diet.

• Weeks 6 – 9 after surgery, you will be on a soft diet.

• Week 10 onwards, you can return to a regular healthy diet.

For further details, please see the diet plan given to you before surgery by the dietitian.

When can I go home?

Provided you are well enough, you should be able to go home on the morning of the 2nd day after your operation. We will give you a 1-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 1-week supply runs out.

Although most patients’ medicine requirements decrease after surgery, we will start you on an acid reducing tablet (PPI) to protect your stomach pouch. You will also need to take multivitamin and mineral supplements.

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 postoperative complications.

You should also do your breathing exercises 3 times each day for the next 6 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, new or worsening stomach pains, constant vomiting or feel unwell in any way, please contact us immediately.

If you have any swelling, discharge or excessive redness around the wound site, please contact your GP as you may have a wound infection. We will give a list of emergency contact numbers to you before you go home.

What happens next?

1 week after surgery

• You may still have some abdominal discomfort, which can be caused by excess wind, 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 6 weeks.

• Make sure that you continue to walk for 30 minutes each day, as well as do your breathing exercises 3 times a day using your inspirometer.

• Continue following a liquid diet as instructed by your dietitian. See your diet sheet for ideas and meal plans.

• We will ask you to return to the outpatient clinic to see us. We will remove your skin clips and check that you are taking the correct medications. If you are diabetic, please bring your glucose monitoring diary with you.

2 weeks after surgery

• You should now be able to start on a diet of puréed foods (see diet sheet for examples of meal plans). Use a blend to purée foods such as tuna or potato.

• 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). You may also not be able to tolerate drinking milk.

• Make sure that you continue to walk for 30 minutes each day, as well as do your breathing exercises 3 times a day using your inspirometer.

5 weeks after surgery

• You can now start eating soft foods, but avoid any food that cannot be mashed with a fork, such as bread or broccoli, because these can swell in the stomach and cause bloating.

• Make sure that you continue to walk for 30 minutes each day, as well as do your breathing exercises 3 times a day using your inspirometer.

12 weeks after surgery

• You can start eating ‘normal’ food (solids), but you should still avoid foods that cannot be mashed with a fork, such as bread or broccoli.

• Make sure that you continue to walk for 30 minutes each day, as well as do your breathing exercises 3 times a day using your inspirometer.

6 months after surgery

• We will send you an appointment to see us so that we can check your progress and that you are taking the correct medications. We will also ask you to have some routine blood tests.

1 year after surgery and thereafter

• We will send you an appointment to see us so that we can check your progress and that you are taking the correct medications. We will also ask you to have some routine blood tests.