Mini E-Book on Gastric Bypass Surgery

5 Things You Need To Know About
Gastric Bypass Surgery

If you’ve tried everything to lose weight and nothing has worked… if you’ve had your fill of being teased and taunted… or the sting of disapproval of our anything-goes-as-long-as-you’re-not fat society, then you may be thinking gastric bypass surgery is your only option. Before you take such a permanent step, there are some things to think about.

Gastric bypass, despite its rising popularity and celebrity patients, is not an easy, effortless way to weight loss. Quite the contrary, there is nothing easy about it. You are considering a procedure that will permanently change your digestive system in a way that can never be reversed. Taking this step means you must be willing to make changes in your head and heart right along with your stomach. So, if the thought of never being able to gorge yourself on junk food makes you sad… gastric bypass probably isn’t for you.

This surgery is a life-altering event. You will never eat (or drink) in the same way. Foods that you have loved over a lifetime may be impossible to tolerate after surgery — you’ll never eat them again. You may have unforeseen complications or side effects from the surgery that can mean months of illness and hospital stays.

And there are long-term risks that the medical community readily admits we haven’t studied. Most important of all, you’ll need to make drastic, complete and wholehearted changes to every part of your life. Think you can do it? Great, why not try sticking to the gastric bypass diet and exercise regime for a few months… see how you do.


Gastric Bypass Surgery: What is it exactly?
According to both the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the most commonly performed weight loss surgery in the United States. It’s the gold standard with more than 140,000 of these procedures being performed in the United States last year alone.

This type of surgery is performed under general anesthesia and lasts about four hours. Depending on your particular situation and surgeon, gastric bypass can be completed using an open technique (a large incision in the abdomen) or a laparoscopic approach, where several smaller incisions are made. A small camera and special instruments are then inserted into the body and used to perform the operation.

No mater which method your doctor uses, the end result is that your digestive system is permanently changed — your stomach is made smaller, using surgical staples or sometimes a plastic band. A smaller stomach restricts the amount of food you can take in at any one time, while bypassing a part of the small intestine limits the number of calories your body will be able to absorb.


Recovering From Gastric Bypass Surgery
Depending on your individual health and response to the surgery itself, you can expect to spend from four to six days in the hospital. Hospital stays for laparoscopic procedures tend to be shorter — sometimes as little as two to three days. After your surgery you’ll wake in a recovery room and be cared for by specially trained medical staff. Once your vital signs are stable, you will be moved from the recovery area to your room where you will be monitored round the clock by the nurses and other staff.

You’ll be medicated for pain as your stomach will be swollen and sore, and you’ll have a wound and dressing that will need care as it heals. You’ll be hooked up to monitors for blood pressure and heart rate, and have intravenous lines planted and taped to your arms or wrists. You will be able to have visitors — a few family members or friends at a time, but mostly you will be spending your energy recovering from the change that has taken place inside your body.

About two to three days after surgery, you’ll be able to take a few sips of water. If your body can tolerate it, you’ll then be able to drink 2 to 3 ounces (about half a juice glass) of water every hour. If the water makes you nauseous or causes pain, there are other alternatives such as dilute, clear fruit juices (apple, grape, cranberry), vegetable or chicken broth, non-carbonated diet soda or sugar free Jell-O that you can use instead.

During your hospital stay you’ll be monitored closely, and may have testing or other scans to check on your progress. Your surgeon and other members of the surgical team will check in on you daily, and the nurses will work to see you are comfortable and on the road to recovery. You may have special bands around your legs to keep blood clots from forming, and you probably won’t have to worry about the bathroom — a catheter can take care of that for you.

You’ll be released from the hospital when you can:
• Move without too much discomfort
• Eat liquid or pureed foods without vomiting
• Don’t need pain medication delivered through an injection

No doubt you’ll be anxious to leave the hospital (most patients are!) and will be glad to head home to rest and heal. Most patients are surprised by how wiped out they feel, and for how long. The truth is, this is major surgery, and as such, isn’t something you can get over in a day or two. You’ll still be sore and moving slowly for a while, but being in familiar, comfortable surroundings without the noise and disruption to sleep of a hospital does a world of good.

As you recover from surgery you’ll follow a diet that progresses from all liquid to puree and soft foods to regular foods. Every surgeon will have his or her own guidelines and preferences about how long to stay on liquids. And, of course all patients are different too. There’s no way to tell how you will react until you’ve had the surgery. Whatever happens, you’ll want to follow the advice of your surgical team in terms of what to eat and when to begin introducing puree, soft and regular foods back into your diet.

To start though, you’ll want to have the following on hand for when you go home.
• Diet Jell-O
• Clear, unsweetened fruit juices
• Beef and chicken bouillon cubes/powder
• Ready to eat clear broths
• Skim milk
• High protein drinks and shakes
• A blender or food processor

It’s hard to imagine being able to survive, much less heal and recover, on such a limited menu, but paitents often have enough stores of fat and other nutritional substances that a few weeks on a liquid diet isn’t a problem. And though the amount of food seems small, paitents report feeling very quickly — sometimes able to take only a few bites of solid food. Your newer, smaller stomach now holds only about a tablespoon of liquid, so you can see why you fill up fast.

Making the move to pureed foods is a key stage in your progress after gastric bypass surgery. This will be the first time you put your new digestive system to work on real foods. At this point patients usually aren’t eating regular meals yet, but rather simple, soft or pureed foods as you can. As you new digestive system heals and adapts, you’ll be able to see what foods you can tolerate and what you’ll have to say good-bye to, for good.

Once you’re eating solid foods again, the key thing you’ll need to remember to do is CHEW. Chew each bite you take from 20 to 30 times before swallowing it. A great many complications can be avoided just by chewing what you’re eating as thoroughly as possible. A good rule of thumb — don’t try to swallow anything bigger than what would fit onto a baby spoon or fork.

At the three month mark most patients are eating three small meals a day and three, small healthy snacks. Your meals will have lean sources of protein such as chicken without the skin or low fat cottage cheese, fruits, veggies and whole grains.


After Surgery… Permanent Changes
A surgery like gastric bypass is a major surgery, and a major change in your life. Once you commit, there’s no going back. Your digestive system will have been altered and you will now need to make permanent changes to the way you take in fluids and nutrients.

For starters, you will likely eat very small meals — feeling full after as few as four to six bites. Mast gastric bypass patients also have to take in fluids separately from food — so other than sips of liquid at a meal, you won’t be able to drink and eat at the same time. Some patients eat on even hours; drink on odd hours, and all find that they need to pay much more attention to the amount of fluid they take in each and every day

Another permanent change comes in the form of food intolerances. Where before surgery you loved a particular food — cucumbers for example, after surgery you may find that just one nibble of a fresh cucumber makes you feel terrible… crampy and nauseous. Some patients report dramatic lessening of desire for the calorie laden goodies they once loved after surgery, but not all patients experience this helpful change.

As a rule, anything with excess fat, sugar or alcohol will cause you trouble after this type of surgery. You’ll need to say good-bye forever to:
• Fast food of any kind
• Deep fried or very greasy foods
• High fat foods
• Gravy
• Ice Cream
• Any food with sugar as one of the first 3 ingredients such as cakes, cookies and candy

Not only will you need to change WHAT you eat, but you’ll also need to make some pretty big changes in HOW you eat. After gastric bypass you’ll need to:
• Eat small amounts of food as overeating can bring on terrible pain, nausea, vomiting and cramps. All meals must be limited to 1 or 1 ½ cups of food.
• Take at least 30 minutes to eat, 30-60 minutes to drink 1 cup of liquid to avoid “dumping” syndrome, where large amounts of food are delivered to the small intestine rapidly causing nausea, vomiting, diarrhea, weakness, faintness, dizziness and sweating.
• Chew thoroughly — 20 to 30 times per bite as big pieces can easily block the new smaller opening between your stomach and small intestine and cause awful vomiting. When in doubt, use the baby spoon as your guide.
• Drink liquid (from 6 to 8 cups per day) between meals as drinking with meals can take up space in a smaller stomach that’s needed for nutrient rich food, and can cause pain, nausea and vomiting as well as trigger “dumping” syndrome.
• Try new foods one at a time to find out which foods you can tolerate and which might cause you trouble. Introduce new foods one at a time and wait a few days to see how your system tolerates it before introducing something else.
• Take the vitamin and mineral supplements your doctor has prescribed. After this type of surgery, your body has trouble absorbing certain nutrients because most of your stomach and part of your digestive tract are bypassed, this can lead to dangerous deficiencies.


5 Stop You In Your Tracks Risks of Gastric Bypass Surgery
As we’ve said, gastric bypass is major surgery. As such, it has some risks you’ll want to consider, seriously and at length, before you go ahead.

The most dangerous risks are:
1. You could die. Fewer than 3 in 200 patients die after this surgery, but this risk should not be brushed aside. A recent study by scientists at the University of Washington put the death rate much higher — at 1 in 50 dying within one month of the surgery. Young or old, you need to carefully research the doctor you choose and the facility where your procedure is to be performed. Your risk will vary depending on your age, your overall health and other medical conditions you might have.

2. You could have a dangerous blood clot. Blood clots in the legs can be dangerous and deadly, and generally are more of a risk for those who are very overweight. They can travel to the lungs and lodge in the arteries causing a pulmonary embolism — a serious condition that damages lung tissue and can easily be fatal. Walking, and using wraps that apply intermittent pressure to the legs are believed to help reduce the risk of blood clots.

3. Your new stomach could leak. This severe postoperative problem, where a leak develops along the line of staples used to make your new, smaller stomach can be treated with antibiotics and in most cases heals over time. There are times however, where the leak can be serious enough to require emergency surgery.

4. You could develop pneumonia. Your extra weight puts stress on the chest cavity and the lungs inside it. This brings a higher risk of developing pneumonia after surgery. If you are in pain, and unable to take deep breaths, this can compound the problem.

5. You need more surgery due to narrowing of the opening. This rare complication where the opening between the stomach and small intestine narrows can be a serious problem. You may need to undergo an outpatient procedure to pass a tube through your mouth to widen (or dilate) the narrowed opening, or corrective surgery to fix the opening.


Recovering from gastric bypass… what else to expect
Gastric bypass causes some pretty big changes in your body. Your body retaliates with some uncomfortable symptoms like
• Body aches
• Feeling tired — as if you have the flu
• Feeling cold
• Dry skin
• Hair thinning or hair loss
• Mood changes

While none of these are particularly dangerous, then can be disruptive and uncomfortable to someone who is already dealing with a full plate of changes and adjustments. As your body adapts, you will find the diet and lifestyle changes you’ve had to make are now becoming a way of life. You’re loosing weight and feeling better than ever — still you’re vulnerable to some nasty complications of your surgery such as:
• Vitamin and mineral deficiencies that can lead to anemia, osteoporosis and
metabolic bone disease
• Dehydration
• Gallstones
• Bleeding stomach ulcer
• Hernia at the incision site


Success Rates for Gastric Bypass Surgery
The success rate of any gastric bypass surgery is most affected by the experience of the surgeon who performs the procedure. Some hospitals let surgeons begin performing this delicate surgery after they’ve attended a single weekend seminar.

Without the proper training and experience, a surgeon new to the technique (one who has done the procedure under 100 times) can increase your risk of dangerous (even life threatening) complications by as much as five times. Since gastric bypass is a technically difficult procedure that requires careful monitoring and rapid follow up in emergencies, choosing a surgeon with ample experience in this one area, and a hospital that is well equipped and well staffed can mean the difference between success and failure.

Most patients who undergo gastric bypass surgery begin to loose weight right away. You will notice most of your weight loss in the first six months, with your body weight stabilizing anywhere from 18 to 24 months after surgery. The estimated weight loss in the first year to two years after gastric bypass is about 1/2 to 2/3 of the excess weight. Some cases have been documented where the weight stayed off for up to 10 years after surgery.

This surgery is considered a success when 50% of a patient’s weight is lost and the weight stays off for five years. So if you are 100 pounds overweight, you should loose 50 pounds of that due to the surgery. One of the things most critical to the success of your surgery, beside the skill or the surgeon and the quality of the facility you select, is your willingness to make the necessary, long term disciplined changes to your diet and exercise routine. By following the instructions of your surgeon and other health care professionals in this, you’ll vastly improve your odds of keeping the all that weight off, for good.


Healthy alternatives to gastric bypass surgery
While gastric bypass surgery is becoming increasingly popular in the United States as an option for large weight loss, it isn’t a quick or easy fix to the problem of obesity. Patients learn very quickly that they are in for a lot of big changes, and must face some very uncomfortable tests, not to mention the perils of surgery, to reduce their weight. A healthier alternative might be to try and live under the gastric bypass surgery diet and exercise guidelines for several months before taking the step toward major abdominal surgery.

Certainly there are patients for whom gastric bypass is a valid, medically necessary choice — loosing weight this way will improve your health. Just be sure that you are going into the procedure with eyes wide open, realistic expectations and an understanding of what will change forever after surgery:
1. How you eat.
2. What you eat.
3. What you drink and when.
4. Your tolerance for certain foods.
5. Your risk of nutritional deficiencies.
6. Your need for follow up surgeries to correct a problem or remove excess skin.

And you should also be aware of the things surgery — any surgery won’t change:
1. The need for disciplined eating and regular exercise — you success, maybe your life, depends on it.
2. The reasons (lifestyle, psychological or emotional) that you overate in the first place.

In the end, whether you decide to go ahead with gastric bypass surgery or not, the choice is not one to rush into. By reading this ebook you’ve taken a huge step toward understanding the risks you face, the changes you will need to make and the potential for success. As with any lasting weight loss, eating right and a commitment to regular exercise are essential to lasting success.