Arturo Rodriguez, MD

December 5, 2009

Life After Gastric Bypass Surgery

Life After Gastric Bypass Surgery

There are a number of important things to consider for patients after they have had Gastric Bypass Surgery. Take some time to read through the information and get informed if you are considering this procedure.

Diet

After having a gastric bypass, the modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss.  Without these necessary changes, such as decreasing or limiting your intake of high-fat, high-sugar foods, you may stop losing weight or even begin to gain weight again.  Limiting high intakes of sugary foods is especially important to decrease the chance of Dumping Syndrome, where these foods move too quickly through the digestive tract into the intestine and can cause cramping, pain and discomfort, among other related symptoms.

Post-surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their gastric bypass surgery. It is important to remember that every surgeon does not perform the exact same weight loss surgery procedure and that the dietary guidelines will be different for each surgeon and each type of bariatric procedure.

What is most important is that you adhere strictly to your surgeon’s recommended guidelines. The following are some of the dietary guidelines I recommend after a gastric bypass:

  • During 4 weeks you will go on a liquid diet and advance in steps to a puree/baby food type diet for one or two additional weeks and transition to an almost normal (solid food) diet after that.
  • When you start eating solid food it is essential that you chew thoroughly.
  • You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
  • Don’t drink fluids while eating. They will make you feel full before you have consumed enough food or they will flush down more food than you should be taking in.
  • Omit desserts and other items with sugar listed as one of the first three ingredients.
  • Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
  • Avoid alcohol.
  • Limit snacking between meals.

Going Back to Work

Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of gastric bypass you had (open or laparoscopic). Many patients return to full pre-surgery levels of activity within six weeks of an open Gastric Bypass procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a week.

Birth Control & Pregnancy

It is strongly advised that women of childbearing age use effective forms of birth control during the first 16 to 24 months after a gastric bypass surgery since the fertility increases during weight loss. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

Long-Term Follow-Up

Although the short-term effects of weight loss surgery are well understood, there are still some questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years are well known if you don’t take the recommended supplements. You will take supplements of Vitamins and Minerals (such as calcium and iron) for life and have a full blood work test done at least once every year.

Support Groups

The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various issues.  Most learn, from example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Most surgeons have support groups in place to assist you with short-term and long-term questions and needs. I highly recommend enrolling into a support group.

Be cautious when turning to message boards as they are full of doctor’s coordinators or brokers more concerned with increasing business in their direction than providing support. You have to be aware of their presence and not allow them to manipulate you; they are only interested in gossiping or scaring you when you are only looking for the right answers.

Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.

Arturo Rodríguez, MD

Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2008-10-26 07:45:58. Republished by Blog Post Promoter

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July 20, 2009

Simplified Gastric Bypass

Simplified Gastric Bypass

What is Gastric Bypass Surgery?

The Gastric Bypass is considered as the “gold standard” of Weight Loss Surgery by the American Society of Metabolic and Bariatric Surgeons (ASMBS).  Roux-n-Y Gastric Bypass Surgery (RYGB) is the most commonly practiced weight loss surgery world wide.

The Gastric Bypass is also considered by the SAGES and ASMBS as the most complex and technically challenging procedure to be done by laparoscopy and requires a large number of operations to achieve competency.

Open RYGB as treatment for obesity was introduced by Dr. Mason and Dr. Ito in 1967. The first Laparoscopic RYGB was performed in 1994 by Dr. Wittgrove following the surgical steps of the open surgery.

The Simplified Gastric Bypass was developed by Dr. Almino Ramos in Sao Paulo, Brazil and was called Simplified Laparoscopic Gastric Bypass consisting in simplifying and standardizing the surgical steps of the traditional Gastric Bypass in a way that it can be done in the superior half of the abdomen easily, by trained Bariatric Surgeons with less operative time (average of 75 minutes) and with more efficiency.  Today, thousands of patients are operated by this technique all over the world.

The Simplified Gastric Bypass technique involves a gastric stapling, and its division (forming the gastroplasty, new gastric chamber or pouch), lowering the gastric capacity by 90% (20-30cc). The Gastric Bypass is done ante-colic (the open way was retro-colic, meaning that was done behind the transverse colon) and as far as 1.5 to 2 m (the small bowel has 4 to 7 m in length).  At the end of the procedure, the gastroplasty is connected with the deviated intestinal limb (gastrojejunostomy) by stapling and suturing them, to allow the food to pass again.

What are the Risks of Gastric Bypass Surgery?

International literature describes an average of 10% of cases with complications (morbidity), and a 2% mortality rate.  Anastomotic leak is the most serious complication of gastric bypass procedure and is associated with increased morbidity and mortality.  The ideal treatment is prevention by meticulous operatory technique and pre and postoperative care.  The leaks that are likely to result in mortality (about 15%) are those for which the patient manifests a high systemic inflammatory response, and is closely related with a high BMI, with fever, increased leukocyte count and heart rate and also signs of organ failure.

How does the Gastric Bypass Work?

This operation involves two effects: predominant gastric restriction, and intestinal malabsorption.  The food arrives at the new stomach (gastroplasty) and promotes distention on the walls of the pouch, inducing satiety and fullness with small amounts of food.  Then the food passes slowly through the calibrated gastrojejunostomy of 11 mm and proceeds for digestion (1.5 to 2m after the new formed gastric pouch).  When the fullness sensation of the small chamber is exceeded, pain or vomiting can occur.

After a Gastric  Bypass, the liquids with high concentration of carbs will not be totally absorbed, especially during the first year.  This may result in “dumping syndrome” where the food moves too quickly into the small intestine.  Symptoms include bowel irritation, abdominal pain, diarrhea, and increased heart rate with palpitation and sweating.

What happens post-op (after surgery)?

Most of the patients are discharged from the hospital within 48 to 72 hours after the operation. The complete return to normal activities occurs in about one week.  During 4 weeks following the operation, the patient should consume a liquid diet, and advance in a stepwise way to a puree/baby food type diet for one or two additional weeks, eventually evolving to an almost normal diet by the fourth week.  In this operation there is a need to supplement vitamins and minerals. Iron must be followed by regular I.V. tests and reposition is usually needed.

Who  would benefit from a Gastric Bypass?

  • Patients with a metabolic disease (Type 2 diabetes, high blood pressure, hyper-lypidemia)
  • Persons with any degree of binge eating disorder
  • Moderate risk patients (few co-morbidities)
  • High expectations (those who need to lose weight, up to 80% EWL [excess weight loss])
  • Low to moderate patient commitment

 

Arturo Rodriguez, MD

http://www.thebariatric.com

Originally posted 2008-07-03 07:48:58. Republished by Blog Post Promoter

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