Gastric Bypass Frequently Asked Questions

Frequently Asked Gastri By-Pass Questions

Here are some answers to the most frequently asked questions about Laparoscopic Bypass Surgery:

What are the tradeoffs with incision size? How long does the surgery take through the laparoscope? I want my surgery through the laparoscope, not a standard incision. Can you guarantee this? Can the surgery be reversed? What are the main risks of surgery? Are there long term risks after surgery? How long is the hospital stay? Does ThaiMed International offer other weight loss options? Will my overall health improve? Will I be able to have children after the procedure? What is dumping? Will I experience dumping? Will I be required to drink protein shakes? How long do I have to take Bariatric Advantage vitamins? How much food can I eat after surgery? Are there specific foods or drugs that I should avoid after surgery? Why don’t people just keep losing weight? How can I prevent stretching out my new stomach? Does surgery affect how well I absorb my medications? How long before I can go to work? Exercise? Drive a car? Will I ever eat normally again? What kind of exercise should I do after surgery? Will I need plastic surgery after I lose weight to remove loose skin? What causes some people to regain their weight? Is this experimental surgery? How many of these procedures has your group done?

Q:	What are the tradeoffs with incision size?
A:	There are pros and cons. Recovery after laparoscopic surgery is much faster and virtually scar and pain free. Length of hospital stay is reduced to days instead of weeks. Scarring is minimal. In general, laparoscopy virtually eliminates two common postoperative complications: wound infections and hernias. The frequency of bowel obstructions and leaks is increased. ^ Top

Q:	How long does the surgery take through the laparoscope?
A:	This varies widely and depends on the experience and skill of the surgeon. Our LBS surgeons routinely do this procedure in about 1 hour. ^ Top

Q:	I want my surgery through the laparoscope, not a standard incision. Can you guarantee this?
A:	We complete about 99% of our cases laparoscopically. It is always possible that a problem might occur, forcing the surgeon to enter the abdomen through a standard incision. ^ Top

Q:	Can the surgery be reversed?
A:	Yes, but it would take another operation and it is not advisable. ^ Top

Q:	What are the main risks of surgery?
A:	As with any surgical procedure there are risks. The most common complications are wound infections, strictures, and hernias. ^ Top

Q:	Are there long term risks after surgery?
A:	Any abdominal operation sets the stage for a possible bowel obstruction the lifetime frequency of which is approximately 8%. Vitamin and mineral deficiencies can occur if calcium, B12, and iron supplements are not taken as prescribed. Less commonly protein deficiency can occur. ^ Top

Q:	How long is the hospital stay?
A:	Our average patient stays 1-2 days. Some patients actually go home the morning after surgery. In Thailand we like to keep patients 2 or 3 days for increased comfort and convenience. ^ Top

Q:	Does ThaiMed International offer other weight loss options?
A:	Yes. We also offer the Lap-Band surgery. In general the Roux-en-Y Gastric Bypass is the procedure of choice, but certain patients may be better candidates for the Lap-Band. Please contact us for a complete evaluation of your situation and what is best for you. ^ Top

Q:	Will my overall health improve?
A:	Morbid obesity can also cause serious health problems. Post surgery, many of our patients no longer experience many of the life threatening symptoms they did before their weight loss, i.e. sleep apnea, joint pain, back pain or high blood pressure. Most patients can stop taking medications for hypertension and type II diabetes. ^ Top

Q:	Will I be able to have children after the procedure?
A:	Yes. Many of our patients have gone on to motherhood. Ideally, pregnancy should be delayed until weight loss is maximal, usually 2 years after surgery. Weight loss makes women more fertile and decreases the likelihood of complications related to pregnancy. ^ Top

Q:	What is dumping?
A:	Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating, flushing, weakness, fatigue, and sometimes abdominal cramps and diarrhea - a phenomenon called 'dumping.' ^ Top

Q:	Will I experience dumping?
A:	Dumping will occur if a large amount of foods high in sugar and fats are consumed after the procedure has taken place. It is imperative to stick to the diet guidelines set forth by your doctor. Most patients learn to control this very well. ^ Top

Q:

Will I be required to drink protein shakes?

A:

No. The shakes ensure adequate protein and calorie intake after surgery, which is important for healing and other reasons. A liquid diet ensures that the pouch and opening will not be stretched early on when that is more easily accomplished. The shakes also interpose a significant change between the way you have eaten and the way we hope that you will eat in the future. Because the shakes are somewhat monotonous, once you switch to a low fat, more healthy diet it will be ‘tasty’ by comparison and therefore more likely to be preferred in the long run. ^ Top

Q:	How long do I have to take Bariatric Advantage vitamins?
A:	For life, if you want to be safe. Indeed everyone ought to take a multivitamin as well to prevent the fairly common and widely varied deficiencies seen as people get older. ^ Top

Q:

How much food can I eat after surgery?

A:

The gastric pouch although initially very small has a hole in the bottom so that a reasonable amount of food can be eaten if taken slowly. As time passes the pouch enlarges and where initially only one or two bites could be taken without a sense of fullness, later a small adult meal can be consumed. As it becomes possible to eat more food it becomes also more important to have developed good habits with regards to food choices. ^ Top

Q:	Are there specific foods or drugs that I should avoid after surgery?
A:	Except for the tiny hormone replacement pills most tablets should be crushed after surgery. Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating, flushing, weakness, fatigue and sometimes abdominal cramps and diarrhea - a phenomenon called 'dumping'. ^ Top

Q:

Why don’t people just keep losing weight?

A:

Everyone who has gastric bypass surgery has a strong genetic capacity to use calories efficiently. So it is always possible to provide high calorie foods and induce weight gain. In practice what happens is that with time people are able to eat more at a time, they lose weight and require fewer calories just to move around and their metabolism becomes even more efficient that it was preoperatively so the weight stabilizes after one or two years. ^ Top

Q:	How can I prevent stretching out my new stomach?
A:	Don’t eat after you feel full. ^ Top

Q:	Does surgery affect how well I absorb my medications?
A:	Generally speaking not, but with certain medications it may be wise to check blood levels after surgery. ^ Top

Q:	How long before I can go to work? Exercise? Drive a car?
A:	We advocate walking and light weight lifting immediately after surgery. Typically patients can return to normal activities two to three weeks after their procedure. ^ Top

Q:

Will I ever eat normally again?

A:

It depends on what you mean by normal. Most of our patients eat small, "normal" adult meals. Many overweight people eat more and make higher calorie food choices than the rest of the population. So it is possible that you were not eating 'normally' to begin with. After surgery although you can eat small amounts of anything, we hope that you will choose low fat foods for the most part. Also you will in general consume fewer calories than someone your size who was not previously overweight. Frequent small amounts of high calorie foods can cause you to gain weight. ^ Top

Q:

What kind of exercise should I do after surgery?

A:

We advocate increasing two kinds of exercise as part of a post surgical lifestyle change: 1) Increase the difficulty of unscheduled everyday activities. For example, try to walk farther - a pedometer is helpful in this regard - climb the stairs instead of taking the elevator; volunteer for small tasks that you might not otherwise choose. 2) Schedule workouts two or three or four times a week simply for the purpose of exercising. Although any activity is helpful, weightlifting is the most efficient for extra weight loss. ^ Top

Q:

Will I need plastic surgery after I lose weight to remove loose skin?

A:

Some of our patients are thrilled with their new look and want plastic surgery to look their very, best. Whether plastic surgery is desirable depends on how old you are (skin is less elastic with age) how much weight you lose (the more weight loss, the more loose skin) and individual differences in elasticity. Loose skin bothers some more than others, but there is nothing shameful about wanting to look your best. We work with some of the finest plastic surgeons in the world to help our patients get the finest results. ^ Top

Q:	What causes some people to regain their weight?
A:	Most often it is forgetting that weight control is a lifelong project. But obviously the genetic pressure to gain is greater in some than others and although we cannot currently recognize it the surgery may be better for certain types of obesity than it is for others. The long-term success rate is better than 90%. ^ Top

Q:	Is this experimental surgery?
A:	Not at all. This is the "Gold Standard" of weight loss surgery. It is recognized and accepted by the American College of Surgeons, American Academy of Family Practice and virtually every organization, worldwide, concerned with health or obesity issues. ^ Top

Q:	How many of these procedures has your group done?
A:	Our group includes the originator of the Laparoscopic Roux-En-Y. Our surgeons have done thousands of these procedures. ^ Top

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Gastric ByPass Thailand

It's always best to lose weight through a healthy diet and regular physical activity. But if you're among those who have tried and can't lose the excess weight that's causing your health problems, weight-loss (bariatric) surgery may be an option.

Gastric bypass, which changes the anatomy of your digestive system to limit the amount of food you can eat and digest, is the favored bariatric surgery in the United States. Most surgeons prefer this procedure because it's safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes.

Gastric bypass isn't for everyone with obesity, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle.

Who is gastric bypass surgery for?

Body mass index (BMI) is a measure of body fat based on height and weight that applies to both adult men and women. Enter your weight and height using Standard or Metric measures. Click on "Compute BMI" and your BMI will appear in the heart of the figure. BMI Categories: Underweight = <18.5 Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30+ Generally, gastric bypass surgery is reserved for people who are unable to achieve or maintain a healthy weight through diet and exercise, are severely overweight, and who have health problems as a result. Gastric bypass may be considered if: 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 problems such as diabetes or high blood pressure Gastric bypass surgery doesn't replace the need for following a healthy diet and regular physical activity program. In fact, the success of the surgery depends in part on your commitment to following the guidelines given to you about diet and exercise. As you consider weight-loss surgery, make sure that you make every effort to exercise, change your eating habits and adjust any other lifestyle factors that have contributed to your excess weight.

Body Mass Index (BMI) is a measurement based on height and weight as it relates to body fat, and can be used to determine how much risk a person has of developing certain health problems because of his or her weight. As a point of reference, someone with a BMI of 27 is approximately 20 percent overweight. The higher the BMI, the greater the risk a person has to develop additional health problems. To determine your BMI, simply select your height and type in your weight where specified in the form below. The calculator will automatically calculate your BMI score. BODY MASS INDEX GRAPH On the BMI graph above, find your score and the health risk for which it is assessed. For example, a BMI score of 20 - 25 is associated with the lowest health risk based solely on BMI scores. If your score is over 27, you are considered to be at increased risk for health problems that are negatively impacted by obesity, such as diabetes, heart disease, high cholesterol or hypertension. Exceptions to a high BMI score include competitive athletes and body builders, whose BMI is high due to increased muscle mass, and women who are pregnant or lactating. The BMI is also not intended for use in measuring growing children or elderly individuals.

How do you prepare for gastric bypass surgery?

Surgical candidates go through an extensive screening process. Not everyone who meets the criteria for gastric bypass is psychologically or medically ready for the surgical procedure. A team of professionals, including a physician, dietitian, psychologist and surgeon, evaluate whether the surgery is appropriate for you. This involves identifying which aspects of your health would be expected to improve after surgery and what aspects of your health may increase the risks of surgery. Surgery is recommended when the perceived benefits of surgery outweigh the recognized risks.

Your willingness and ability to follow through with the recommendations made by your health care team and to carry out prescribed changes in your diet and exercise routine help determine your readiness for surgery. The surgery may not be recommended or may be postponed if there's any sign that you aren't psychologically or medically ready for surgery.

It's important to follow your doctor's directions in preparing for gastric bypass surgery. This includes restrictions on eating, drinking, starting a program of physical activity, and limiting or stopping the use nicotine products.

How is gastric bypass surgery done?

In gastric bypass (Roux-en-Y gastric bypass) the surgeon creates a small pouch at the top of your stomach and adds a bypass around a segment of your small intestine.

The surgeon staples your stomach across the top, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold about an ounce of food. The pouch is physically separated from the rest of the stomach. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch.

This redirects food, bypassing most of your stomach and the first section of your small intestine, the duodenum (doo-o-DEE-num). Food enters directly into the second section of your small intestine, the jejunum (jay-JOO-num), limiting your ability to absorb calories. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in your small intestine.

Some surgeons perform this operation by using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen (laparoscopic gastric bypass). The tiny camera on the tip of the scope allows the surgeon to see inside your abdomen.

Compared with traditional "open" gastric bypass, the laparoscopic technique usually shortens your hospital stay and leads to a quicker recovery. Fewer wound-related problems also occur. Not everyone is a candidate for laparoscopic gastric bypass, however. Talk to your doctor about whether this approach is appropriate for you.

What can you expect during the surgery?

Gastric bypass surgery is performed under a general anesthesia. This means you inhale analgesics as a gas or receive them through an intravenous (IV) line so that you're asleep during the surgery.

During surgery, a tube is passed through your nose into the upper stomach pouch. Occasionally, this tube stays in overnight. The tube is connected to a suction machine after surgery to keep the small stomach pouch empty so that the staple line can heal.

You may have another tube in the bypassed stomach. This tube would come out of the side of your abdomen and is removed four to six weeks after surgery. Some skin irritation may develop around this tube.

Gastric bypass surgery takes about 90 minutes. After surgery, you wake up in a recovery room, where medical staff monitor you for any complications. Your hospital stay may last from three to five days.

What can you expect after gastric bypass surgery?

You won't be allowed to eat for one to two days after the surgery so that your stomach can heal. Then, you'll follow a specific dietary progression for about 12 weeks. This begins with liquids only, proceeds to pureed and soft foods, and finally to regular foods.

With your stomach pouch reduced to the size of a walnut, you'll need to eat very small meals throughout the day. In the first six months after surgery, eating too much or too fast may cause vomiting or an intense pain under your breastbone. The amount you can eat gradually increases, but you won't ever be able to return to your old eating habits.

You may experience one or more of the following changes as your body reacts to the rapid weight loss in the first three to six months:

• Body aches
• Feeling tired, as if you have the flu
• Feeling cold
• Dry skin
• Hair thinning and hair loss
• Mood changes

Within the first two years of surgery, you can expect to lose 50 percent to 60 percent of your excess weight. If you closely follow dietary and exercise recommendations, you can keep most of that weight off long-term.

What are the benefits of gastric bypass surgery?

In addition to dramatic weight loss, gastric bypass surgery may improve or resolve the following conditions associated with obesity:

• Type 2 diabetes
• High blood cholesterol
• High blood pressure
• Obstructive sleep apnea
• Gastroesophageal reflux disease (GERD

The improvements observed in type 2 diabetes, high blood pressure and high blood cholesterol may significantly decrease the risk of cardiovascular events in individuals who have undergone gastric bypass surgery compared with those treated through other means. Gastric bypass surgery has also shown to improve mobility and quality of life for people who are severely overweight.

What are the risks of gastric bypass surgery?

As with any major surgery, gastric bypass carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Possible risks specific to this surgery include:

• Death. A risk of death has been associated with gastric bypass surgery. The risk varies depending on age, general health and other medical conditions. Talk to your doctor about the exact level of risk gastric bypass surgery may pose for you.
• Blood clots in the legs. Blood clots in the legs are more likely to occur in very overweight people. Blood clots can be dangerous. In some cases, they travel to the lungs and lodge in the lungs' arteries causing a pulmonary embolism — a serious condition that damages lung tissue and can lead to death. Walking and using leg wraps that apply intermittent pressure to the leg can help reduce this risk of blood clots in the legs.
• Leaking at one of the staple lines in the stomach. This severe postoperative problem would be treated with antibiotics. Most cases heal with time. Sometimes, the leak can be serious enough to require emergency surgery.
• Pneumonia. Excess weight places extra stress on the chest cavity and lungs. This means a higher risk of developing pneumonia after the surgery.
• Narrowing of the opening between the stomach and small intestine. This rare complication may require either an outpatient procedure to pass a tube through your mouth to widen (dilate) the narrowed opening or corrective surgery.

Gastric bypass can also cause dumping syndrome, a condition where stomach contents move too quickly through the small intestine causing nausea, vomiting, diarrhea, dizziness and sweating. Other common complications of gastric bypass surgery include:

• Vitamin and mineral deficiency
• Dehydration
• Gallstones
• Bleeding stomach ulcer
• Hernia at the incision site
• Intolerance to certain foods

What are other weight-loss surgery options?

Though it's the most commonly used, gastric bypass is just one kind of weight-loss surgery. Other types include:

• Adjustable gastric banding. The surgeon uses an inflatable band to partition the stomach into two parts. He or she then wraps the band around the upper part of your stomach and pulls it tight, like a belt, creating a tiny channel between the two pouches. The band keeps the opening from expanding and is designed to stay in place indefinitely. But it can be adjusted or surgically removed if necessary. Most surgeons perform this operation using a laparoscope.
• Vertical banded gastroplasty. This operation divides the stomach into two parts — limiting space for food and forcing you to eat less. There is no bypass. Using a surgical stapler, the surgeon divides your stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch — the rest of your stomach. Partly because it doesn't lead to adequate long-term weight loss, surgeons use it less commonly than gastric bypass.
• Biliopancreatic diversion. In this procedure, a portion of your stomach is removed. The remaining pouch is connected directly to your small intestine, but completely bypasses your duodenum and jejunum where most nutrient absorption takes place. This weight-loss surgery offers sustained weight loss, but it presents a greater risk of malnutrition and vitamin deficiencies and requires close monitoring.

Looking Ahead After Gastric Bypass Surgery

Surgery for weight reduction isn't a miracle procedure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after gastric bypass surgery depends on your commitment to making lifelong changes in your eating and exercise habits. But the feeling of accomplishment as you lose weight and your improved health are significant benefits and are well worth your efforts.

Click Here To Review Frequently Asked Questions Regarding Gastric By-Pass

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Plastic Surgery, General Health Care, and Dentistry
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