What is Gastric Bypass (RNY) Surgery?
The Laparoscopic Gastric Bypass procedure otherwise known as the The Roux-en-Y Gastric Bypass ( RNY) is considered the ‘gold standard’ of weight loss surgery and is the most commonly performed bariatric procedure worldwide. It works by restricting food intake and by decreasing the absorption of food.
Food intake is limited by a small pouch that is similar in size to the adjustable gastric band. In addition, absorption of food in the digestive tract is reduced by excluding most of the stomach, duodenum, and upper intestine from contact with food by routing food directly from the pouch into the small intestine.
THE PROCEDURE
The Gastric Bypass surgery entails dividing the stomach into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both.
The operation is performed by our surgeons laparoscopically and involves making five to six small incisions in the abdomen through which a small scope connected to a video camera and surgical tools are inserted.
The surgeon staples the top portion of the stomach so it is separated from the bottom to create a small stomach pouch.
This small pouch restricts food intake.
A section of the small intestine called the jejunum is then attached to the small stomach pouch permitting food to bypass the lower stomach, the duodenum. This bypass reduces the amount of calories and nutrients the body absorbs, called malabsorption.
The surgeon then takes the end of the small intestine that is still connected with the remainder of the stomach and attaches it to the bottom of the “Roux limb.” This allows the digestive juices produced by the stomach to meet up with the food in the intestines
In addition, there are 2 catheters (tubes) used to keep both portions of the stomach clear – the first is inserted through the mouth and into the pouch. The second is for the larger portion of the stomach and is threaded through an opening in the side of the patient’s abdomen.
Rarely, a cholecystectomy (gall bladder removal) is performed to avoid the gallstones that may result from rapid weight loss. More commonly, patients take medication after the operation to dissolve gallstones.
The procedure itself takes about 4 hours to complete.
Most people typically stay in the hospital for 2-3 days after gastric bypass surgery.
Gastric Bypass (RNY) Surgery Advantages
Average weight loss after the Roux-en-Y procedure is generally higher if you rigorously follow instructions than with other restrictive procedures.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your Gastric Bypass surgery preparation you will complete a detailed bariatric specific questionnaire, which will allow our doctors to determine your eligibility for Gastric Bypass surgery. If you are not ready to make lifestyle changes, you will not be considered eligible for the procedure.
To help you adjust to your new lifestyle, we advise you to empty your home of all edible “temptations”, creating a suitable environment for your return, post operatively.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
After hospital admission, you will receive psychological advice. This will help you adhere to a healthier lifestyle. Without changing your lifestyle, the surgery will not be a success. You will also receive nutritional counseling before (and after) your surgery, by our specialists.
RECOVERY AFTER SURGERY
Upon your discharge from the hospital you should be able to:
You will remain on liquid or pureed food for several weeks after the surgery. Even after that time, you will feel full very quickly, sometimes only being able to take a few bites of solid food. This is because the new stomach pouch initially only holds a tablespoonful of food. The pouch eventually expands. However, it will hold no more than about one cup of thoroughly chewed food.
You will be instructed on eating small meals frequently throughout the day, rather than large meals that your stomach cannot accommodate.
Your new stomach may not be able to handle both solid food and fluids at the same time. So, you should separate fluid and food intake by at least 30 minutes and only sip what you are drinking. You won’t be able to tolerate large amounts of fat, alcohol, or sugar. You should reduce your fat intake, especially fast food meals, deep-fried foods, and high-fat foods, as well as high-sugar foods like cakes, cookies, and candy.
You can generally resume exercise 6 weeks after the operation. Even sooner than that, you will be able to take short walks at a comfortable pace, with the approval and guidance of our doctor. Exercise improves your metabolism, while both exercise and attending a group support can boost your self-esteem and help you stay motivated.
LIFE AFTER SURGERY
Following your recovery diet you will slowly begin to introduce new foods in increasing quantities until about 6 months after surgery when your new bariatric diet will be in full swing. All weight loss surgery procedures require a complete change in diet for your procedure to continue to be effective and Laparoscopic Sleeve Gastrectomy is no different.
Assuming you follow the diet and exercise guidelines of our surgical team, all indications are that weight loss and health improvement following Sleeve Gastrectomy surgery may be permanent. However, some patients are likely to experience weight regain as a result of your stomach stretching over time.
Post-Surgery Nutrition
After surgery, you will need a new nutrition plan. Our surgeon and/or dietitian can help you learn about and get used to the changes in lifestyle and eating habits you need to make. It is very important to follow the eating and drinking instructions beginning immediately after the operation.
In the first few weeks after your surgery, you will be on a liquid diet since only thin liquids will be tolerated by your stomach at that time. As you heal, you will gradually progress to pureed foods (three to four weeks post-op) and then soft foods (five weeks post-op). Finally, you will be able to eat solid foods.
When you are at the stage to eat solid foods without problems, you will need to pay close attention to your diet.
Upon follow up, your doctor will determine if you need replacement of iron, calcium, vitamin B12, or other nutrients. Supplements, such as a multivitamin with minerals, will be prescribed to provide any nutrients that you may not be getting from your diet.
It is recommended that you eat only three small meals a day and make sure that these meals contain adequate nutrients. Foods that have a concentrated supply of calories with little nutritional value, such as milkshakes, syrups, jam, and pastries, should be avoided as much as possible.
Exercise Plan
Exercise is very important and incorporating regular physical activity into your daily routine is as important as following your nutrition plan.
Often Weight Loss Surgery patients have been inactive due to decreased activity tolerance, psychological constraints and in some cases, physical disabilities. After Laparoscopic Sleeve Gastrectomy aerobic activities, particularly walking and gentle swimming are generally best tolerated. Your surgeon will advise you on which activity is right for you.
The weight loss results of gastric bypass surgery are generally good. Most patients lose an average of 10 pounds per month and reach a stable weight between 18 and 24 months after surgery. Often, the greatest rate of weight loss occurs in the very beginning (that is, just following the surgery when you are still on a liquid diet).