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 The Laparoscopic Gastric Bypass
The Gastric Bypass is considered by the American Society of Bariatric Surgeons and the National Institutes of Health to be the gold standard of weight loss surgery and the single most successful procedure for excess weight loss and long-term weight control. A combination restrictive/malabsorptive operation, it is the operation of choice for most Bariatric surgeons in the United States. Studies show the Gastric Bypass has some patients more than 15 years post-surgery and maintaining about 75% of their excess weight loss. Now, with modern refinement of the operation, there are many patients losing 85% to 100% of their excess weight and keeping that weight off.
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With Laparoscopic surgery, the camera and surgical instruments are inserted into the abdomen through five or six small incisions. This gives the surgeon better visualization of the anatomy and better access to key anatomical parts. Proudly, we are one of the few Bariatric centers in the world using the Vista 3-Dimensional Visualization System — cutting-edge Laparoscopic camera technology enabling the surgeon to operate more precisely, efficiently, and safely. Normally with Laparoscopic surgery, the surgeon looks at the image inside the abdomen on a flat two-dimensional TV screen. With the Vista 3-D System, the surgeon sees inside the abdomen as if they were looking with their own two eyes — in three dimensions. |
Compared with traditional 'open' incisions, Laparoscopic surgery with small incisions offers a better surgical outcome. A recent study shows that patients with Laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and higher overall oxygen levels - and with better healing. There are also fewer wound complications such as infection or hernia with patients returning to normal pre-surgery activity levels more quickly. |
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Many people have heard of the old intestinal gastric bypass or jejuno-ileal gastric bypass and should be aware that this operation is obsolete because it caused serious problems including diarrhea. The Gastric Bypass is not the same as this old operation and ordinarily will not cause diarrhea. Nor does it cause the serious problems that the old intestinal bypass did cause.
Diets for Gastric Bypass Patients
The preop Diet for all patients with a 40+ BMI (for two weeks pre-op):
DIET: Breakfast, Lunch, and Dinner should be low calorie protein shakes or Non fat yogurt.
·The rest of the day or if you are still hungry at meal time you can have clear liquids.
·You should drink about 8 glasses of water or more a day.
·And Jell-O the low calorie kind is a clear liquid.
·Other clear liquids are beef and chicken broth, apple and grape juice, nonfat milk, and cranberry juice.
FOR GASTRIC SLEEVE AND RNY BYPASS PATIENTS EXCLUSIVELY:
Do Balloon exercises:
Just blow up 30 balloons for nonsmokers and 40 balloons for smokers each day during the two week preop diet period. (The small party balloons that are hard to blow up). Discard each one after you inflate it.
The diet will reduce the risk of complications during your surgery and will reduce the size of your liver. The balloons will strengthen your lungs for surgery. Both are very important to do preop. Please let me know if you have any other questions regarding your preop diet or exercise.
NOTE: IF YOU ARE A SMOKER: YOU MUST ALSO DO THE FOLLOWING:
Quit Smoking Immediately and Do the above mentioned Balloon exercises.
The POSTOP diet, Gastric Bypass is a common sense diet without weighing or measuring foods. You should eat three small meals a day without drinking with meals as the pouch will not hold liquid and solid at the same time. All liquids should be calorie free. Essentially your diet should be protein, meaning meat, fish, egg or fat free cheese as well as fresh fruit, green vegetables and salads. Fat and sugar should be avoided and starch should be mainly in the form of fruit or vegetables.
It is possible following the Gastric Bypass to develop lactose intolerance. This means milk or milk products such as cheese may cause diarrhea. This is not very common, but can easily be managed by avoiding these foods or using Lactaid. Following a Gastric Bypass certain nutrients are not absorbed as well. In particular, these may be fat soluble vitamins, such as vitamin A, D and K, iron, calcium and vitamin B12. Because of this you should take a multivitamin with minerals as well as extra iron, and calcium in the form of Tums following this surgery. These should be taken permanently.
Risks: You should be aware that any surgery may have complications, and this is major surgery. Specific complications will be discussed further with you, in person, but it is possible that death may result and the risk of death is approximately 1 in 300. You should therefore carefully weigh the benefits versus the risks. You should consider whether you have any alternative way to lose weight. Also, you should consider whether you are a viable candidate for the Band Surgery. Usually, if you are 100 lbs or more overweight, it is impossible to lose weight and keep it off by any means. If you do not have surgery you will probably continue to gain weight and develop other complications of obesity, which may seriously affect your health and may shorten your life. The decision to undergo the surgery should not be taken lightly as it is intended to be permanent and for life. The changes which it can produce in your life are generally very positive, but you should fully consider all the implications.
Contraindications
The Bypass is not right for you if:
• You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe oesophagitis or Crohn's disease.
• You have severe heart or lung disease that makes you a poor candidate for surgery.
• You have some other disease that makes you a poor candidate for surgery.
• You have a problem that could cause bleeding in the oesophagus or stomach. That might include oesophageal or gastric varices (a dilated vein). It might also be something such as congenital or acquired intestinal telangiectasia (dilation of a small blood vessel).
• You have portal hypertension.
• Your oesophagus, stomach or intestine is not normal (congenital or acquired). For instance you might have a narrowed opening.
You have experienced an intra-operative gastric injury, such as a gastric perforation at or near the location of the intended band placement.
• You have cirrhosis.
• You have chronic Pancreatitis.
• You are pregnant. (If you become pregnant after the Lap-Band® System has been placed, the band may need to be deflated. The same is true if you need more nutrition for any other reason, such as becoming seriously ill. In rare cases, removal may be needed.)
• You are addicted to alcohol or drugs.
• You are under 15 years of age.
• You have an infection anywhere in your body or one that could contaminate the surgical area.
• You are on chronic, long-term steroid treatment.
· You cannot or do not want to follow the dietary rules that come with this procedure.
· You might be allergic to materials in the device.
• You cannot tolerate pain from an implanted device.
•You or someone in your family has an autoimmune connective tissue disease. That might be a disease such as systemic lupus erythematosus or scleroderma. The same is true if you have symptoms of one of these diseases. |
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