Gastric Bypass Surgery: Long-Term Care

Gastric bypass surgery, also known as Roux-en-Y gastric bypass (RYGB) surgery, is a type of bariatric (weight-loss) surgery that involves creating a small pouch out of a patient's existing stomach. The surgery has many potential benefits, including the improvement (even reversal) of health conditions like high blood pressure and diabetes.

That said, gastric bypass surgery is not a "cure" or a magic solution to obesity. Patients must make a lifelong commitment to following a healthy diet and exercise regimen in order to maintain their weight loss.

Benefits of Surgery

The primary benefit of gastric bypass surgery is significant weight loss with subsequent alleviation of obesity-related health problems.

While not an exhaustive list, some diseases that may be cured, or at least improved, from surgery include:

• Type 2 diabetes
• Heart disease
• High blood pressure
• Obstructive sleep apnea
• Non-alcoholic fatty liver disease
• Osteoarthritis
• Infertility
• Depression

Gastric bypass surgery has also been found to reduce the risk of death from diabetes, heart disease, and cancer. In addition, patients report improvements in energy levels, satisfaction with body image/appearance, and quality of life.

Possible Future Surgeries

While gastric bypass surgery is considered an overall safe surgery, future surgical procedures may be indicated if certain post-operative complications arise.

Examples of such complications include:

• Marginal ulcer formation: A marginal ulcer is like a peptic ulcer. It may form near the site where the stomach pouch and small intestine are connected during the gastric bypass. Surgery may be indicated if the ulcer perforates (forms a hole in the gut), or if a patient has persistent pain or bleeding, despite medical therapy.
• Incisional hernia formation: An incisional hernia, which is an abnormal opening in the abdominal wall, may occur after gastric bypass. Surgery may be indicated emergently if a patient experiences severe pain or small bowel obstruction.
• Late-onset dumping syndrome: Dumping syndrome occurs when food moves rapidly from the stomach to the small intestines causing nausea and abdominal cramping. It symptoms do not get better with dietary changes and medication, revisional bariatric surgery may be required.

Another indication for a possible future surgery (specifically, a revisional bariatric surgery) is if a patient fails to lose weight. This complication is rare and usually is due to poor eating habits that begin after surgery.

Weight regain, which occurs in up to 20% of patients, is another indication for revisional bariatric surgery. Weight regain may occur as a result of the following:

• Nonadherence to eating and lifestyle changes after surgery
• Development of a gastrogastric fistula, which is when an abnormal tract forms between the new stomach pouch and the old stomach remnant
• Progressive stretching and enlargement of the new stomach pouch
• Widening of the connection between the stomach pouch and the small intestines (called the gastrojejunal anastomosis)

Lastly, due to excess, sagging skin, patients may opt to undergo skin removal surgery after losing weight from gastric bypass surgery.

Lifestyle Adjustments

After laparoscopic gastric bypass surgery, approximately 80% of patients lose more than 70% of their excess body weight over two years. In order to maintain this weight loss after surgery, patients must adhere to several lifestyle practices.

Eating and Drinking Right

Patients will leave the hospital on a full liquid diet with protein shakes. They usually continue the full liquid diet for about two weeks or until their first post-operative follow-up appointment. After that, they will progress to a soft diet and eventually, a diet containing foods of a regular consistency. During this time, it's essential that patients stay hydrated, drinking around 60 ounces of water per day.

When tolerating oral foods, some lifelong food or meal guidelines that a patient must follow include:

• Incorporating protein into every meal to meet daily requirements, which is around 60 grams. Consumption of a protein shake or a low-calorie protein food (e.g., a reduced-fat string cheese) in between meals may be needed to meet this requirement.
• Stopping eating when full.
• Not drinking for at least 30 minutes prior to and after meals.
• Drinking around 60 ounces of water a day to prevent dehydration
• Avoiding all carbonated drinks (bubbles can stretch the stomach) and foods high in sugar or fat.
• Taking a daily multivitamin, along with calcium, vitamin D, iron, vitamin C, and vitamin B12)

Exercising Regularly

Exercising regularly (five to seven days a week) after surgery is essential for burning fat, preserving muscle strength, controlling appetite, and reducing stress. Many patients benefit from working with a fitness coach or physical therapist to help them find enjoyable, long-term physical activities, whether that be hiking, swimming, or dancing.

Joining a Support Group

To help patients cope with the aftermath of surgery, many bariatric surgery programs offer post-operative support groups. Joining a group (whether in person or online) can help patients remain committed to their new lifestyle habits (which may seem rigorous at first, but eventually become second nature). Support groups can also provide emotional support, as well as, extended contact and access to healthcare professionals if questions or concerns arise.

Seeing Your Healthcare Provider Regularly

Even after recovering from surgery, it's important for patients to follow-up with their bariatric surgeon and primary care healthcare provider as instructed (usually every three months, six months, and then annually).

The purpose of these visits is to:

• Evaluate for possible long-term surgical complications related to the surgery
• Monitor nutritional deficiencies through blood tests (taken at least every six months)
• Monitor chronic health conditions and adjust medications, as needed
• Keep track of a patient's weight loss progress (weight loss may continue for up to two years after surgery)

Women in their childbearing years should also see their primary care healthcare provider or gynecologist in order to discuss birth control options. The American College of Obstetricians and Gynecologists (ACOG) recommends that people not become pregnant in the first 12 to 18 months after bariatric surgery.

A Word From Verywell

For many patients, gastric bypass surgery is a jumpstart into a life they dreamed of and deserved for years. Still, while surgery is a reliable means of achieving significant weight loss, it's only the first step. Patients must remain proactive and committed to their follow-up care and everyday habits.