How long does the surgery take?
Most cases require about 2 hours of actual operating time. This can be quite variable and depends upon a patient’s anatomy and whether they have adhesions inside the abdomen and whether there has been previous surgery.
How long am I in the hospital?
Most patients remain in the hospital until the second post-operative day for the gastric bypass. Many adjustable gastric banding patients are discharged on the same day as their surgery. If there are circumstances that require continued monitoring or therapy the stay can be prolonged. Some patients are ready to leave the first post-operative day but this is relatively rare. You are required to remain in the area for a full week after your surgery.
How long does the process take once I have had an appointment with Dr. Bauman?
That depends upon whether the other elements of the workup have been completed. The time it takes to obtain appointments for the pre-op workup will make a difference in how long it will be before we can send your insurance letter requesting prior approval. The turn-around time for insurance letters appears to be one to two weeks. We will contact you once we receive your letter of approval from the insurance company. You may receive your letter before you do but we will contact you as soon as we receive our authorization number in order to proceed with posting your surgery.
Has the surgery ever been cancelled or stopped?
One surgery was cancelled because of incomplete documentation pre-operatively and one surgery was stopped because of unexpected findings at surgery and will be completed at a later time.
Will I have an NG (nasogastric) tube?
No, unless there is a problem with your surgery and you require an open incision.
How often does that happen?
In the last 1000 surgeries it has occurred five times and has been due to either unexpected adhesions or circumstances that prevented the surgery from being done safely laparoscopically.
How big is the pouch in the gastric bypass?
How long will I be out of work?
Different people recover at different rates. You will be expected to walk in the halls the evening after your surgery and on a regular basis in the following days. Many people find they are ready to return to work in 2 weeks. Some feel they can return earlier, some later.
How is the Gastric Bypass done and how does the operation help me lose weight?
The patient is brought to the operating room and goes to sleep with general anesthesia. Six small incisions were made in the abdomen and carbon dioxide is placed inside the abdomen creating enough room to see its contents and to carry out the operation. A telescope is inserted through one of those incisions and the gastric pouch is created from the patient’s stomach by using a special device that staples and cuts. The pouch is created around a tube that is inserted through the patient’s mouth and into the stomach. The pouch is approximately 5-6 cm by 1-2 cm and holds approximately 30-40 CC. The small bowel is then divided approximately 50-100 cm from where it begins in the abdomen and the downstream segment (the Roux limb) is connected to the gastric pouch using a special stapling device that staples and cuts. The upstream segment (biliopancreatic limb) is then reconnected to the downstream segment at a distance that is selected to correspond to the patient's BMI, again using the special device that staples and cuts. This ranges anywhere from 75 cm to 180 cm. In this way the patient's stomach has been drastically reduced in size and the amount of food that the patient will be able to eat has been greatly restricted. The food that the patient does eat does not begin to be digested until it reaches the reconnection site of the two pieces of small bowel. It is only at this site that food can be combined with pancreatic juice and bile to begin the process of digestion. An important portion of the bowel is bypassed in this way and this element of the operation serves as a malabsorption component and greatly helps in the process of weight loss.
What are some of the possible complications from the gastric bypass?
A patient can develop deep venous thrombosis (a blood clot in the leg) that can be life-threatening. If the blood clot travels to the heart and lungs it can cause death. A leak from the sites where the bowel is reconnected can occur and this can cause severe infection and lead to death. Re-operation may be necessary for a number of reasons. Leaks, narrowing of the connection sites, bleeding, injury to other organs are some of the reasons re-operation may become necessary. The goal of the surgery is to perform a gastric bypass laparoscopically however there is no guarantee that the operation will be completed laparoscopically. If the procedure cannot be completed safely with the laparoscopic method an open technique may become necessary although our intention is to avoid an open technique if possible. There is no guarantee that the patient will lose as much weight as they wish and likewise there is no guarantee that the patient will not lose too much weight. Vitamin and mineral deficiencies are a very real danger and strict attention must be paid by both the patient and the medical doctor that follows the patient in the post-operative period.
What is the post-operative period for the gastric bypass like?
Early on the first post-operative day water is begun and this is advanced to a high-protein food supplement. The diet for the first 2 weeks consists of a high-protein food supplement of the patient’s choice that can be supplemented with broth, crystal lite, Gatorade and a number of different liquids. The goal during the first 2 weeks is an intake of approximately 45 grams of protein. The third week includes soft foods such as mashed potatoes, yogurt, cottage cheese, pureed and baby food. The fourth week marks the return of small volumes of soft regular food unless the Fobi pouch has been performed. (In this case the soft and pureed foods continue until the 6th week). During this time encouragement is rendered to begin the lifestyle change regarding good nutrition and exercise that will be important for the remainder of the patient’s life. The amount of this comfort that each patient experiences after the surgery is quite different depending upon the individual. Some patients feel comfortable returning to a limited work schedule within a number of days however most patients remain out of work for approximately 2 weeks. There are many exceptions both of longer and shorter duration, however a good rule of thumb is to avoid excessive fatigue or exertion until the patient’s energy level has returned to a workable level. Driving can be resumed when the patient feels that they can drive responsibly.