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About Advanced Bariatric Care

Description of Roux en Y Gastric Bypass
(“Classic” or Short Limbed)

Gastric bypass is considered a restrictive procedure because it diminishes the amount of food that can be eaten. This weight loss surgery is usually done laparoscopically. Several small incisions are made on the abdomen through which plastic tubes or ports are inserted and through these ports, the surgeon uses a small video camera, called a laparoscope, and other thin instruments to perform the procedure. A small pouch (one to three ounces) is created from the upper part of your stomach. The larger part of your stomach is left in its place, as it will continue to produce digestive juices that will go down into the small intestine, passing the section where the two pieces of intestine are attached (see B in picture) for food digestion. During surgery your surgeon may choose to make an incision down the middle of your abdomen, from your breast bone to your belly button; otherwise, you will only have four to six small laparoscopic puncture sites.

Picture of roux en y

What to Expect

Surgery can last for two to four hours, depending on how difficult it is and whether your surgery is done openly or laparoscopically. When the surgery is done, you will remain in the recovery room for at least one hour. When you return to your room, you will be asked to get up and walk as frequently as possible. To prevent stomach distention, some patients may be given a nasogastric tube, which enters through the nose and goes down into the stomach. The tube will be removed when your surgeon feels it is safe to do so, usually later in the day or the morning after surgery. You will not be allowed to swallow anything orally until after you have had an upper GI series and your surgeon has reviewed it. First you will be given ice chips and water to sip on. If you tolerate them well, you will then be placed on a clear liquid diet. You will also have an IV, which will deliver fluids for hydration, antibiotics, pain medications, and other mediations, and if necessary, a bladder catheter. The bladder catheter will be removed when you are awake and able to use the bathroom or bedside commode. A compression device that massages the legs to increase blood circulation and decrease the possibility of blood clots will be used as well. These will be used until you can walk regularly. You will also be asked to cough frequently, take deep breaths, and breathe into a device called an incentive spirometer, all steps taken to prevent breathing problems and pneumonia.

Day 1 After Surgery

Your nurse will assist you and make sure you get up and walk. You will be transported to the Radiology Department for an upper GI series, to ensure that there are no leaks from your new pouch or the connections. Once the results are reviewed by your surgeon, you may be started on ice chips and possibly clear liquids. If you have a nasogastric tube (NG tube) you will not be given anything to eat or drink. If your catheter was not removed already, it may be removed on this day. You will be encouraged to walk frequently. When you are not walking, the compression devices will be placed on your legs. Use your pillow to help make it easier to cough and deep breath often. It is important that you continue using the incentive spirometer at this time. Let your nurse know if you are having any significant pain or if you just feel that something is not right.

At staff member at the Advanced Bariatric Care Center will visit you at the hospital and provide you with supplemental instructions for home care. Depending on your surgeon’s recommendations, you may remain on a full liquid diet for two to three weeks before being moving on to soft foods. Gradually you will be able to eat solid foods, which will require chewing each bite 15 to 30 times. It is very important to stop eating just before you feel full to prevent stretching your new pouch. Do not drink with meals – you can drink up to 30 minutes before and half an hour to1 hour after meals. You must eat at least 65 grams of protein each day, especially during your recovery. Initially this can be accomplished by drinking protein supplements and taking your vitamins and calcium citrate as instructed.

Until You Go Home

Your surgeon will monitor your progress and make any necessary changes to your care throughout your stay. Most of the discomfort you experience will come from the gas used during your laparoscopic surgery or from the incision created if you had an open procedure done. You may not be hungry but you must sip liquids to prevent dehydration. The more you get up and walk, the faster your recovery will be. A staff member from the Advanced Bariatric Care Center will visit you during your hospital stay and provide you with instructions for when you are discharged.

What to Do With “The Roux en Y” at Home

It is very important that you follow the instructions given to you by your surgeon and the Advanced Bariatric Care staff. This will help you prevent possible damage to your new stomach pouch and succeed in your weight loss.

Eating and Drinking. Your new stomach holds about two ounces and will take some time to heal after the surgery. The suture line usually heals in about six weeks. Filling and stretching your pouch, before you are fully healed, may cause it to rupture. For the next few weeks, it is not important whether you eat meals or not. It is important that you consume the recommended vitamins and protein, and drink fluids. However, when you are able to eat, chew your food very well (about 25 bites). We would like you to limit the amount of simple sugars and starches you consume (like pasta, breads and potatoes) and plan to do this as you begin to eat regular foods. Do not overfill your pouch and pay attention to your body. When you become full and feel uncomfortable in your stomach or esophageal area, stop eating immediately. If you don’t, you will become sick and stretch your pouch.

Do not drink liquids for 30 minutes before or one hour after eating. Be mindful of what you drink – no caffeine, no carbonation, no alcohol, and no concentrated sweet beverages.

Protein and Vitamins - While your body does not demand food for three weeks after surgery, it is very, very important that you take vitamins and ingest adequate protein everyday. Again, this is very, very important for healing and successful weight loss.

During the first couple of weeks of your recovery, we want you to consume at least 75 grams of protein a day. Afterwards you will need about 65-100 grams of protein for maintenance, depending on your pre-surgery weight and goals. Protein supplements are available at the Advanced Bariatric Care Center, both in your ready to drink and powdered forms. A nutritionist is available to help you plan and meet your liquid and protein intake requirements, as well as address your concerns if you are lactose intolerant.

Changing HOW and WHAT you eat may be challenging at first but in time and with practice you will learn what your body needs and how to get your needed nutrients. Vitamins are also important. Your surgeon will recommend special vitamin capsules when your pouch has fully healed. Right after surgery, however, you can take any chewable or liquid multivitamin. Since vitamin D deficiency sometimes occur after weight loss surgery, you should try to spend some extra time outdoors, to make sure you get ample amount of sunshine. Vitamin B-12 deficiency may also occur. Your doctor will check your B-12 levels after surgery and make any necessary recommendations. Thereafter, you should have your B-12 levels checked annually.

Liquids - It is vital that you drink a sufficient amount of liquid every day. Initially, you should have three to four glasses a day and then increase to seven or eight a day. All clear liquids are okay— water, sugar-free Jell-O, tea, broth, or sugar-free powdered drink mixes such as ice tea, lemonade or others. Only specially formulated Stage 1 protein are permitted. In the beginning, drinking may be difficult for you, but developing a habit of sipping a little bit at a time, is quite helpful.

Calcium and iron - You may need to take iron and calcium supplements for the rest of your life. The vitamins we recommend you take once your pouch is healed, may contain your iron requirements. You will also need to take 1200mg of calcium citrate daily. Your calcium needs and intake will be addressed in your four-week follow-up visit. As with B-12 iron, calcium and related tests will be done annually.

Exercise - Exercise is an extremely important part of your weight loss program. We do however, advise that you do not lift anything heavier than 10 pounds the first three weeks after your surgery. You should begin walking one week after your surgery, gradually increasing the time and distance you walk.

Wound care - You will most likely have steri-strips on your abdominal wounds (if done laparoscopically). When showering, direct the shower stream directly on your incisions. When finished, pat (do not rub) the incision area dry. Once in a while, there may be some small openings in the outer layer of your incision. This normally happens when the stitches begin to irritate your skin. Some patients develop an infection or abscess in the area between the skin and the abdominal muscles. A bulging redness accompanied by pain, fever (usually 101° or above), and sometimes drainage, may indicate infection. If you are experiencing any of these symptoms or suspect an infection, you must immediately call your surgeon at 718-240-8446.

The above information, along with other written and verbal suggestions we have made, should answer most of the questions you have about your home care. If other concerns arise, please do not hesitate to call us.

Congratulations as you progress towards a new lifestyle!!

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