Frequently Asked Questions

Q: At What Point is Gastric Bypass considered successful?

A: Gastric Bypass is a success when half of extra weight is lost and the loss is persistent for up to five years. A patient who is one hundred pounds over their ideal weight ought to lose fifty pounds or more. That weight loss should be maintained for five years. It is interesting to note that Ninety-five percent of Gastric Bypass patients are considered successful after Gastric Bypass surgery. 85% of Gastric Bypass recipients continue to lose twothirds or more of their extra mass.

Q: After the Gastric Bypass, are there any restrictions?

A: After the operation, particularly while taking any pain medication, we advocate that you refrain from driving. Lifting may be limited, based on how well you are recuperating from the Gastric Bypass.

During the first two weeks after the Gastric Bypass most people are not sufficiently comfortable to lift heavy objects.

Q: Is it possible to have a leak that is not identified by the gastrographin x-ray study?

A: Yes, sometimes it is difficult to identify a leak.

Signs and Symptoms of a leak may include rapid heart rate, rapid breathing, left shoulder pain, and anxiety. While these signs and symptoms may seem quite vague, they are not normal and certainly would prompt your doctor to investigate fully.

Q: Why do I need to follow a diet before and after surgery?

A: Prior to surgery it is expected of you to lose between 7-10% of your body weight. The main goal of the bariatric program is to teach you to make a healthy lifestyle change – it could take quite some time to make a successful lifestyle change. By placing you on a healthy diet prior to surgery you are taking the first step in making that change.

By following a healthy diet prior to surgery we assess whether it is possible for you to stick to a diet. If you are successful at losing a small amount of weight preoperatively, the chances are that you are likely to do well post-operatively as well, when you are only able to consume tiny amounts of food at a time. If you do not follow the postoperative diet, complications could set in.

Most obese patients tend to have an enlarged liver. By following a healthy preoperative diet with enough protein, you can shrink the liver and reduce some of the abdominal fat. This will make it much easier for the surgeon to see your internal organs and perform the surgery safely. After surgery the reasons to follow a diet is much more obvious. The most important reason is to ensure that you do not get complications. The diet will also help to prevent you from getting dumping syndrome. Dumping can occur due to food passing too quickly from the small stomach pouch into the jejunum.

By meticulously following the diet will alsohelp prevent dehydration.

Q: How will my diet change in the long term?

A: Three months after surgery you will be on a normal diet. After your stomach have healed, you may eat most foods that won’t cause you discomfort. It is necessary that your food intake consist of six to eight small meals a day in order to
maintain an optimal nutritional status. After three months your stomach pouch can tolerate one, to one-and-a-half cups of food at a sitting (equivalent to a very small plate of food). If you do not follow these guidelines, there is a risk of becoming deficient in certain vitamins and minerals. By three months postoperative most patients can tolerate most types of food in moderation. In some cases it can take a patient a bit longer to tolerate foods like tough meats, alcohol and bread. Dumping symptoms is usually most prominent during the first postoperative year. Although it never completely goes away, it certainly becomes less of a problem over time. When you follow a healthy diet you should not experience dumping symptoms. Annual follow-ups are recommended after the 6 month diet program.

Q: How much weight can I expect to lose?

A: That depends on each individual. The first six months after surgery is known as the rapid weight loss phase. During the first three months after surgery you can expect an average weight loss of ten kilograms per month. Thereafter weight loss generally levels of for the next one to two years.

One tends to lose 80% of ones excess body weight in the first year, and the remaining 20% in the second year after surgery. A regain of up to 10% of your excess body weight is possible after 2-5 years.

Q: Why do I need to take vitamins for the rest of my life?

A: Vitamin and mineral deficiencies can develop following any gastric bypass procedure. This is very unlikely to occur if you take supplemental Iron, Vitamin B12, Calcium and a good multivitamin.

Vitamin D is also important for people who live in areas where winters are long and sunlight scarce. In sunny areas people can go out in the sunlight during the winter time and make their own vitamin D. Your dietitian or surgeon will recommend specific amounts of these supplements. With your annual follow-up you will go for blood tests to determine if your vitamin and mineral levels stays optimal.

Q: What will the pre- and postoperative diet consist of?

A: The preoperative diet consists of two main phases. The first phase is a healthy eating plan to help patients to start losing weight and in most cases reduce insulin levels. The second phase is a preoperative preparation diet to prepare the
stomach for surgery. The preoperative preparation diet consists of four phases and takes the following transition: It begins with clear liquids; followed by full liquids; puréed food; and lastly soft food, before going over to a normal healthy eating plan.

Q: Can I eat whatever I want after the Gastric Bypass?

A: Fats and sweets, when consumed above advised levels, can lead to abdominal cramping, sweating and lack of energy.

Q: What is "dumping syndrome?"

A: Gastric bypass surgery causes food to be moved from the small stomach pouch straight into the small intestine. Sweets and foods high in fat can irritate the small intestine and produces an unpleasant feeling. If you eat while drinking fluids, the same affect is produced. You should wait half an hour between drinking and eating.
 

Q: What other foods have a high glycemic index and might cause the dumping syndrome?

A: Foods such as white rice, white bread, some breakfast cereals including high-sugar cereals and, surprisingly, cereals such as cornflakes may also cause dumping syndrome.

Q: What will exercise be like after Gastric Bypass?

A: It is best to begin walking as soon as you can after the Gastric Bypass operation. You should also get some exercise on a daily basis. Exercise will lead to a healthy body and you will lose more weight. Walking is a good exercise that significantly speeds up weight loss. It is recommended that you take a nice long walk every day after you have fully recovered from your Gastric Bypass.

Q: After Gastric Bypass surgery, when do I follow up with the doctor?

A: During your recovery you will see Prof. van der Walt on a regular basis. There will usually be a follow-up visit after two weeks, and again six weeks your Gastric Bypass operation. Follow-up visits occur every three months to help your weight stabilize and to make sure that you are comfortable with your new lifestyle. After your weight is stable, you'll have regular yearly follow-up visits.

Q: Can I reverse my Gastric Bypass?

A: Gastric Bypass surgery can be reversed, but turnaround operations are usually more problematic than the original Gastric Bypass. The only patients that would be considered for reversal are those who experience noteworthy long term
problems. It is significant to note that any person who has their Gastric Bypass reversed will probably recover any weight loss seen after the first surgery.

Q: Who should not have Gastric Bypass Surgery?

A: Choosing to have a Gastric Bypass surgery is evidently a very serious choice. People who suffer from depression, bipolar disease, or schizophrenia should consult and be under the care of a psychiatrist before Gastric Bypass. Weight loss can exaggerate these conditions. To qualify for a Gastric Bypass, you'll need to be medically categorized as "morbidly obese". Click here to check your body mass index, which will tell you what category you fall into.

Q: What will my hospital stay be like?

A: The hospital stay is usually three days unless a complication from the surgery develops.

Q: When can I resume normal behavior?

Weight Loss Surgery Terms
Absorption: Process by which digested food is absorbed by the lower part of the small intestine into the bloodstream.
Adipose: Fatty; pertaining to fat
Anastomasis: Surgical connection between two structures
Bariatric: Pertaining to weight (from the same root as in barometer — measuring the “weight” of air) Bariatric surgery may be performed by bariatric surgeons. Bariatric physicians are usually internists who specialize in non-surgical weight management.
BMI: Body mass index. One of the anthropometric measures of body mass. A formula for standardizing the extent of overweight.
Clinically severe obesity: The newer term for morbid obesity. Body Mass Index of 40 or more, which is roughly equivalent to 100 pounds or more over ideal body weight; a weight level that is life risking.
Cardiovascular: Pertaining to heart and blood vessels.
Co-Morbid: Associated illnesses (i.e, arthritis, hypertension) and disabling conditions associated with clinically severe obesity or obesityrelated health conditions.
Colon: Large intestine beginning at the end of the small intestine and ending at the rectum.
Contraindications: Any symptom or circumstance indicating the inappropriateness of an otherwise advisable
treatment (i.e., alcoholism, drug dependency, severe depression, sociopathic personality disorder)
Criteria: Defines potential candidate for surgery
Digestion: Process by which food is broken down by stomach and upper small intestine into absorbable forms.
Dilation: Process of enlargement a passage or anastomosis
Disease: Process injurious to health and/or longevity
Duodenum: First 12 inches of small intestine immediately below stomach. Bile and pancreatic fluids flow into duodenum through ducts from liver and pancreas, respectively.
Gastric: Pertaining to stomach.
Dumping syndrome: Whereby stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming so weak and sweaty that the patient may have to lie down until the symptoms pass.
Esophagus: The tube that connects the pharynx (throat) with the stomach. The esophagus lies between the trachea (windpipe) and the spine. It passes down the neck, pierces the diaphragm just to the left of the midline, and joins the cardiac (upper) end of the stomach. In an adult, the esophagus is about 25 centimeters long. When a person swallows, the muscular walls of the esophagus contract to push food down into the stomach. Glands in the lining of the esophagus produce mucus, which keeps the passageway moist and facilitates swallowing. Also known as the gullet or swallowing tube. From the Greek oisophagos, from oisein meaning to bear or carry + phagein, to eat.
Gastric Bypass: Operation designed to make nonfunctional a portion of the stomach.
Gastrointestinal: Pertaining to stomach or intestine.
Gastric banding: In this procedure, a band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach.
Gastrojejunostomy Anastomosis: Upper connection of the gastric bypass operation
Obesity: Pertaining to excessive weight or adipose tissue
Obsruction: Narrowing of an anastomosis or segment of gastrointestinal tract that retards normal passage of food or waste materials
Extensive gastric bypass (biliopancreatic diversion): In this more complicated gastric bypass operation, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, thus completely bypassing both the duodenum and jejunum.
Although this procedure successfully promotes weight loss, it is not widely used because of the high risk for nutritional deficiencies.
Gastroplasty: Operation for morbid obesity that reshapes the stomach.
Hernia: The protrusion of a loop of an organ or tissue through a weakened opening. Ten to 20 percent of patients who have weight-loss surgery develop a hernia.
Hypertension: High blood pressure
Ileum: Ten feet of small intestine responsible for absorption.
Intestinal bypass (no longer done): This procedure has evolved and improved since it was first introduced some twenty years ago. In the early days, intestinal bypass — which is totally different from gastric bypass — had some very serious complications.
Compared to the intestinal bypass, gastric bypass is relatively safe with fewer complications.
Jejunum: Ten feet of small intestine; the part responsible for digestion.
Open: Making an incision to do the operation; opening the abdomen.
NIH: National Institutes of Health
Preop: Before surgery (Pre Operation). The time/events prior to surgery.
Postop: After surgery (Post Operation). The time/events after surgery.
Periop: Surrounding surgery (Peri=“around”, as in periscope [“around-looking”]).
The time/events before, during and after surgery.
Panniculectomy: The removal of the tissue and skin from the abdomen; a tummy tuck. (Never use the term “tummy tuck” when communicating with an insurance company. They like to deny this surgery!)
Pouch: The new small stomach created during most bariatric surgeries.
Malabsorption: Impaired intestinal absorption of nutrients, causing food to be poorly digested and absorbed.
Morbid: Pertaining to disease, illness, increased risk of death.
Morbid Obesity: Severe obesity in which a person's BMI is over 40. This is generally equivalent to having 100 or more pounds to lose.
Mortality: Pertaining to death
Multidisciplinary: Team approach to evaluation and treatment of clinically severe obesity; includes surgical, internal medicine, nutrition, psychiatric, and exercise physiology, assessment, and treatment
Psychotherapy: Evaluation and treatment of mentally related disorders.
Kilogram: Measure of weight equal to 2.2 pounds.
Laparoscopy: Method of visualizing and treating intra-abdominal problems with long fiber-optic instruments.
Psychotherapy: Evaluation and treatment of mentally related disorders.
Pulmonary: Pertains to lungs.
Restriction operation (weight-loss surgery):

Restriction operations are the surgeries most often used for producing weight loss. Food intake is restricted by creating a small pouch at the top of the stomach where the food enters from the esophagus. The pouch initially holds about 1 ounce of food and expands to 2-3 ounces with time. The pouch's lower outlet has a small opening. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness.

Restriction operations for obesity include gastric banding and vertical banded gastroplasty.

Both operations serve only to restrict food intake. They do not interfere with the normal digestive process.

Roux-en-Y gastric bypass (RGB):

This operation is the most common gastric bypass procedure. First, a small stomach pouch is created by stapling or by vertical banding. This causes restriction in food intake.

Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum (the first segment of the small intestine) as well as the first portion of the jejunum (the second segment of the small intestine). This causes reduced calorie and nutrient absorption The procedure is more extensive than the VBG (below). Some people prefer it because of a a sick feeling that results (called “dumping”) when post op patients overeat. This can be a powerful feeback/learning mechanism whereby people lose their interest — at a “gut instinct” level — in eating excessive carbohydrates.

Staples: Surgically sterile devices for connecting tissue; usually permanent and made of stainless steel or titanium.
Strictures: Narrowing of anastomosis or section of intestine; often related to scarring or ulcers.
Therapy: Treatment
Type 2 diabetes: A disorder of glucose and insulin metabolism.
Vertical banded gastroplasty (VBG): This procedure is becoming the most frequently used restrictive operation for weight control. It is less extensive than the RNY (above). Both a band and staples are used to create a small stomach pouch. The procedure works best on individuals who are not binge
eaters.