An anastomosis is a surgical connection between the stomach and bowel, or between two parts of the bowel. The surgeon attempts to create a watertight connection by connecting the two organs with either staples or sutures, either of which actually makes a hole in the bowel wall. The surgeon will rely on the healing power of the body, and its ability
to create a seal like a self-sealing tire, to succeed with the surgery. If that seal fails to form, for any reason, fluid from within the gastrointestinal tract can leak into the sterile abdominal cavity and give rise to infection and abscess formation. Leakage of an anastomosis can occur in about 2% of gastric bypass procedures, usually at the stomach-bowel
connection. Sometimes leakage can be treated with antibiotics, and sometimes it will require immediate re-operation. It is usually safer to reoperate if an infection cannot be definitely controlled immediately.
As the anastomosis heals, it forms scar tissue, which naturally tends to shrink ("contract") over time, making the opening smaller. This is called a "stricture". Usually, the passage of food through an anastomosis will keep it stretched open, but if the inflammation and healing process outpaces the stretching process, scarring may make the opening so small that even liquids can no longer pass through it. The solution is a procedure called gastroendoscopy, and stretching of the connection by inflating a balloon inside it. Sometimes this manipulation may have to be performed more than once to achieve lasting correction.
Before surgery you will undergo an ultrasound of your gallbladder. If you have existing gallstones then your gallbladder will be removed at the time of surgery. The reason this is done is that the rapid weight loss you will experience following gastric bypass can increase the risk of developing symptomatic gallstones. If you already have gallstones the risk is high enough that preventive removal of your gallbladder is warranted.
Dumping syndrome happens in response to the presence of a high carbohydrate load entering into the intestine. After gastric bypass surgery, if you eat sweets it may sometimes be “dumped” into the intestine instead of being released gradually, in small amounts.
Symptoms: Abdominal fullness, nausea, crampy abdominal pain followed by diarrhea within 15 minutes after eating. As a result, you may feel warm, dizzy, weak, faint, have an increased pulse rate, and break into a cold sweat.
Look for foods labeled sugar-free or no addedsugar. Foods labeled dietetic, may not be sugar free.
Hyperparathyroidism, due to inadequate absorption of calcium, may occur in over 30% of GBP patients. Calcium is primarily absorbed in the duodenum, which is bypassed by the surgery. Mostpatients can achieve adequate calcium absorption by supplementation with Vitamin D and Calcium Citrate (carbonate may not be absorbed - it requires an acidic stomach, which is bypassed).
Iron frequently is seriously deficient, particularly in menstruating females, and must be supplemented.
Again, it is normally absorbed in the duodenum.
Ferrous sulfate can cause considerable GI distress in normal doses; alternatives include Ferrous fumarate, or a chelated form of iron. Occasionally, a female patient develops severe anemia, even with supplements, and must be treated with parenteral iron.
Vitamin B-12 requires intrinsic factor from the gastric mucosa to be absorbed. In patients with a small gastric pouch, it may not be absorbed, even if supplemented orally, and deficiencies can result in pernicious anemia and neuropathies. Sublingual B-12 appears to be adequately absorbed.
Thiamine deficiency (also known as beriberi) will, rarely, occur as the result of its absorption site in the jejunum being bypassed. This deficiency can also result from inadequate nutritional supplements being taken post operatively.
Protein malnutrition is a real risk. Some patients suffer troublesome vomiting after surgery, until their GI tract adjusts to the changes, and cannot eat adequate amounts even with 6 meals a day. Many patients require protein supplementation during the early phases of rapid weight loss, to prevent excessive loss of muscle mass.