Gastric Bypass Surgery

Gastric Bypass vs. Gastric Sleeve

These are both types of weight loss surgeries, but they work in different ways. Gastric bypass creates a small pouch at the top of your stomach and reroutes food to a lower part of the small intestine. This limits how much food you can eat and how many calories you can absorb.

With a gastric sleeve, the surgeon permanently takes out most of your stomach. They staple what’s left behind into a banana-like pouch. Since you can’t fit very much food in your stomach, you get full faster. 

Also called sleeve gastrectomy, this surgery doesn’t affect how you digest food. But removing so much of your stomach changes hormones or bacteria in your gut that affect your hunger levels and metabolism. This helps control your weight and blood sugar.

Benefits of Gastric Bypass Surgery

Gastric bypass can help you lose excess weight, reduce your risk of obesity-related health problems, and improve some existing medical conditions. It may also help you live longer.

Benefits of gastric bypass surgery include: 

• Significant long-term weight loss 
• More energy and less joint pain 
• Long-term blood sugar control
• Improved blood vessel and heart health
• Less depression
• Better overall emotional health and quality of life
• Lower risk of obesity-related cancer
• Improved fertility and lower risk of pregnancy complications

Gastric bypass can help prevent or manage health conditions such as: 

• Type 2 diabetes
• Heart disease 
• High blood pressure
• High cholesterol
• Gallbladder disease
• Sleep apnea
• Gastroesophageal reflux disease (GERD)
• Urinary incontinence
• Arthritis or joint pain

Very rarely, you may not lose weight after gastric bypass. But you’re more likely to lose weight and keep it off when you stick to regular exercise and eat a balanced, nutritious diet. Talk with your care team about healthy changes you can work into your daily or weekly routine. 

Risks of Gastric Bypass Surgery

All surgeries come with risks. Some short-term problems that may happen with abdominal procedures like gastric bypass include: 

• Too much bleeding
• Infection
• Bad reaction to anesthesia
• Blood clots in the legs or lungs
• Fluid leakage from your digestive tract

You may also get: 

• Breakdown of the staples or sutures around your pouch or intestine 
• Ulcers in the stomach or small intestine
• Stretching of the stomach pouch or esophagus
• Gallbladder inflammation
• Ongoing vomiting or belly pain

Let you doctor know right away if you have any signs of infection, including: 

• Severe pain at the surgery site
• Redness or stinky fluid oozing from the surgical cut
• A fever higher than 101.5 F

Other signs of an emergency may include: 

• Chest pain or trouble breathing
• Throwing up for more than 12 hours
• Pain, redness, or swelling in your legs
• Not being able to pee for eight hours or more (urinary retention)
• Serious pain despite taking painkillers 

Gastric Bypass Surgery Complications

Gastric bypass surgery is generally considered safe, but you may need to take supplements or medication to lessen the chances of certain surgery-related health problems. Around 10% to 20% of people may need a follow-up operation to fix something that goes wrong after the first procedure. 

Long-term complications of gastric bypass may include:

Malnutrition. You may not get enough vitamins, minerals, or other nutrients from food. This can happen because your stomach doesn’t absorb nutrients the same way as before gastric bypass or because you’re not eating enough food. 

If you don’t take supplements, nutrients you may  lack after gastric bypass include: 

• Vitamin B12
• Vitamin B1
• Vitamin D
• Iron
• Calcium
• Copper 

Your doctor will regularly check to see if you're lacking any vitamins or minerals. You may need these blood tests every six months for the rest of your life. They’ll let you know what kind of supplements you can take to stay healthy.

Gallstones. Obesity increases your chances of gallstones. Losing weight quickly or dropping more than a quarter of your body weight can also raise the risk – both can happen after weight loss surgery. 

Up to 40% of people who have gastric bypass may get gallstones. You can have them and not know it, but symptoms can include: 

• Belly pain
• Yellowing skin (jaundice)
• Inflammation of the pancreas 

Surgery can treat gallstones, but your doctor may give you medication to prevent them. Expect to take your prescription for around six months or so after your surgery. 

Stomal stenosis. The new opening between your stomach and small intestine can become tight and narrow. This happens to around 3% to 12% of people who have gastric bypass surgery. 

Symptoms of stomal stenosis include: 

• Nausea or throwing up
• Trouble swallowing
• Acid reflux
• Not being able to eat or drink anything without feeling sick

Your doctor can easily treat stomal stenosis, so tell them right away if you get any of the above symptoms. They might put a tool down your throat to widen the narrow part (endoscopic dilation) or need to fix it with another kind of surgery. 

Hernia. This is when an internal organ bulges out of a space in your muscle wall. After gastric bypass, you could get a hernia inside your intestines, on your abdominal wall, or where the cut was made for your surgery. 

Symptoms of a gastric bypass fistula can seem like those of other conditions and may include:

• Weight regain
• Anemia
• Nausea or throwing up
• Pain in your upper belly, under your ribs
• Bleeding in your digestive tract

Surgery can widen or repair strictures and fistulas. 

Peritonitis. This is when a leak in your stomach causes inflammation in the lining of your belly (peritoneum). Symptoms of peritonitis include: 

• Fever
• Belly pain that gets worse
• Back pain or pelvic pressure
• Hiccups
• Fast heart rate for no reason
• A feeling that you need to move around

Call your doctor right away if you have the above symptoms. Peritonitis can be serious, and you’ll need fast medical attention. 

Gastric bypass and dumping syndrome

As many as half of people who get gastric bypass or other bariatric surgeries have some level of dumping syndrome. That’s when your stomach empties food into your small intestine too quickly. 

Symptoms of early dumping (about 15-20 minutes after you eat) may include: 

• Nausea
• Throwing up
• Diarrhea 
• Bloating 
• Stomach cramping
• Fast heartbeat and sweating 
• Dizziness or passing out

Who’s a Good Candidate for Gastric Bypass Surgery?

Gastric bypass surgery isn’t right for everyone, but it may be an option for you if you have obesity and haven’t been unable to lose weight through lifestyle changes or other medical treatments. 

In general, doctors recommend gastric bypass surgery for adults who have a BMI of:

• 40 or higher
• 35 or higher and at least one ongoing obesity-related health condition, like type 2 diabetes, heart disease, or high blood pressure 
• 30 to 35 and type 2 diabetes that's not well-controlled with lifestyle changes or other medical treatments

Gastric bypass may be an option for people under 18 who have obesity and related health issues. A recent study of adolescents who had obesity (average age 17) showed a decrease in BMI and elimination of certain preexisting conditions, including high blood pressure, high cholesterol, and type 2 diabetes, 10 years after having the surgery. The health outcomes were much greater than those seen in adults who had gastric bypass. 

The rules for weight loss surgery are similar for teens and adults. More research is needed to confirm if having gastric bypass earlier leads to better health benefits and to compare outcomes of the surgery vs. medication for obesity in teens. 

Your child’s doctor will determine what’s best based on their specific needs. 

How to Prepare for Gastric Bypass Surgery

Your care team will talk to you ahead of time about adopting a new exercise routine and changing your eating habits. You’ll also want to plan for things you may need during recovery, like child care or help at home. 

To prepare for surgery and life after gastric bypass, you may meet with a:

• Surgeon
• Dietitian
• Nurse
• Physical therapist
• Psychologist 
• Other weight management specialists

A month before surgery. You’ll need a pre-surgery checkup. Your doctor will let you know what to expect, but you may need bloodwork, X-rays, or other medical tests to make sure you're physically and mentally prepared for surgery.

A week before surgery. You’ll need to avoid aspirin, ibuprofen, or other medications that may increase bleeding. Tell your doctor if you regularly take prescription medication or supplements, including vitamins. They’ll let you know which ones you’ll need to stop. 

The day before surgery. Your doctor will give you specific instructions, but you probably won’t be able to eat or drink anything after midnight the night before your surgery. You may need to use a special antibacterial soap the night before or morning of the procedure.

What to Expect During Gastric Bypass Surgery

You’ll get general anesthesia, which means you won’t be awake for the procedure. Your doctor may do the surgery one of two ways:

• Laparoscopically. They'll put tools through a few small cuts in your belly. This is the most common way to do gastric bypass. 
• Open. Your doctor operates through one big cut.

During the procedure, the surgeon creates a small pouch in the upper part of your stomach and staples it shut. They then connect this pouch to a section of your small intestine called the Roux limb. This reroutes food so most of it skips your stomach and the first part of your intestine.

How long does gastric bypass take?

Expect to be in surgery for at least a few hours. You’ll spend a little more time in the recovery room while the anesthesia wears off. 

Does gastric bypass hurt?

As with other abdominal surgeries, you may be in some discomfort after you wake up from the procedure. This may include gas pains, particularly in your shoulder and neck. This happens because the surgeon has to fill your belly up with gas during the procedure. 

Your care team will give you pain medication to take in the hospital and at home, including strong painkillers to take for the first few days after your surgery. Let your doctor know if the medication doesn’t help control your pain.

Gastric Bypass Recovery

You’ll stay in the hospital for a day or two after surgery. You should be able to walk around after the first night, but full recovery will likely take several weeks.

During the first three to six weeks after surgery, your doctor may suggest you:

• Take small, frequent sips of water (aim for 1.5 to 2 liters a day). 
• Avoid strenuous activity.
• Don’t lift anything heavier than 15 to 20 pounds.
• Take short walks, gradually walking longer distances.
• Opt for water exercises until you’ve healed.
• Work up to walking 30-45 minutes a day.

Recovering from gastric bypass in the hospital

The first night after surgery, a nurse or other health professional will help you stand. This may hurt a little, but you should feel better each time you do it. 

The day after surgery, you may need to: 

• Get out of bed and walk around a few times a day.
• Do feet and leg exercises every hour.
• Cough and breathe deeply to clear your lungs.

When can I go home after gastric bypass surgery?

Your doctor will let you know when it’s safe to leave the hospital. But if everything goes well, you’ll probably be able to go home a day or two after your surgery. Speak up if you have any concerns about leaving. A nurse can let you know if you have anything to worry about. 

Your doctor will let you know when to come back for your follow-up appointment, which is usually two to three weeks after surgery. 

Gastric bypass side effects

Any kind of surgery is hard on the body, and it’s normal to feel tired for at least a few weeks. 

Other short-term side effects of gastric bypass may include: 

• Feeling sick to your stomach
• Throwing up
• Trouble sleeping
• Surgical pain
• Weakness
• Dizziness
• Not feeling hungry
• Loose stools

During the first three to six months of your recovery, you may lose weight quickly and not get as many nutrients. As a result, you may: 

• Feel cold
• Have body aches
• Lose some hair or notice hair thinning
• Get dry skin
• Go through ups and downs with your mood 

Tell your doctor if you have any post-surgery symptoms that are hard to manage. Your bariatric care team is there to help ease your recovery.

Gastric Bypass Surgery Cost

The average cost of bariatric surgery is around $17,000 to $26,000, but it’s usually covered by health insurance. How much you’ll have to pay depends on if you have health insurance coverage and the type of plan you have. 

Call your insurance provider to find out if they’ll cover gastric bypass and what your out-of-pocket costs might be for in-network and out-of-network doctors and hospitals. 

Life After Gastric Bypass Surgery

Your bariatric care team will help prepare your for what to expect after surgery. Here are some topics you may want to bring up: 

Medications and supplements

You shouldn’t take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen. NSAIDs increase your chances of stomach ulcers. 

After surgery, you may need to take: 

• An acid-reducer to prevent ulcers in your digestive tract (omeprazole)
• Medication to prevent gallstones (ursodiol)

To make sure you get all the nutrients you need, your doctor may suggest you supplement with the following for the rest of your life:

• Daily multivitamin
• Daily calcium supplement
• Vitamin B1
• Vitamin B12
• Vitamin D
• Iron 

Gastric Bypass Diet

You’ll follow a clear liquid diet right after surgery, slowly moving up to thicker liquids once you get home. You may not be able to eat regular foods until about six to eight weeks after surgery. 

The goal of a gastric bypass diet after surgery is to prevent damage or stretching to your stomach as you heal, get you used to eating smaller amounts of food, and to lessen the chances you’ll have surgery-related problems.

Here are some general diet tips to follow after surgery: 

• Work up to drinking eight cups of water a day (2 liters, or 64 ounces). 
• Don’t drink 30 minutes before or after you eat. 
• Eat small portions. Chew slowly and thoroughly. 
• Prioritize protein-rich foods. 
• Avoid alcohol, caffeine, carbonation, and anything spicy.
• Don’t eat or drink anything with sugar, including fruit juice. 
• Avoid high-fat or greasy foods
• Take your doctor-prescribed vitamins and supplements.

Here’s a general breakdown of the different phases of the gastric bypass diet: 

Soft foods may include: 

• Unsweetened applesauce
• Yogurt or cottage cheese 
• Scrambled eggs
• Tofu
• Hummus
• Tuna or chicken salad 
• Lean or ground meats
• Pureed vegetables
• Hot cereals
• Mashed potatoes
• Canned tuna fish or lean fish
• Canned fruits 

Phase 4 and beyond. Around two months after your surgery, you may be able to start eating regular foods. But it’s important to keep in mind that your new diet may include different food choices than before gastric bypass. 

Here are some general recommendations for how to eat after surgery:

• Eat three meals a day with two nutritious snacks (900-1,000 calories a day).
• Aim for 60 to 80 grams of protein a day. 
• Include colorful fruits and vegetables. 
• Don’t graze in between scheduled meals and snacks. 
• Limit bread, rice, and other starchy foods. 

You may not be able to tolerate:

• Dry, tough meats that are hard to chew (like pork or steak)
• Any food or drink with added sugars
• Stringy vegetables like celery or fruit skins
• Greasy or high-fat foods

Takeaways

Gastric bypass is a weight loss surgery for people with obesity. It makes your stomach smaller and reroutes food past part of your intestine. This helps you feel full faster and absorb fewer calories. Because of these changes, you’ll likely need to take vitamins to get all your nutrients. 

The surgery can significantly improve obesity-related health problems, including type 2 diabetes, high blood pressure, and sleep apnea. You’ll need to follow a balanced diet and exercise regularly for long-term success.

Check in with your doctor regularly after gastric bypass. They’ll want to ensure your mental and physical recovery are going well. 

Gastric Bypass Surgery FAQs

Who is a good candidate for gastric bypass surgery?

You might be a good candidate if your BMI is 40 or higher, or if it’s 35 or higher and you have another health condition like type 2 diabetes, heart disease, or high blood pressure. It may also be an option if your BMI is between 30 and 35, you have other obesity-related health problems, and other weight loss methods haven’t worked for you. 

What is the success rate of gastric bypass surgery?

Gastric bypass is one of the most successful ways for people with obesity to achieve long-term weight loss. Most people lose at least 50% of their body weight within the first one to two years. For many, surgery also improves or even reverses obesity-related health conditions, including type 2 diabetes, high blood pressure, and sleep apnea. 

How does your body change after gastric bypass?

You’ll have a smaller stomach, so you won’t be able to eat as much food or digest it in the same way. This typically results in fast weight loss. Most people who get gastric bypass are satisfied with how their body changes over time, but you may lose muscle mass at first due to reduced calorie and nutrient absorption.