Laparoscopic Gastric Bypass

What is a Laparoscopic Gastric Bypass?

A gastric bypass is a life changing operation. It is used to help people to lose weight and improve their health. By losing weight, you will lower your risk of developing medical problems linked with obesity (being very overweight). These include high blood pressure, diabetes, sleep apnoea, arthritis, breathing problems and asthma.

The operation makes your stomach smaller and bypasses part of your small bowel. This reduces the amount you eat and prevents absorption of the food you have eaten. Due to this, you will lose weight.

The operation also changes the hormone signals from the stomach and intestine (small bowel) to parts of your brain that control your appetite and the feeling of fullness. 

As the size of your stomach will be reduced, so will the size of your meals. This, together with a healthy well balanced diet and exercise will help you to maintain your weight loss.

The operation is carried out through a laparoscope (viewing instrument), which is inserted into your abdomen (tummy).  This is also known as keyhole surgery.  This means your recovery will be quicker.

Your operation will be performed under a general anaesthetic (a state of carefully controlled and supervised unconsciousness (deep sleep) that means you are unable to feel any pain).

During surgery, it is sometimes not possible for the surgeon to carry out a Gastric Bypass. They may need to change your operation to a mini gastric bypass or sleeve gastrectomy. This may be due to technical reasons or problems during your operation.

Are there any risks or possible complications?

As with any surgical operation, there are some risks. These can vary depending on your age and other illnesses you may have.

These can include:

• Risks linked with anaesthesia – You will be given a leaflet that will explain in detail about anaesthesia. Your Anaesthetist (a Doctor with special training in anaesthetics) will discuss this with you. You may need to be admitted to the Critical Care Unit.

• Accidental injury during the operation to internal organs such as the bladder, bowel, liver, pancreas, spleen, uterus, ureter (the tube leading from your kidney to your bladder) or blood vessels.

This is because cutting instruments need to be used during the operation. Sometimes these may not be obvious during the operation but may be suspected later. If this happens, you will need another operation and a longer stay in hospital. 

• Anastomotic leaks from staple lines – A special mesh (staple line) is used to seal the stomach. This will be checked for leaks using a blue dye, you may have blue staining around your mouth or in your hair afterwards and when you first pass urine it may be blue or green. 

Sometimes staple lines can leak after your operation. You will be closely monitored after your operation. If this happens, you will need another operation.

• Inability to complete the operation using the laparoscope – Your Doctor may need to convert to a laparotomy (open surgery). The reasons this may be needed include, the presence of adhesions (scar tissue) from previous surgery, bleeding and accidental injury to internal organs.

If this happens, you will need a longer stay in hospital and may need to stay off work for up to 4 to 6 weeks.

• Wound infection – This can happen to patients having this operation. If you feel feverish and your wound becomes hot, red and sticky, you should see your GP. This can be treated with antibiotics and you will not usually need to be re-admitted to hospital.

• Bleeding – You may develop bleeding inside your abdomen or from your wounds after your operation. If this happens, it will be treated. You may need a blood transfusion or another operation.

• Pain – This could be shoulder tip or abdominal pain due to irritation from the air used in your abdomen so your surgeon can see your organs.

• Bruising – A little bruising may develop around your wound sites. This is normal and will settle over time.

• Scarring – You will have 5 to 6 small scars following surgery from the incision sites.

• Deep vein thrombosis – DVT (blood clots in the leg veins) or pulmonary embolism – PE (blood clots in the lungs).

• Return to theatre – If you do not recover as we would expect, there is a chance that you may need to go back to theatre for a further operation.

All adult patients will have their risk of developing a blood clot assessed within 12 hours of admission. Patients who are being admitted for planned surgery may have their risk assessed at pre-assessment.

The Nurse or Doctor who carries out your assessment will discuss your risk factors with you and advise on treatment to reduce your risk.

• Death – 1 patient in every 1,000 who has weight loss surgery can die as a result of complications.¹

Some complications can develop a long time after your gastric bypass surgery.

These can include:

• Internal hernia – As you lose body fat, defects (a weakness) can be created inside your abdomen (tummy), which could cause an internal hernia.

• Port site hernia (hernia at the site of surgery) – Some patients can develop a hernia where the laparoscope was used.

• Anastomotic stricture (narrowing) at the joins in your new stomach and bowel – This can make eating and drinking more difficult.

If you develop these symptoms, you may need to have further tests. In some cases, you may need an endoscopy to stretch the narrow areas. If this is needed, you will be given a leaflet explaining an endoscopy in more detail.

• Hair loss or thinning in the first 6 months – This is a temporary side effect of the rapid weight loss you will have.  Your hair will re-grow.

• Gallstones – You may develop gallstones as a result of the rapid weight loss.

• Anastomotic ulcers – These can develop at joins within the stomach. The risk of these developing increases for patients who smoke after surgery.

• Irritable bowel syndrome (IBS) – If you have been diagnosed with IBS your symptoms may get worse.

• Dumping syndrome – If you eat very sugary or starchy foods, you may have symptoms of abdominal cramps, sweating, lethargy and diarrhoea. There is no treatment and the symptoms can last for 40 to 60 minutes.

• Excess skin – Following surgery, as you lose weight, you may develop loose skin. To remove this, you would need plastic surgery, which is not part of the bariatric pathway.

• Nutritional deficiency – This can develop due to reduced absorption of food. You will need to take multi-vitamin supplements for the rest of your life and this may still happen despite taking supplements, although this is rare.

• Pancreatic insufficiency – Following surgery, this can develop because the pancreas sometimes cannot produce enough enzymes to digest the food you eat properly.

This means your body can’t absorb enough nutrients, proteins and vitamins from your food. If this happens, you would need to take supplements to replace the enzymes your pancreas can’t produce.

• Rapid weight loss or weight gain – If you do not follow the dietary and exercise advice given, you may lose too much weight or you may put weight back on.

What will happen at the pre-assessment clinic?

You will meet the Nurse practitioner who will explain your operation and answer any questions you may have. The Nurse will complete your admission forms and start to discuss and plan your discharge from hospital after your operation.

Some routine health checks will be taken at the clinic. These will include blood and urine tests, ECG – electrocardiogram (heart tracing), and X-rays if needed.

This reduces the length of time you will need to stay in hospital as an inpatient. You will be given a leaflet that describes your pre-assessment clinic appointment in detail.

You can expect your appointment to last between 1 to 3 hours, depending on what tests and checks need to be done.

What do I need to bring with me?

The National Institute for Health and Care Excellence (NICE) recommends that you keep warm, before, during and after your operation because it can reduce side effects, complications and help you recover from your operation faster.²

Please make sure you bring socks and slippers, a dressing gown, a vest or other warm clothing to help you feel warm while you are in hospital. Please arrange for someone to collect your clothing and any items you will not need while you are in hospital, as storage space on the wards is limited.

Please bring in any new medicines your Doctor may have started after your pre-assessment visit. If doses of any other medicines change after your pre-assessment visit, you must tell your Nurse or Doctor when you are admitted.

Please make sure you bring your Continuous Positive Airway Pressure (CPAP) machine into hospital with you if you suffer from obstructive sleep apnoea (a condition where the walls of the throat relax and narrow during sleep). This means you stop breathing for short periods of time and use a CPAP machine.

What will happen while I am in hospital?

On admission to the ward, you will be introduced to your ‘named Nurse’ who is responsible for planning your nursing care with you.  Your named Nurse is part of a team of Nurses who are there to help and advise you on a day-to-day basis and to make your stay as comfortable as possible.

You will be weighed on admission. If you have not lost enough weight on the liver shrinkage diet, it will be discussed with you whether it is safe to proceed with your operation.

What will happen before my operation?

When you arrive, one of the Nurses who will care for you will welcome you to the Access Lounge. They will re-check your details taken at the pre-assessment clinic to make sure nothing has changed.

You will be seen by one of your Doctors, who will tell you the time of your operation and answer any questions you may have.

Before your operation, one of your Doctors will again explain the reasons for your operation, the operation itself and the precautions we take to avoid any risks or complications.

When you fully understand the operation, you will be asked to sign a consent form, if you have not already done so.

You will be asked to remove any jewellery you are wearing (except your wedding ring), contact lenses, make-up and nail varnish. You will also be asked not to use any body lotions, deodorants and perfumes. You will be asked to put on a theatre gown.

False teeth, glasses and hearing aids may be removed in the operating theatre.

You may be given a ‘pre-med’ (some tablets to help you relax).

Just before the time of your operation, one of your Nurses from the ward will go with you and transfer your care to a theatre nurse.

If you have any worries or concerns, tell the staff, they are there to help and support you.

Your theatre Nurse will check your details again before taking you into the anaesthetic room. In the anaesthetic room, you will meet your Anaesthetist again. He or she will give you your anaesthetic before you are taken into the operating theatre. They will stay with you throughout your operation.

Your Nurse will take your temperature before you are taken to the operating theatre. If it is below 36^oC (96.8^oF), the operation will not start until you are warm. A warm air blanket or jacket may be used to raise your temperature.

When in the operating theatre and the recovery room, your Nurse will take your temperature regularly. If it falls below 36^oC (96.8^oF), you will be placed under a warm air blanket or jacket.

Please tell your Nurse or Doctor if you feel cold during your stay in hospital.

Before and during your operation:

• a cannula (fine needle) will be placed in the back of your hand or arm so we can inject drugs. Sometimes, when drugs are injected they may feel cold and sting a little.

• an intravenous drip may be attached to your cannula, but this usually takes place when you are asleep.

• you may be asked to breathe some oxygen through a face mask before you are given the anaesthetic.

• your blood pressure will be measured.

• your pulse will be taken, and the amount of oxygen in your blood will be measured by attaching a special clip on to your finger. This does not hurt.

• your heart rate will be monitored by placing sticky pads on your chest. These are attached to some leads to show a tracing of your heart on a monitor. This is routine and is nothing to worry about.

Why am I asked not to eat or drink before my operation?

Your Nurse will tell you when you must stop eating or drinking before your operation. This is very important. You must follow the instructions. Nothing means nothing at all, (including water and chewing gum).

If you forget these instructions and you do eat or drink something, you must tell your Doctor or Nurse, as your operation may need to be postponed for your safety. This is because when you are unconscious, if your stomach contains food or drink, you may be sick and it could get into your lungs, affect your breathing and cause an infection.

What will happen during my operation?

You will have 5 to 6 small incisions (cuts) on your abdomen (tummy).

Your abdomen will be filled with air so that the laparoscope can be inserted safely and your organs can be seen clearly. The laparoscope allows the Surgeon to see the inside of your abdomen. 

It is also possible to pass instruments through the small cuts in your abdomen to carry out the surgical operation. When the Surgeon is finished, the air is released.

The small wounds are closed either by using dissolvable sutures (stitches) or by sutures that need to be removed by a practice Nurse at your GP’s surgery. Your ward Nurse will tell you which type you have.

The operation can take 2 to 3 hours. This will depend on what needs to be done. Your Doctor will discuss this with you before your operation.

What will happen after my operation?

After your operation, you will be taken to the recovery room, where specially trained staff will look after you until you are ready to go to your ward. Most people do not remember waking up in the recovery room or going to a ward. The Nurses in the Operating Department will transfer your care to your ward or unit Nurse.

You will be made comfortable in bed. Apart from Nurses checking your pulse, blood pressure, pain level and wound regularly, you will be allowed to rest. You will have surgical stockings as well as pumping devices on your legs to help prevent blood clots.

The Doctor will tell you when you are able to drink water, which is normally after your operation. You will not be able to eat until the Doctor is satisfied it is safe for you to do so. This is normally the next day.

If at any time you are in pain or feel sick, please let one of your Nurses know and they will give you medication to relieve it.

A little bruising may develop around your wound sites, but this will clear.

You may have:

• Some discomfort in your upper abdomen and shoulders. This is due to the air that was pumped into your abdomen. You should get better in 2 to 3 days.

• Colic type abdominal pain for a few days after your laparoscopy. It is important to keep moving to get rid of the air.

• Discomfort around your wound sites. Taking painkillers at regular intervals works best, rather than waiting until you are in pain. It will also reduce the need to take stronger painkillers. Always follow the instructions provided in the leaflet supplied with your tablets.

• Some nausea (feeling sick) or vomiting (being sick) due to the effects of the anaesthetic. These will usually settle within 24 to 48 hours. It is important to drink plenty of fluids, but not alcohol to avoid dehydration.

It is normal to feel tired for up to 48 hours after your operation. 

You will be encouraged to get out of bed as soon as possible after your surgery. This helps to reduce the chance of post-operative complications such as blood clots in the legs or chest infections.

The day after your operation, the amount and types of fluids you can drink will be increased. The intravenous drip and small needle will be removed when you are drinking enough to be hydrated.

On the day after your surgery, you may be allowed to eat pureed food. If you do not have any problems with eating you will be able to go home.

After your surgery, you will need to follow the advice given by your Bariatric Dietitian.

When can I bath or shower again?

During the first week after your surgery, you are advised not to soak in the bath. This is to help avoid a wound infection. You can have a shower as soon as you are able.

When can I have sex again?

You may have sex again when you feel comfortable, unless you have been advised not to by your Doctor.

Women should not become pregnant for 2 years after surgery.

When can I drive?

You may drive as soon as you feel comfortable wearing a seatbelt and are able to carry out an emergency stop. You should check with your insurance company for their advice on driving after keyhole surgery.

When can I return to work?

You may return to work when you feel comfortable. This will depend on the type of work you do. Your Doctor or nurse will advise you.

Will I need a follow-up appointment?

You will receive a telephone call in the week after your discharge.  About 6 to 8 weeks after your operation, you will have an outpatient appointment to check on your progress. You will also have regular appointments with the Bariatric Team for up to 2 years after your operation.

Depending on your circumstances, you may need further follow-up from psychology or the dieticians.

When will I be able to exercise?

You must not do any abdominal exercises or heavy lifting for 6 weeks after your operation. Walking is encouraged and distances should be gradually increased. After 6 weeks, you should increase your exercise, as this will help your weight loss.

What medications will I have after my operation?

When in hospital, you will be started on multi-vitamins and calcium supplements, which you will need to take for the rest of your life.

You will need to have a vitamin B12 injection at your GP’s surgery 3 months after your gastric bypass. You will need to continue these injections every 3 months for the rest of your life.

Contact numbers

If you need further advice or have any problems, please contact the appropriate number below:

North Tees and Hartlepool NHS Foundation Trust

Bariatric Nurse Specialist

Telephone: 01642 624601

Opening hours: 9:00am to 5:00pm

Ward 31

24 hours a day, 7 days a week.

Telephone: 01642 624592

Consultant’s secretary

Telephone: 01642 383292 or 01642 383290

Monday to Friday, 9.00am to 5.00pm

Further information is available from:

National Obesity Forum

First Floor, 6A Gordan Road

Nottingham

NG2 5LN

Telephone: 0115 846 2109

WLSinfo (Weight Loss Surgery Information and Support)

Unit 2 Brook Mill, High Street

Leigh, Lancashire

WN7 2AD

Telephone: 0151 222 4737

References

1. The National Bariatric Surgery Registry (data updated April 2020). Publication of Surgeon-Level Data in the Public Domain for Bariatric Surgery in NHS England. Available at:

• National Institute for Health and Care Excellence (NICE), 2008, updated 2016, ‘Hypothermia: prevention and management in adults having surgery’. Clinical guideline 65.

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