Gastric By-Pass (R-YGB)

Laparoscopic Gastric By-Pass (R-YGB) surgery is the most common type of combined surgery. Gastric Bypass is one of the methods that draw attention with its successful results in obesity surgery. While the stomach volume is reduced with this surgery, absorption of nutrients decreases as the pathway in the small intestine becomes shorter.

The part at the beginning of the stomach is separated from the rest, leaving about 30-50 cc. Some of the small intestines are also bypassed and connected to the newly formed small stomach. In this way, patients reach the feeling of saturation quickly with much smaller portions. At the same time, the absorption of a significant part of the high-calorie foods taken is prevented. 
 
Effective and permanent weight loss is achieved with laparoscopic Gastric By-Pass (R-YGB) surgery. Patients reach a feeling of full satiety with much smaller portions due to the reduced new stomach pouches, similar to only volume-constraining surgeries. 

Gastric By-Pass surgery can be recycled when necessary.

In Which Diseases Is Gastric By-Pass (R-YGB) Surgery Performed?

Gastric By-Pass (R-YGB) is primarily a morbid obesity surgery. Gastric By-Pass (R-YGB) therapy can be applied in the presence of many diseases accompanying obesity. Foremost among these is Type 2 diabetes. In surgical treatment of type 2 diabetes patients who cannot be controlled, positive results can be obtained with gastric bypass surgery. 

How is Gastric By-Pass (R-YGB) Surgery Performed?

Before Gastric By-Pass Surgery
Patients who are planned to have an operation undergo a detailed evaluation. In addition to physical examinations, each patient is definitely evaluated in detail before the surgery by endocrinology and psychiatrists. 

How is the surgery performed?

• Gastric By-Pass is performed by laparoscopic method. Robotic surgery has also been preferred in recent years. 
• Surgery is performed through 4-6 holes in 1 cm diameter. 
• In gastric bypass surgery, the stomach is reduced just like in tube stomach surgery. Approximately 95% of the stomach is bypassed. 
• Part of the stomach, which is divided into two by surgical methods, is inserted into the middle of the intestine by bypassing the duodena.  The other part continues its duty by not being removed from the body. Thus, the food consumed is prevented from passing through the duodena.  
• The operation aims saturation of the patients with less food and to absorb some of the food they receive.

After the operation

Patients should be followed up in the hospital for 4-6 days. While being discharged, nutrition until the first control is planned by the dietician. During the first year, close monitoring is performed by the endocrinology, psychiatry and dietitian, except for the obesity surgeon. 

FREQUENTLY ASKED QUESTIONS ABOUT GASTRIC BY-PASS OPERATION

What are Gastric Bypass Types?

Roux en Y Gastric Bypass: From the point where the stomach meets the esophagus in the operation, a stomach volume of approximately 25-30 cc is divided into two with a special stapler between the two stomachs. This leaves a small stomach pouch and the other part of the stomach. At the same time, the connection is established by forming a stoma between the small intestine and the small stomach pouch. The new connection between this pouch and the small intestine is called Roux en Y arm. Thus, the food from the esophagus bypasses most of the stomach and the first part of the small intestine.Mini-Gastric Bypass: In this procedure, the stomach is formed as a tube using special stapler tools.

 This newly created stomach pouch is larger than Roux en Y type. The small intestine segment is then connected to this newly formed stomach pouch at a distance of about 200 cm. The most important difference from Roux en Y type is that it is technically easier and only one connection is found. Weight loss mechanism is the same in both gastric bypass types.
What are the Risks of Gastric Bypass Surgery?

 

• In this procedure, bleeding, infection, postoperative ileus (intestinal obstruction), hernia (hernia) and general anesthesia complications can be seen like in many other abdominal surgeries.
• The most serious risk is leakage that may occur in the connection between the stomach and small intestine and a second operation that may be needed as a result.
  A number of additional surgical risks increase due to obesity. Blood clot formation (embolism) and cardiac problems may occur in the feet and lungs.
• 10-15% of patients who have undergone this surgery experience some of the above complications. In general, more serious complications are rare, and those that are common are acceptable and treatable.

For Which Patients Is Gastric By-Pass Surgery Suitable?
Obesity surgeries are evaluated based on body mass index. Patients with a body mass index of 40 and above, or patients with a body mass index of 35-40 with medical problems associated with obesity, such as type 2 diabetes, hypertension, sleep apnea, are suitable for this surgery. 

How Long Will The Hospital Stay After Gastric By-Pass Surgery?
Usually 3-4 days of stay in the hospital. Problems that may occur during the preoperative evaluation and postoperative recovery period may extend this period.

Can the patient heavy-lift after gastric bypass surgery? 
After leaving the hospital, heavy activities should be restricted. The patient should not lift heavy loads for 6 weeks. 

When a Patient Can Drive After Gastric By-Pass Surgery?
The patient should not drive for 2 weeks after surgery. The patient can walk, climb stairs and take a shower.

When to go back to work after gastric bypass surgery?
Patients with calm business life can return to work after 2-3 weeks. Patients with intense physical activity should wait 6-8 weeks after surgery. 

When does weight loss start in gastric bypass surgery?
Weight loss occurs gradually being fastest in the first months. 1.5-2 years may be required for maximum weight loss. 70-80% of the excess weight is lost within this period.
What Should Be Considered in Nutrition After Gastric Bypass Surgery?

• It should be ensured that at least 3 meals a day are eaten and well fed. 
• Meals should include primarily protein, fruit and vegetables, and lastly whole wheat grain groups. 
• Especially in the first 2 weeks, liquid should be consumed and between the third, fourth and fifth weeks mashed foods should be consumed.
• To prevent dehydration, at least 1.5-2 liters of fluid should be consumed. (With a minimum of 6-8 glasses of water per day) Otherwise, the patient may encounter with situations such as headache, dizziness, nausea, weakness, white sores on the tongue and dark urination, etc. 
• Soft and clear foods should be consumed. For example, diet / diabetic puddings prepared with low-fat milk, mashed potatoes, cereals soaked with milk, cottage cheese, soft omelets and crushed fish may be preferred. 
• Simple sugars (powder / sugar cubes, candies, sweets, etc.) should be avoided.
• It is important to chew the food thoroughly and swallow it when the food becomes puree. If the food is not chewed enough, it may block the stomach outlet causing pain, discomfort, and vomiting. 
• It should be ensured that enough protein is taken. 3 cups of skim milk or soy milk can provide enough protein and calcium to stay healthy.
• Solid foods and liquid foods should not be taken at the same time. Drinking fluid with meals fills the remaining small stomach and causes vomiting early. It can stretch the stomach, causing a feeling of early saturation, or by washing the stomach early, it does not make you feel full and may cause more eating. 
• Fluid should not be taken for 30 minutes before or after meals. 
• Food should be eaten slowly. 2 plates of food should be eaten in 20 minutes. Many keep the average time at 45 minutes. 
• Eating and drinking should be stopped when a feeling of satiety or pressure is felt in the middle of the abdomen.
• It will be beneficial to keep the consumed foods on a daily basis and write your results.

If there are regular vomiting complaints, professional support should be obtained.

Which Foods to Avoid After Gastric Bypass Surgery?
Foods (not to be eaten)    Alternatives
Fresh bread    Toast or Crackers
Rice pilaf    Rice soup
Pure meats    Slow cooked in crushed small pieces
Fiber fruits: celery; sweet corn, raw fruits,     Peeled, slow and long cooked, broccoli, peeled tomato, cauliflower
Fruits such as oranges, grapefruit    The peels are peeled; fruit juice diluted 

What to Eat in the Weeks After Gastric Bypass Surgery?

 

Foods (not to be eaten)	Alternatives
Fresh bread	Toast or Crackers
Rice pilaf	Rice soup
Pure meats	Slow cooked in crushed small pieces
Fiber fruits: celery; sweet corn, raw fruits,	Peeled, slow and long cooked, broccoli, peeled tomato, cauliflower
Fruits such as oranges, grapefruit	The peels are peeled; fruit juice diluted

1st Week After Gastric Bypass Surgery 

• Meat broth, chicken broth
• Apple juice (consume by diluting)
• Vegetable juice (consume by diluting)
• Sugar-free compote
• Skimmed milk
• Diluted salted yogurt drink made from nonfat yogurt
• Half-fat diluted salted yogurt drink
• Qnt or whey protein powder 1-3 scales / day
• Sugar-free herbal tea

2nd week after Gastric Bypass Surgery: In addition to the first week; blended soups without grains.

• Unseasoned soup 
• Fish soup
• Noodle soup to chicken broth (without grain)
• Tomato soup (without tomato paste)
• Yogurt soup
• Lentil soup

3rd Week After Gastric Bypass Surgery: After 2 weeks, the foods can be consumed gradually in soft crushed form. Food should be cut into pieces with a fork and crushed. Food selection should be as much protein-calcium as possible. 
In the Soft Juicy / Puree diet, there is a wide choice compared to liquids. However, the priority should be foods rich in protein and calcium. 

• Soft-boiled egg 
• Soft-boiled egg + lean curd 
• Non-fat yogurt
• Fruit puree (can be mixed with milk or yogurt)
• Vegetable puree 
• Spinach puree
• Purslane puree
• Squash puree
• Leek puree
• Vegetable soup
• Tuna puree
• Chicken puree (drumstick)
• Mashed potatoes with cheese (curd may be preferred)
• Baby food (a particularly good alternative for working patients)
• Diabetic custard

While making your fruit purees, every fruit can be pureed. If it is thought that not enough protein is taken, protein powder (without flavor, without sugar) can be used in consultation with the doctor. Instead of puree, thick fruit yogurt can be prepared.  

4th week and 5th week after Gastric Bypass Surgery: In addition to other weeks, you can add consistencies that can be crushed with a fork.

• Vegetable puree with mushrooms
• Soup with meat
• Yogurt soup
• Seasoned meatballs in a pot meal
• Cheese omelet

6 Week After Gastric Bypass Surgery: After the 6th week, it is possible to pass from protein-rich calorie to low-diet products step by step.
It should be ensured that a sufficient amount of protein is taken every day. 

In the long term, any kind of solid food can be consumed, but it is healthier to make this transition gradually during the transition period. 
Cooking dishes in meat / chicken broth is more beneficial for protein intake. 

Is Constipation Experienced After Gastric Bypass Surgery?
Changes in bowel habits may occur because the patients eat smaller rates compared to the foods consumed before surgery. 

Initially, the need to use the toilet can be every 2-3 days. 

• High fiber foods: Whole wheat breakfast cereals; foods made from shelled wheat products
• Baked dried beans
• Crackers prepared from whole wheat
• Constipation is prevented by consuming fruits and vegetables. 

Also, it should be ensured that at least 8-10 cups of liquid are taken between meals.

What is Dumping Syndrome After Gastric Bypass Surgery?

Excessive consumption of simple carbohydrate foods after surgery can cause dumping syndrome.  These are complaints that occur when the stomach is emptied very quickly. In addition to preventing dumping syndrome by limiting the possible foods in the nutrition program, adequate and balanced nutrition can be provided in the slimming program. 

Diabetic desserts should be preferred for dessert. 
Sugary foods that need special attention:

• Ice cream 
• Chocolate with milk
• Fruit yogurts
• Fruit syrups
• Instant juices
• Sugar-added muesli
• Sweet buns
• Cakes
• Frosted candies
• Jellybeans 
• Cookies, cakes
• Lemonade
• Teas with sugar 
• Instant coffees 
• Sugar cubes
• Honey, marmalade
• Sugary Gums

Prepared by Memorial Medical Editorial Board.