having a gastric bypass - · pdf filehaving a gastric bypass hope building upper g.i. /...

Having a Gastric Bypass

Hope BuildingUpper G.I. / Bariatrics0161 206 5062

© G14040702W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2014. Document for issue as handout. Unique Identifier: SURG23(14). Review date: August 2016


21

This booklet aims to describe: l What is a gastric bypass page 2

l How is the operation performed page 3

l How the surgery works. page 4

l The risks and benefits associated with the operation page 5

l Mini-bypass page 7

l What are the results of the operation page 8

l Will I need medication when I go home page 9

l Recovering from the operation page 10

l Additional information page 11

l Becoming pregnant after surgery page 11

l Further information and useful websites page 12

Alongside this information booklet you will also need to read “Having bariatric surgery”

What is a Gastric Bypass?It is a type of weight-loss surgery that is mainly restrictive, reducing the size of your stomach by stapling across the top in order to create a small pouch.

A section of your intestine is then cut and reconnected to the pouch so that the food you eat bypasses part of your digestive system. None of your stomach is removed in the procedure.


43

l The operation is performed using keyhole surgery (laparoscopic)

l You are put to sleep using a general anaesthetic

l The surgeon then makes five small cuts into your abdomen (1-2cm)

l Gas is then injected into the abdomen to “blow out” the abdominal wall. This enables the surgeon to see the internal organs more clearly

l A small tube-like camera is inserted through one of the cuts to view the area of the operation, this is then shown on a large screen. Other instruments to do the operation are then passed through the other cuts in your abdomen

How the operation is performed

l The top part of your stomach is stapled to create a small pouch

l Your intestine is then connected to the pouch, the greater part of your stomach and some small intestine is then bypassed to complete the procedure

l The instruments are removed and the gas is released from your abdomen

l The cuts are then closed with either staples or stiches

The operation usually takes between 2-3 hours however you will be away from the ward longer as you will also spend some time in recovery

How the surgery works

Restriction: By reducing the size of the stomach, only small amounts of food can be eaten at any one time, but your appetite is still satisfied.

Malabsorption & Hormones: By-passing part of the small intestine certain hormones are produced differently which make you feel less hungry and full quickly. These hormones also have a positive effect on your blood sugar control. The effect of bypassing the upper portion of the intestine also decreases nutrients that are absorbed into the body, this is why you will need to have regular supplements following your surgery.

Dumping syndrome: This occurs when the contents of the gastric pouch empty too quickly into the small intestine. It usually occurs after the consumption of large quantities of refined sugar. The partially digested food then draws in increased amounts of fluid into the small intestine which can cause nausea, cramping, diarrhoea, sweating, feeling of light headedness and palpations. These symptoms pass over time and usually lead to loss of cravings to sweets, chocolate etc.

It is important to remember that this surgery is a tool to aid weight loss after surgery and to maintain it in the long term you must continue to work on your diet and life style.


5 6

l Clots in the legs and/or lungs; to minimise the risk, you will be given elastic stockings to wear before the surgery and will be advised to keep them on for 2-3 weeks afterwards. You will also receive a small injection under your skin to thin your blood before surgery and will be sent home on a course of injections for a minimum of 5 days (a nurse will show you how to administer this injection yourself)

l There is a 0.5% risk of a leak from the newly-formed staple line along the stomach. This is tested routinely near the end of the operation by using a special blue dye to make sure that it is water-tight

l There is a 16% chance that patients can develop an ulcer along the joins fashioned during gastric bypass for up to 2 years

The risks and benefits associated with the operation

Risks:There are risks associated with any type of surgery. Some of the complications that may occur with this operation include:

l Complications associated with the general anaesthetic

l Chest infection: people who smoke must stop for a minimum of two weeks before surgery; otherwise your operation will be cancelled on the day

l Wound infection; this is rare after laparoscopic surgery. Prophylactic antibiotics are given during the surgery

Benefitsl On average people tend

to achieve approximately 65-70% excess weight loss (EWL) within the first year of surgery. EWL is defined as any extra weight above the upper limit of the normal body mass index (BMI) of 24.9 kg/m2

l Ability to exercise more comfortably, compared with open surgery

lA reduction in complications associated with obesity which can include but not limited to high blood pressure, diabetes, heart disease, respiratory disease, increased risk of cancer, infertility, improved self-esteem

l A small proportion of patients may develop a stenosis around the join between the stomach and intestine, which later may require dilatation with a balloon using a camera (a gastroscope)

l A small proportion of patients (probably 1%) may develop an internal small bowel hernia years following gastric bypass. If this happens, it can often be managed by laparoscopy and correction of the internal hernia. Rarely, if someone presents late, an open surgery will be required

l While the surgery is a relatively safe, nationally this operation has a mortality rate of 0.5%


What are the results of the operation?On average people loose between 60-75% of their excess weight during the first 18 months, this weight loss plateaus off after this time.

It is possible to reach your ideal body weight; however this may take some extra effort on your part towards the end of the two years.

If you have suffered from any obesity related complications, such as diabetes, heart disease or high blood pressure you will begin to see a marked improvement.

Approximately 10% of patients may regain weight in the long term if they continue to overeat, stretching the Pouch and thereby reducing the restrictive effect of the procedure.

87

Omega Loop Bypass (Mini-bypass)This is a variation on the surgical technique of gastric bypass and is carried out instead of a Roux-en-Y technique.

Around 200cm of the small intestine is bypassed and attached to a slightly longer stomach pouch.

The Omega loop gastric bypass (mini-bypass) has been gaining popularity as it takes a shorter operating time and carries slightly lower risk of complications.

This technique it is particularly of benefit when there are technical reasons to avoid a Roux-en-Y technique such as in patients with a high BMI and with a large-sized liver.

However, a minority of patients may develop bile reflux that rarely requires conversion to a Roux-en-Y technique.

New stomach

Bypasssed portion of small intestine

Bypasssed portionof stomach


9 10

Will I need medication when I go home?

YES

You will be given a discharge prescription before you go home. This will have all the medications you require. All your medications will be supplied in a form that will allow you to take them while on a liquid diet. You will need to arrange a repeat prescription from your G.P before they run out.

What you will be given:

Painkillers: Paracetamol and possibly codeine which should be sufficient on discharge.

Antacid: This is given to reduce the amount of acid in your stomach which will enable your stomach to heal and protect against the formation of ulcers at the join between the stomach and the intestine, this is extremely important and you will be asked to take these for a minimum of two years weeks.

Anti-coagulation therapy: You will be given small injections of heparin to have once a day for a minimum of 5 days, in order to prevent clots in the legs and lungs. You will either be taught to give the injections to yourself before you go home or referred to the district nurse.

Vitamin and Mineral supplements: Your G.P will be asked to start you on iron, Calcium and multivitamin supplements approximately 3 weeks after your operation.

Your normal medications Will be altered to allow you to take them on a liquid diet. Diabetes medications maybe reduced immediately following your surgery. However as you begin to lose weight your G.P should review your medications on a regular basis.

You may resume driving 10-14 days following your operation. You should be able to competently carry out an emergency stop and no longer be on strong pain killers.

Most people return to work 1-2 weeks following their operation.

Recovering from the operation

It is important to stay mobile after the operation and gentle exercise is very much encouraged. Your wounds will take approximately 1-2 weeks to heal and you are advised to avoid heavy lifting or straining during this time.

You should start to build your exercise tolerance such as swimming, brisk walking or going to the gym and aim for four 30 minute sessions per week. Your ability to exercise will improve dramatically following your surgery. As you are aware exercise helps weight loss by burning off extra calories and helps build muscle tone and to a lesser extent, excess skin that results from surgery.


11 12

Salford Royal Bariatric Servicehttp://www.srft.nhs.uk/bariatric/

Further information:Support is available through Salford Royal NHS Foundation Trust:

Useful websites:

Specialist Nurse

British Obesity Surgery Patient Association (BOSPA)

British Obesity and Metabolic Surgery Society (BOSS)

Weight Loss Surgery Information and Support (WLSinfo)

Drinkaware – alcohol advice

Weight Loss Resources UK

Dietitian

Secretary

Hospital switchboard

(voicemail service)0161 206 5062

08456 020 446

02073 044 786

0151 222 4737

020 7766 9900

01733 345 592

0161 206 1223

0161 206 0449

0161 789 7373

www.bospauk.org

www.bomss.org.uk

www.wlsinfo.org.uk

www.drinkaware.co.uk

www.weightlossresources.co.uk

Additional information:

What will happen if I decide not to go ahead with surgery?You will be referred back to your G.P or referring consultant for conservative (medical) weight management.

What are the alternatives to this procedure?There are alternative surgical and medical treatments available. If you wish to discuss these further you should contact the consultant secretary to arrange a further appointment.

Becoming pregnant after surgeryObesity can cause infertility, but following weight loss surgery ovulation and periods can recommence. Pregnancy is safe after surgery, reduces the risk of miscarriage, high blood pressure and diabetes.

However patients are advised not to get pregnant for the first 12 months after surgery, to allow the weight loss to slow down and establish a regular eating pattern. If you were to get pregnant it is advised that you should your dietician and G.P to ensure that you are having all the nutrients you and your baby require. Once you become pregnant you are advised seek medical advice on the medications you are taking to ensure they are suitable for pregnancy.

There is no reason why you should not have a normal delivery and be able to breast feed after surgery.


13 14

Notes

For further information on this leaflet, its references and sources used, please contact 0161 206 5062

Salford Royal operates a smoke-free policy.

For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779

Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD

Telephone 0161 789 7373www.srft.nhs.uk

www.srft.nhs.uk/for-members

If you would like to become a Foundation Trust Member please visit:

If you have any suggestions as to how this document could be improved in the future then please visit:

http://www.srft.nhs.uk/for-patients

Under the Human Tissue Act 2004, consent will not be required from living patients from whom tissue has been taken for diagnosis or testing to use any left over tissue for the following purposes: clinical audit, education or training relating to human health, performance assessment, public health monitoring and quality assurance.

If you object to your tissue being used for any of the above purposes, please inform a member of staff immediately.

Copies of this information are available in other languages and formats upon request.

In accordance with the Equality Act we will make ‘reasonable adjustments’ to enable individuals with disabilities, to access this treatment / service.

If you need this interpreting please telephone

© G14040702. Design Services

Salford Royal NHS Foundation Trust

All Rights Reserved 2014

This document MUST NOT be photocopied

Information Leaflet Control Policy:

Unique Identifier: SURG23(14)

Review Date: August 2016

having a gastric bypass - · pdf filehaving a gastric bypass hope building upper g.i. /...

Documents