Laparoscopic Gastric Bypass / Open Gastric Bypass

Topics Covered:

• Laparoscopy versus open surgery
• Gastric Bypass
• What you will experience the day of surgery at St. Vincent’s Medical Center
• Discharge and follow-up
• Medications
• Diet
• When to Notify Physician

Laparoscopy versus open surgery

Laparoscopy is the surgical procedure that allows visual examination with an instrument called laparoscope. Laparoscope is inserted through a small incision made in the abdominal wall. Other incisions are added to allow the surgeon to us specially designed surgical instruments. In many cases laparoscopy can be done instead of laparotomy – open or classical surgery – that uses a larger incision in the belly. Laparoscopy is superior to the laparotomy in terms of post-operative pain, recovery time, and incidence of incisional hernia, wound infection and cosmetics. Surgical “job” and long-term results are eventually the same for both, laparoscopy and laparotomy.

Gastric Bypass

Either way, laparoscopic or open, this procedure has several steps where a small gastric pouch is created and a by-pass or “detour” redirects the food directly to the small bowel. The stomach is reduced from the size of a football to the size of a golf ball. The new smaller stomach is attached to the middle of the small intestine, bypassing a section of the small intestine (duodenum and jejunum), in affect, limiting the absorption of calories.

Surgery is very technically demanding and stapling devices are used to create new connections – anastomosis – between stomach pouch and small bowel (so called G-J anastomosis) and between two loops of small bowel (so called J-J anastomosis).

Our surgeons’ precision, use of the latest generation of staplers, and vigorous testing of anastomosis that we perform in every single case during a surgery (with the help of intra-operative esophagogastroscopy) give the best chance for healing of new gut connection sites.

After surgery patients wake up with multiple small incisions (usually 5 to 7) or longer midline incision and a drain. The drain is a plastic tube that stays for a couple days and is removed just prior to discharge home.

What you will experience the day of surgery at St. Vincent’s Medical Center

On the day of your procedure you will go to the surgery center. You are prepared for surgery and an IV will be put in place at this time. You will be transferred to the holding area to meet your surgeon, your anesthesiologist and OR staff taking care of you. In the OR you will be put asleep after inhaling oxygen enriched air via face mask by intravenously fast acting medication.

After surgery you will be transferred to the recovery room. If you have a history of sleep apnea you will receive extra monitoring at this time.

After you completely awake you may proceed to the nursing floor or to the intensive care unit. Placement in the ICU doesn’t mean that there is a surgical complication – it is usually for a patient who needs very close monitoring due to medical conditions that were present before surgery.

Pain after surgery is controlled by Patient Controlled Analgesia (PCA). This is a computerized pump that allows you to request and receive pain medication whenever you might want it. It is very safe and effective in controlling pain.

A swallow test is performed the next day after surgery. You will be asked to drink a small cup of clear liquid x-ray dye. This test helps us to confirm proper placement of the band.

After the swallow study you will be offered sugar free liquids and diet popsicles.

Discharge and follow-up

• Activity as tolerated. Exercise in encouraged, however, no heavy lifting or strenuous activity for four weeks.
• You may take a bath or shower.
• Abdominal binder for comfort as desired.
• You may remove the Steri-strips after 5 or 6 days.
• You may drive when you are no longer taking pain medication.

Medications

• Resume pre-surgery home medications as instructed by physician.
• Multivitamin twice a day (chewable or liquid).
• Nexium (prescription) or Prevacid (over the counter) for heartburn.
• Roxicet every four hours as needed (prescription) for pain.

Diet

• Drink a lot of water – at least 2 quarts (64 ounces) each day.
• Do not gulp. Take frequent (every 5 to 10 minutes) small sips.
• Clear liquids: Beef, chicken or vegetable broth.
• Diet drinks, such as Crystal Light.
• Sugar-free frozen fruit flavored ice pops, such as Popsicles.
• Sugar-free gelatin, such as Jell-O.
• Flavored waters.
• You may have caffeinated diet drinks sparingly (limit to two 8 ounce servings per day).
• Avoid carbonated beverages.

When to Notify Physician

• Notify your physician if your temperature exceeds 101۫ F.
• Notify your physician if you experience signs of infection which include redness or drainage from incision site, chills or pain not controlled by pain medications.
• Notify your physician if you have pain and swelling in your leg or calf, if you have chest pain, palpitations or shortness of breath.
• Notify your physician if you are constantly nauseated and/or you vomit for prolong period of time; if you cannot keep down your medications including vitamins.

Additional Instructions may be given based on individual circumstances.

Call 904-389-8871 to schedule follow-up appointment.
If you are Diabetic and seen by Endocrinology associates, please call their office.

This information is selective and does not include all possible side effects and complications resulting from this medical condition, diagnostic procedure or treatment. Potential complications should be discussed in more detail with your physician.