Candidates tend to have a BMI over 40, or a BMI between 35 and 40 with accompanying diseases such as diabetes, sleep apnea, cardiomyopathy (heart damage) or severe joint degeneration and pain. They should have a long record of failed previous non-surgical weight loss interventions (diet, exercise) before considering gastric bypass.
Candidates who may be especially susceptible to gastrointestinal reflux disease (GERD) and who desire having dumping syndrome as a negative reinforcement to facilitate weight loss are better candidates for gastric bypass. The rates of GERD are lower for gastric bypass compared to gastric sleeve.
Patients who have current drug and alcohol abuse, a history of binge eating, untreated major depression or psychosis, severe cardiac disease, or disorders that interfere with healing such as blood clot disorders are not good candidates for gastric lap band. Gastric bypass surgery should not be considered a first-line option for weight loss and should be considered only after exhausting non-surgical weight loss options.
You may be asked to change your diet, lose or maintain a stable weight, or alter your dietary habits (i.e. eating smaller meals throughout the day) before surgery. This increases the probability of successful, sustained weight loss after surgery. Like other surgeries, gastric bypass requires you to undergo certain general surgery procedures such as preoperative blood testing, medications, and cessation of smoking or use of pain relievers and anti-inflammatory drugs
Recovery is a slow and gradual healing and readjustment process as you adjust to eating smaller portions of food. Pain in the first 2 to 3 days after surgery in the upper left part of your abdomen is common, but can be managed with pain relievers, and should be minimal to nonexistent by 2 to 3 weeks after the surgery. Although light walking is suggested soon after surgery, strenuous exercise should be avoided for the first few weeks.
Patients should stick to an all-liquid diet for the first week, before gradually easing into soft foods and eventually, back to normal. However, portion sizes should be heavily restricted and patients should eat slowly in order to accurately gauge their satiety. It’s important that lifestyle changes implemented before the surgery be maintained long-term.
The most common complications from gastric bypass surgery are nausea and vomiting, malnutrition (as it induces malabsorption of nutrients in order to reduce calorie consumption), gallstones, and internal hernia. Nausea and vomiting are not true complications, but do occur in 50% of patients post-operation.
Major complications—which occur in less than 3% of procedures— include bowel obstruction, staple line leak, internal hemorrhaging, and pulmonary embolism. As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. A proper assessment of every patient, along with complete lab work, will help prevent postoperative complications. Gastric bypass has a higher risk profile than gastric sleeve or lap band surgery, due to prolonged procedure time and level of invasiveness.