The Operation

The operation creates a very small upper stomach pouch (less than one ounce) by transecting the stomach. Ingested food passes out of the upper pouch through a small opening into the small intestine. Most of the stomach and the first part of the small intestine are bypassed by the food. Thus, the operation is termed a "gastric bypass with Roux-en-y gastrojejunostomy." The major objective is to exclude most of the stomach. The point where the bile and pancreatic secretions are returned to mix with the ingested food is placed several feet down from the stomach. If the gallbladder is diseased, it may be removed during the operation.

The operation is usually done with laparoscopic instruments through several small incisions. This technique involves inserting a video telescope into the abdomen through a 12-mm incision. Five additional incisions (1-12mm & 4-5mm) are placed in the upper abdomen. The same operation is then carried out using specialized instruments. This approach has the potential advantage of smaller incisions, less pain, quicker recovery, fewer wound complications, earlier discharge from the hospital and less scarring while potentially providing the same weight reduction as the traditional open approach. Occasionally, it requires an incision from the breastbone to just above the umbilicus in order to gain access to the internal organs. If for whatever reason, the operation cannot be safely completed using the small incisions, the abdomen will be opened, and the operation will be completed in that manner. Not every patient is a candidate for the laparoscopic procedure. The surgeon will determine this during your initial visit.

Preparation for Operation

Surgical candidates are required to receive Pre-Admission Testing in the Kirklin Clinic prior to surgery. On the day of the surgery, most patients come in via the Jefferson Tower, 11th Floor, to Same Day/One Day Surgery at 6:00 a.m.

On the day before the operation, the patient should only eat liquids, drink a bottle of magnesium citrate at 2:00 p.m., and take a shower or bath with hibiclens. Nothing should be eaten or drunk after midnight.

Day of Operation

The patient will then be moved to the operating room and placed on a special, narrow table. Cuffs will be placed on an arm and the legs. The anesthesia team will explain things as they are being done. Usually, the patient is told before being put to sleep. The operation ordinarily lasts about 1-2 hours.

After the Operation

Following the procedure, you will be taken to the Recovery Room and will remain there until awake. If you awaken before the endotracheal tube (breathing tube) is removed, you will not be able to talk. This is normal and should not frighten you. As soon as the tube is removed, speaking can be resumed. Once awake and recovered from the anesthesia, you will usually go to a room on one of the surgical nursing floors. Sometimes patients with special problems will be taken to the Intensive Care Unit. Your family may wait in the surgical waiting room, and the surgeon will speak with them after the operation.

After the operation, you should take frequent deep breaths and cough. This is very important to keep the lungs fully expanded and to clear any secretions. Some discomfort may be present from the incision, especially when coughing, but voluntary coughing is still important. Coughing, dep breathing, or sneezing will not break sutures. Medicine will be available for pain if you require it. While it may not take all the pain away, it will usually make you more comfortable.

Liquids are often begun on the first day after the operation. Patients who have an uneventful course usually go home on about the second or third day after the operation. At home, you may use stairs as necessary, bathe, or shower. All meals should be taken sitting up. Daily exercise should be started immediately and progressively increased.

It is important to crush pills after the operation. All liquid sweets such as cola or sweetened tea should be avoided after discharde. All patients should be very careful to remain on the special diet in the booklet as outlined by your surgeon for 6-8 weeks to allow complete healing of the staple line. A chewable vitamin should be taken daily. It is wise to have a vitamin B-12 injection every 4-6 months.