Gastric Bypass

During gastric bypass surgery, a large part of the stomach is bypassed and a small portion of the stomach (approximately 30-50 cc) is prepared and sutured to the small intestine during surgery. In this surgery, as in other obesity surgeries, it is aimed to reduce the volume of the stomach and to eliminate some of the intestines by expelling some of the foods consumed without being absorbed. In this way, patients feel satiated with less food and a part of the food is absorbed.

Gastric Bypass for Weight Loss

What is a gastric bypass?

The gastric bypass is currently the second most common intervention in the world. In a gastric bypass, the stomach is cut off a few centimeters below the entrance to the stomach. A small residual stomach remains, a “pouch”, which holds approximately 15 ml and serves as a brake for the food supplied. The small intestine is also severed. One end of the intestine is connected to the small residual stomach and the other is diverted in such a way that the food and digestive juices are only mixed in the middle of the small intestine, and the upper small intestine, which is directly adjacent to the stomach, is bypassed. The digestive juices are introduced into the lower parts of the intestine and, thus, digestion can only begin here by breaking down the food components. The result is that not all food components can be broken down, and therefore only a part is “resorbed”. There are therefore fewer nutritional building blocks available to the blood. The undigested food is transported to the large intestine. It is primarily a malabsorptive procedure with mild restrictions.

Nutritional therapy after gastric bypass

The food build-up after the operation takes place slowly and in individual phases. It is very important that you stick to this for the first few weeks. In this way, you help to prevent complications and learn to cope with the new situation step by step. Before you are discharged home, you will receive a detailed overview scheme and important points can be discussed at this point.

Diet regimen after surgery

• From the 1st day after the operation: clear liquids
• From the 3rd day after the operation: clear liquids, yoghurt, soups
• From the 2nd week after the operation: pureed food, liquids, dairy products 6 small meals a day
• From the 4th week after the operation: Normal food with a soft consistency, 5 meals a day
• From the 6th week after the operation: normal food, 3 – 5 meals depending on tolerance

Diet recommendations after gastric bypass

With regard to food selection and the energy density of the food composition, the remaining length of the small intestine must be taken into account.

Depending on the severity of a reduced absorption capacity in the intestine (absorption), certain foods must be eaten more frequently and in larger quantities.

Foods that usually trigger intolerance symptoms are high-sugar foods and liquids, as well as high-fat foods and meals.

Chewing food well and for a long time facilitates the absorption of nutrients. Small portions of food reduce severe food intolerance reactions in the stomach and intestines.

If lactose intolerance develops, products with a low lactose content or lactose-free milk products should be selected.

If the remaining length of the small intestine is less than 100 cm, oxalic acid-rich foods should only be consumed in small quantities.

What are the disadvantages of gastric bypass? Or what complications can occur?

The physiology of the digestive process is changed. Not only is the intake of calorie carriers reduced, but also that of vitamins, minerals, and trace elements. In particular, vitamin B 12 can no longer be “absorbed” via normal digestive processes and it must be given by injection for life. In individual cases, this also applies to the absorption of iron. The long-term intake of a multivitamin preparation is required daily. Certain medications may no longer be taken orally because they can damage the intestinal mucosa. Others are less effective, e.g. hormones.

Depending on the composition of the food, side effects such as flatulence, foul-smelling fatty stools, diarrhea, and the so-called “dumping syndrome” with circulatory waste and sudden defecation can occur after eating very sugary foods and drinks.

The restrictive effect of the small pouch may be lost over time and normal to large amounts of food may be eaten again.

It is no longer possible to carry out an endoscopic gastroscopy or to remove bile duct stones. (ERCP).