Roux-en-Y Gastric Bypass Surgery and Nutritional Concerns

Bariatric surgery is performed for patients who have chronic problems and difficulties losing weight, in order to be of a healthy body mass index for their individual size and frame. Weight loss surgery is a major surgery, yet it is safe and effective. It is not considered a cosmetic operation. It is considered to be permanent. One particular bariatric surgery, that I have noticed more common compared to other procedures, is the Roux-en-Y Gastric Bypass procedure.

Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. In this procedure, stapling creates a small (15-30cc) stomach pouch. The outlet from this newly formed pouch bypasses most of the stomach and several feet of the small intestine, preventing your body from absorbing all the calories and nutrients from the foods you eat. By combining the smaller stomach and the malabsorption feature, this surgery produces more weight loss than operations that only decrease the intake of food. The malabsorption of nutrients, especially calcium, iron, and Vitamin B12 can be managed through proper diet and vitamin supplements. An excess intake of sugar and fat may trigger a condition known as “dumping syndrome.” The results can be extremely unpleasant and can include nausea, weakness, abdominal cramping, and diarrhea.

Reasons for the procedure

Obesity lowers quality of life. This can result in poor overall health, and contribute to a higher risk for depression. Your doctor may suggest a RYGB surgery if you have a body mass index (BMI) of 40 or more or if you have a BMI of 35 and also suffer from serious obesity-related health problems such as diabetes, coronary heart disease, sleep apnea, high blood pressure, or severe arthritis.

Doctors generally recommend the weight-loss surgery only if you are severely obese. That means about 100 pounds overweight for men and 80 pounds for women. They also usually don’t recommend it unless you haven’t been able to lose a large amount of weight and keep it off through diet, exercise, and changes in lifestyle.

Before the procedure

It’s important that your weight-loss surgery be arranged at a qualified bariatric center, where you will complete an extensive educational and preparatory program before surgery. Your doctor can obtain a referral from the American Society for Metabolic and Bariatric Surgery (ASMBS).

  • Your doctor will typically test you for nutritional deficiencies and prescribe supplements to correct any problems before the operation. Your surgeon may ask you to have tests and visits with other health care providers before surgery such as a dietitian and a psychologist.
  • Because smoking slows recovery and increases risks of surgery, your doctor will suggest you stop smoking for good several weeks before surgery. Tell your doctor or nurse if you need help quitting.
  • You’ll want to check with your health insurance provider to make sure bariatric surgery is covered in your health insurance plan, as many plans will not pay for it.
  • Let your doctor know about any prescription or over-the-counter drugs, vitamins, and herbs you are taking. In the week before surgery you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other blood-thinning drugs. Ask what drugs you can take on the day of your surgery.
  • Let your doctor know if you have had any trouble with anesthesia in the past.

During the Procedure

With either open or laparoscopic RYGB surgery, you will be given general anesthesia for the procedure. Initially your doctors will start an IV and may deliver medications to help you relax. Your anesthesiologist will use a drug or combination of drugs to control pain and make you unaware of the procedure.

When you reach the operating room, your medical team will use routine monitoring equipment throughout the procedure or longer, depending on your health conditions.

The surgery to create the stomach pouch and the bypass usually takes several hours.

After the Procedure

You may stay in the hospital for two to four days after the procedure. You will typically only have liquids or puréed foods for at least three to six weeks after surgery. Rarely, you may have a catheter, or tube, from the larger bypassed part of your stomach that will come out of your side to drain excess fluids from your abdomen for four or more weeks.

Your RD may slowly add soft food and then regular food to your diet about a month after surgery. You will be instructed to chew slowly and completely and not to drink 30 minutes before or after you eat food.

Talk with your doctor, surgeon, and RD about proper wound care, the type of pain-relieving drugs that are safe to take, and when you can resume physical activities. Your surgeon will tell you how often to change the dressing on your incision.

You should inform your doctor immediately if you develop a fever or if your wound becomes painful or hot to the touch or has a foul-smelling drainage. Also look for any coughing or difficulty breathing, vomiting and diarrhea, pain in the abdomen, chest, shoulder, or legs, or any other unusual symptoms.

Your initial weight-loss may occur quickly, so it’s important to get all of the nutrition and vitamins you need as you recover. Your doctor will prescribe certain vitamin and mineral supplements that your body may no longer absorb well from food alone.

Recommendations for the following supplements to prevent nutritional deficiencies after recovery from surgery are:

  • Daily vitamin D and calcium supplements. Vitamin D deficiency is common in people who have had this kind of gastric bypass. Multivitamins containing 1,200 mg of daily calcium citrate and 400 to 800 IU of vitamin D don’t appear to provide enough protection for bone health, studies suggest. Some experts have had success stopping bone loss by increasing vitamin D intake to 1,600 to 2,000 IU daily. Additional calcium supplementation of 1,600 mg daily is also suggested.
  • Multivitamins. You should take a daily multivitamin that contains 200% of the daily values. Wait two hours to take a calcium supplement after your multivitamin.
  • Vitamin B12 supplements. Doctors recommend vitamin B12 supplementation for all weight-loss surgery patients to help prevent bone fractures. You may need to give yourself B12 injections for the rest of your life.
  • Oral vitamin D supplementation if a deficiency is detected. Your doctor may prescribe 50,000 IU of vitamin D2 taken orally once a week for 8 weeks, some people require lifelong vitamin D supplementation.
  • Iron supplements. Research suggests that after RGBY surgery, the amount of iron contained in a standard multivitamin may not be enough to prevent anemia. Teens and menstruating women may require the amount of iron found in two multivitamins, along with 50 to 100 mg of elemental iron a day.

Because nutritional deficiencies are so common after this surgery, RDs recommend that your blood be tested every 6 months for the rest of your life to ensure that you are getting the right amount of vitamins and minerals.

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