What are the requirements to qualify for gastric bypass surgery?
Gastric bypass surgery requirements are similar to those of other bariatric procedures. You must be recommended for surgery by a qualified healthcare provider. In general, you may be a candidate for gastric bypass surgery if you:
- Have been diagnosed with class III obesity. This is determined by your BMI (body mass index). Class III obesity means a BMI of at least 40 kg/m2
- Have a BMI of at least 35 with at least one obesity-related condition.
- Have obesity-related type 2 diabetes. Because of its positive effects on blood sugar regulation, you may qualify for gastric bypass surgery to help manage your type 2 diabetes, if it’s unmanaged and you have a BMI of 30 or higher.
If you’ve met these benchmarks, you may be recommended for surgery. But your surgeon will have additional requirements. Before scheduling your surgery, you’ll meet with a team of healthcare specialists for counseling and screening. They’ll want to know:
- That you're committed to lifelong lifestyle changes. Surgery is a powerful tool for weight loss, but it won’t work if you won’t work with it. You’ll have to change the way you eat forever. If you don’t, you could regain the weight you lose.
- That you’re physically and mentally fit for surgery. You’ll likely take some standard medical tests to make sure the procedure will be safe for you. You may also be screened for mental health and for alcohol or tobacco use.
- That you’ve tried to lose weight by other means. Health insurance companies may ask you to prove that weight loss surgery is medically necessary. They may require that you try a supervised diet and exercise program first.
How is gastric bypass surgery performed?
Most Roux-en-Y surgery operations today are performed by laparoscopy, a minimally-invasive surgery technique. The laparoscopic gastric bypass was introduced almost 30 years ago and has since become the standard of care for most people.
Laparoscopic surgery involves three to five small incisions in your abdomen, each about a half an inch. Smaller cuts mean fewer complications, less bleeding, less pain and a faster recovery. Your surgeon will perform the operation through these openings, using long, narrow tools.
Sometimes laparoscopic operations such as Roux-en-Y are done with robotic assistance. Robotic surgery is still controlled by the surgeon. It just means that the surgeon attaches robotic arms to the laparoscopic tools. They control the arms with a computer.
While 90% of Roux-en-Y surgeries are performed laparoscopically, some people may need to have open surgery to manage their specific conditions. Rarely, some laparoscopic Roux-en-Y surgeries may need to convert to open surgeries to be completed safely.
What happens during the Roux-en-Y procedure?
All laparoscopic surgeries begin with a single “keyhole incision” in your abdomen. Your surgeon uses this first keyhole to inflate your abdominal cavity with carbon dioxide gas. This helps separate your abdominal wall from your organs and makes everything easier to see.
Then your surgeon will place a tiny lighted video camera called a laparoscope through the keyhole to visualize your organs. The laparoscope will project onto a computer screen. Your surgeon will use additional keyhole incisions to access your organs.
The first step in the Roux-en-Y procedure is to divide the top portion of your stomach from the remainder with a surgical stapler. The resulting pouch is about the size of an egg. The remainder of the stomach is still attached to your small intestine.
The next step is to divide your small intestine several feet down its length and bring the lower segment up to attach to your new stomach pouch. Your food will now pass from your stomach pouch into this segment of your lower small intestine.
The final step is to reattach the upper branch of your small intestine to the trunk further down. Now your small intestine has two branches attached to the trunk: one leading from your stomach pouch, and the other leading from the remainder of your stomach.
The right side of this “Y” is the new branch, the one that your food will pass through. The left side is the original upper part of your small intestine (your duodenum). This is the part where your liver, gallbladder and pancreas deliver their digestive juices.
The left branch will deliver these juices into the new trunk of your small intestine, where they will mix with your food. This will enable you to properly digest your food, even though your shortened intestinal pathway will absorb fewer nutrients from it.
How long does gastric bypass surgery take?
The procedure itself takes between two to four hours. Afterward, you’ll probably remain in the hospital for two days. You won’t be able to eat solid foods yet.
How painful is gastric bypass surgery?
You’ll feel moderate pain in the first few days, but you’ll have pain medication on demand through a catheter in your vein. You won’t be discharged from the hospital until you’ve weaned from your pain medication and are able to move around comfortably on your own.
At home, you’ll have prescription pain medications to take. Most people wean from these within a week. You may continue to feel your incision wounds while they heal, but the smaller laparoscopic surgery incisions heal relatively quickly.
