Gastric sleeve

Roux-en-Y gastric bypass by laparoscopy (RYGB)

The procedure First, the stomach is divided into a smaller upper part the size of an egg, which is 10% of the stomach. What remains the larger part of the stomach (90% of the part of the new stomach) is not removed but it is bypassed and no longer stores or digests food.

The small intestine is also divided and separated just after the duodenum and connected to the new stomach pouch allowing food to pass through. The remaining portion of the intestine is connected to the lateral portion of the intestine, creating an intestinal junction that resembles form a "Y", from which the name of the "Roux-en-Y" technique comes. Eventually, the stomach acids and digestive enzymes from the bypassed stomach and the first part of the small intestine mix with the food that is eaten. Food bypasses a portion of the small intestine (50%) that absorbs calories and nutrients. The smaller stomach pouch makes patients feel full faster, so they eat less, and since the food does not pass through the entire small intestine, calorie absorption is lower. Roux-en-Y gastric bypass is one of the most common surgeries and is very effective in treating obesity and related diseases.

How it works? The newly created stomach pouch is smaller and can hold less food, which means fewer calories are delivered. Also, the food does not come into contact with the first part of the small intestine, resulting in less absorption. Most importantly, changing the food pathway through the gastrointestinal tract has a profound effect on reducing hunger, increasing satiety, and allowing the body to achieve and maintain a healthy weight.

Advantages Patients state that they feel a sense of satiety more quickly and therefore have less desire to eat. In general, they lose weight faster than patients who have undergone purely restrictive procedures. According to our statistics, you can lose almost 70 % of your excess weight with gastric bypass and not gain it back as long as you follow the post-operative instructions.
Warning: Each individual result may vary. Some patients will lose all of their excess weight, while others who do not follow the rules will lose less. If you suffer from any of the following conditions, they may be corrected or resolved after surgery:

• Type 2 diabetes
• High blood pressure
• Sleep apnea
• Dyslipidemia
• Asthma
• Lower back pain and disc discomfort
• Osteoarthritis of weight-bearing joints: hips, knees, ankles and feet
• Dermatitis caused by skin folds
• Stress incontinence
• Gastroesophageal reflux disease

General risks The benefits are not without risks. Because the duodenum has been bypassed, poor absorption of iron and calcium can lead to a decrease in the total amount of iron in the body and promote anemia caused by iron deficiency. This condition is of particular concern in patients with bleeding hemorrhoids or in patients who have very heavy menstrual bleeding. Women who are already at risk for osteoporosis after menopause should be aware of the increased risk of calcium loss from the bones. In some patients, the bypass of the duodenum can lead to metabolic bone disease that causes bone pain, reduced height, a hunched back, and rib and hip fractures.

All of the above deficiency symptoms can be managed with a good diet and vitamin supplements.
A disorder known as "dumping syndrome" can occur as a result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered by eating too much sugar or large amounts of carbohydrate foods. Symptoms include nausea, sweating, weakness, and sometimes diarrhea after eating. Although this syndrome is not considered a health hazard, the consequences can be extremely unpleasant and show that you are not following the diet recommended by your doctor. This syndrome is a sort of "safety valve" and reminds you that you will have to pay if you try to cheat!

What happens after Roux-en-Y gastric bypass surgery? After surgery, you may stay in the hospital for 1 to 2 days. Discuss with your doctor about wound care, pain medicines, and when you can start physical activity. Your doctor will tell you how often to change the dressing on your incision.

Tell your doctor right away if you have any of the following symptoms:

• Fever
• Your wound feels painful or hot, or fluid is coming out
• Cough or difficulty breathing
• Vomiting and diarrhea
• Pain in your stomach, chest, shoulder, or legs
• Any other problems or symptoms

Bariatric diet: For the first 1 to 2 weeks after surgery, you will eat only liquid foods. About a month after surgery, your doctor may slowly add soft foods and then regular foods to your diet. You must chew slowly and completely and not drink anything for 30 minutes before or after eating.

Initial weight loss may occur quickly. Therefore, it is important that you eat all the nutrients and vitamins you need during your recovery. Your doctor will prescribe vitamin and mineral supplements that your body cannot absorb well through food alone.

To avoid nutritional problems after gastric bypass surgery, many doctors advise:

• Multivitamins
• Calcium supplements
• Vitamin D
• Vitamin B-12 supplements
• Iron supplements

Because nutrient deficiencies may occur after this surgery, experts recommend having your blood checked at least every 6 months for the rest of your life to make sure you are getting the right amount of vitamins and minerals.

Side effects: During weight loss, you may experience body aches, dry skin, mood swings, temporarily thinning hair, and feel tired and cold. As your weight stabilizes, these problems should go away. Weight loss lasts for about a year and then stops. After a year, you may be able to eat more as the pouch expands. You should use the first year to develop good eating and exercise habits so you do not gain the weight back.

In addition to follow-up appointments with your doctor and surgeon, you will probably see a dietitian to teach you how and what to eat with your reduced stomach. You may also need to see a psychologist to help you deal with your feelings and concerns about your lifestyle change.

POST-OPERATION GASTRIC DIET PLAN: WHAT TO EAT AFTER THE SURGERY?

• Consume protein shakes or protein powder.
• Stop smoking
• Avoid alcoholic beverages
• Eliminate high sugar beverages, such as juice, sodas, milkshakes
• Eliminate or reduce your intake foods that are high in carbonhydrates such as desserts, pasta, potatoes, bread.
• Eliminate or reduce your intake of saturated fats including whole milk products, fatty meat and fried foods

PHASE 1: CLEAR LIQUID

The most important aspect of your diet immediately after bariatric surgery is to make sure you are drinking enough fluids. Remember that your stomach still needs to recover from bariatric surgery. It is normal to experience nausea or vomiting at this time. Your bariatric surgeon will advise you when you can move on to the next phase of your diet.

• Recommended liquids:
• Water
• Clear broths, such as chicken, beef, or vegetable broth.
• Fruit juice, such as apple, grape, or cranberry juice, diluted with water.
• Decaffeinated coffee or tea
• Sugar-free gelatin or popsicles

PHASE 2A: FULL LIQUID

• Consume protein shakes or protein powder
• Stop smoking
• Avoid alcoholic beverages
• Eliminate high sugar beverages, such as juice, sodas, milkshakes
• Eliminate or reduce your intake foods that are high in carbonhydrates such as desserts, pasta, potatoes, bread.
• Eliminate or reduce your intake of saturated fats including whole milk products, fatty meat and fried foods

PHASE 2B: PUREED

Congratulations. You have moved on to pureed foods. You will now be eating protein-rich foods that will aid in the healing process. It is recommended that you consume 60-80 grams of protein. Consume these proteins with meals first. We recommend protein supplementation to meet your protein

The pureed phase:

• Skim milk with added protein powder or nonfat dry milk.
• Light yogurt or cottage cheese with a small amount of cottage cheese
• Mixed cream soups with added baby food meat or finely chopped meat
• Scrambled eggs or egg substitutes
• Pureed beef, chicken or turkey
• Pureed, moistened whitefish
• Canned chicken or canned tuna (in water)
• Hot, diluted cereals such as oatmeal, cream of wheat, grits, farina, or cream of rice
• Mashed potatoes or sweet potatoes
• Pureed fruits
• Pureed vegetables
• Baby food Meat, vegetables, fruit

PHASE 3: ADAPTIVE /SOFT

You will move to eating more solid foods such as soft meats, fish, whole grains, cooked vegetables, and soft fruits, while still making sure to eat quality protein and stay hydrated.

PHASE 4: STABILIZATION

This phase serves to provide a template for healthy eating for life.
Continue to stick to the goal of 60 to 80 grams of protein from food sources. Consume this protein first with meals. Patients may need to eat a high-protein food between meals to meet their daily requirements.

• Lean meat, poultry, fish
• Low fat dairy products
• Vegetables and fruits

About 4 months after the operation you can eat normally again.
However, portion control is still important. Make sure your diet consists mainly of fruits, vegetables, lean protein, and healthy carbohydrates. Avoid unhealthy foods that are high in fat, carbohydrates and calories.
If you eat healthy, you can continue to enjoy your health without gaining the weight back.

Do I meet the requirements for a gastric bypass? For any obesity treatment surgery (gastric sleeve, or gastric bypass surgery), you must meet several requirements:

• You are over 20 years of old
• You are ready for a significant change
• You have been on an adapted diet for one year without success.
• You have a BMI of:
• Equal to or over 40;
• Equal to or over 35 with other complications such as diabetes or cardiovascular disease;
• Equal to or over 35 and previous surgeries have caused complications or resulted in inadequate results.

How the BMI is calculated? You can calculate your own BMI with a simple formula, for either the metric system or the imperial system, explains the American Cancer Society.
BMI is an inexpensive and simple screening method for weight categories:
Underweight, Healthy Weight, Overweight, Obese and Morbidly Obese For the metric system, divide the number of kilograms you weigh by your height in square meters to get your BMI. For the imperial system, multiply the number of pounds you weigh by 703. Divide the result by your height in square inches. The answer is your BMI.

How is the BMI interpreted for adults? For adults 20 years of age and older, BMI is interpreted using standard weight status categories. These categories are the same for men and women of all body types and ages.
The standard weight status categories associated with BMI ranges for adults are shown in the following table.