Laparoscopic Gastric Bypass Information for patients This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request. This leaflet tells you about laparoscopic gastric bypass. What is a laparoscopic gastric bypass? A gastric bypass is a life changing operation. It is used to help people to lose weight and improve their health. Losing weight lowers the risk of developing medical problems linked with obesity (being very overweight), for example, high blood pressure, diabetes, sleep apnoea, arthritis, breathing problems and asthma. The operation makes your stomach smaller and bypasses part of your small bowel. This reduces the amount you eat and prevents absorption of the food you have eaten. Due to this you will lose weight. The operation also changes the hormone signals from the stomach and intestine (small bowel) to parts of your brain that control your appetite and the feeling of fullness. As the size of your stomach will be reduced, so will the size of your meals. This, together with a healthy well balanced diet and exercise, will help you to maintain your weight loss. The operation is carried out through a laparoscope (viewing instrument), which is inserted into your abdomen (tummy). This is also known as keyhole surgery. This means your recovery will be quicker. Your operation will be performed under a general anaesthetic (a state of carefully controlled and supervised unconsciousness (deep sleep) that means you are unable to feel any pain). Are there any risks or possible complications with having a gastric bypass? As with any surgical procedure there are some risks. These can vary depending on your age and other illnesses you may have. These can include: risks linked with anaesthesia. You will be given a leaflet . “You and your anaesthetic”, which explains in detail about anaesthesia. Your anaesthetist (a doctor with special training in anaesthetics) will discuss this with you. You may need to be admitted to the Critical Care Unit. Surg/470 (2015) Page 1 of 11 For Review Summer 2018 Laparoscopic Gastric Bypass accidental injury during the operation to internal organs such as the bladder, bowel, liver, pancreas, spleen, uterus, ureter (the tube leading from your kidney to your bladder) or blood vessels. This is because cutting instruments need to be used during the operation. Sometimes these may not be obvious during the operation but may be suspected later. If this happens you will need another operation and a longer stay in hospital. anastomotic leaks from staple lines. A special mesh (staple line) is used to seal the stomach. This will be checked for leaks using a blue dye, you may have blue staining around your mouth or in your hair afterwards and when you first pass urine it may be blue or green. Sometimes staple lines can leak after your operation. You will be closely monitored after your operation. If this happens you will need another operation. inability to complete the operation using the laparoscope. Your doctor may need to convert to a laparotomy (open surgery). The reasons this may be needed include, the presence of adhesions (scar tissue) from previous surgery, bleeding and accidental injury to internal organs. If this happens, you will need a longer stay in hospital and may need to stay off work for up to 4 - 6 weeks. wound infection. This can happen to patients having this operation. If you feel feverish and your wound becomes hot, red and sticky, you should see your GP. This can be treated with antibiotics and you will not usually need to be re-admitted to hospital. bleeding. You may develop bleeding inside your abdomen or from your wounds post operatively. If this occurs it will be treated accordingly. You may need a blood transfusion or another operation. pain. This could be shoulder tip or abdominal pain due to irritation from the air used in your abdomen so your surgeon can see your organs. bruising. A little bruising may develop around your wound sites. This is normal and will settle over time. scarring. You will have 5 – 6 small scars following surgery from the incision sites. deep vein thrombosis – DVT (blood clots in the leg veins) or pulmonary embolism – PE (blood clots in the lungs). You will be given a leaflet “Reducing the risk of a venous thromboembolism (blood clot) while you are in hospital and after you have been discharged”, which explains about this in detail. Surg/470 (2015) Page 2 of 11 For Review Summer 2018 Laparoscopic Gastric Bypass All adult patients will have their risk of developing a blood clot assessed within 12 hours of admission. Patients who are being admitted for planned surgery may have their risk assessed at pre-assessment. The nurse or doctor who carries out your assessment will discuss your risk factors with you and advise on treatment to reduce your risk. You will also be given information, “Your personal advice for the prevention of venous thromboembolism”, advising you on how to reduce your risk of developing a blood clot while you are in hospital and when you go home. death. 1 patient in every 1,000 who has weight loss surgery can die as a result of complications.1 Some complications can develop a long time after your gastric bypass surgery. These can include: internal hernia. As you lose body fat, defects (a weakness) can be created inside your abdomen, which could cause an internal hernia. port site hernia (hernia at the site of surgery). Some patients can develop a hernia where the laparoscope was used. anastomotic stricture (narrowing) at the joins in your new stomach and bowel. This can make eating and drinking more difficult. If you develop these symptoms you may need to have further tests. In some cases you may need an endoscopy to stretch the narrow areas. If this is needed you will be given a leaflet explaining an endoscopy in more detail. hair loss or thinning in the first 6 months. This is a temporary side effect of the rapid weight loss you will have. Your hair will re-grow. gallstones. You may develop gallstones as a result of the rapid weight loss. anastomotic ulcers. These can develop at joins within the stomach. The risk of these developing increases in patients who smoke after surgery. irritable bowel syndrome (IBS). If you have been diagnosed with IBS your symptoms may get worse. dumping syndrome. If you eat very sugary or starchy foods you may have symptoms of abdominal cramps, sweating, lethargy and diarrhoea. There is no treatment and the symptoms can last for 40 minutes - 1 hour. Surg/470 (2015) Page 3 of 11 For Review Summer 2018 Laparoscopic Gastric Bypass excess skin. Following surgery, as you lose weight, you may develop loose skin. To remove this you would need plastic surgery, which is not part of the bariatric pathway. nutritional deficiency. This can develop due to reduced absorption of food. You will need to take multi-vitamin supplements for the rest of your life. rapid weight loss or weight gain. If you do not follow the dietary and exercise advice given you may lose too much weight or you may put weight back on. What will happen at the pre-assessment clinic? You will meet the nurse practitioner who will explain your operation and answer any questions you may have. The nurse will complete your admission forms and start to discuss and plan your discharge from hospital after your operation. Some routine health checks will be taken at the clinic, for example, blood and urine tests, ECG – electrocardiogram (heart tracing), and x-rays if needed. This reduces the length of time you will need to stay in hospital as an inpatient. See leaflet, “Your pre-assessment clinic appointment”. You can expect your appointment to last between 1 – 3 hours depending on what tests and checks need to be done. What do I need to bring with me? The National Institute for Health and Care Excellence (NICE) recommends that you keep warm, before, during and after your operation because it can reduce side effects, complications and help you recover from your operation faster.2 Please make sure you bring socks and slippers, a dressing gown, a vest or other warm clothing to help you feel warm while you are in hospital. Please arrange for someone to collect your clothing and any items you will not need while you are in hospital, as storage space on the wards is limited. Please bring in any new medicines your doctor may have started after your pre- assessment visit. If doses of any other medicines change after your pre-assessment visit you must tell your nurse or doctor when you are admitted. If you suffer from obstructive sleep apnoea (a condition where the walls of the throat relax and narrow during sleep). This means you stop breathing for short periods of time and use a Continuous Positive Airway Pressure (CPAP) machine please make sure you bring your CPAP machine into hospital with you. Surg/470 (2015) Page 4 of 11 For Review Summer 2018 Laparoscopic Gastric Bypass What will happen while I am in hospital? On admission to the ward, you will be introduced to your ‘named nurse’ who is responsible for planning your nursing care with you. Your named nurse is part of a team of nurses who are there to help and advise you on a day-to-day basis, and to make your stay as comfortable as possible. You will be weighed on admission. If you have not lost enough weight on the liver shrinkage diet it will be discussed with you whether it is safe to proceed with your operation.