What is Gastric Bypass (R-YGB) Surgery?

Laparoscopic Gastric Bypass (R-YGB) is the most commonly performed type among combined bariatric procedures. This method is known for its effectiveness in weight loss by both reducing stomach volume and shortening the absorption path in the small intestine.

The upper portion of the stomach is separated to leave a pouch of approximately 30–50 cc in size. A segment of the small intestine is bypassed and then connected to this newly formed small stomach pouch. As a result, patients feel full with significantly smaller food portions. Additionally, the absorption of high-calorie foods is notably limited.

With Laparoscopic Gastric Bypass (R-YGB), long-term and effective weight loss can be achieved. Like other restrictive surgeries, patients reach satiety with small food portions due to the reduced stomach pouch.

Gastric Bypass surgery can be reversed if needed, meaning its effects are not necessarily permanent.

In Which Conditions Is Gastric Bypass (R-YGB) Surgery Used?

This procedure is primarily used to treat morbid obesity. It is also effective in the presence of comorbid conditions, particularly in the surgical treatment of uncontrolled Type 2 diabetes, where positive outcomes have been observed.

How Is Gastric Bypass (R-YGB) Surgery Performed?

Preoperative Process

Patients considered for surgery undergo a thorough evaluation. In addition to physical examinations, endocrinology and psychiatry specialists also perform detailed assessments before the operation.

Surgical Procedure

Gastric Bypass is usually performed using laparoscopic techniques. In recent years, robotic-assisted surgery has also been used. The operation is carried out through 4 to 6 incisions, each about 1 cm in size. Similar to sleeve gastrectomy, a large portion of the stomach is bypassed. After the stomach is divided, one part is connected to the mid-section of the small intestine, bypassing the duodenum. The remaining stomach is not removed and continues to function. This prevents food from passing through the duodenum.

The main goal is to help the patient feel full with less food and reduce nutrient absorption.

Postoperative Process

Patients typically remain in the hospital for 4 to 6 days. Upon discharge, a diet plan is provided by a dietitian for the period until the first check-up. Throughout the first year, patients are closely monitored by a team including a bariatric surgeon, endocrinologist, psychiatrist, and dietitian.

Frequently Asked Questions About Gastric Bypass Surgery

What Are the Types of Gastric Bypass?

Roux-en-Y Gastric Bypass: In this technique, a small stomach pouch of about 25–30 cc is created near where the esophagus joins the stomach. This pouch is separated from the rest of the stomach using a special stapler device. A stoma is then created to connect this small pouch to a section of the small intestine. The new connection between the pouch and the intestine is called the Roux-en-Y limb. This allows food to bypass most of the stomach and the upper portion of the small intestine.

Mini Gastric Bypass: This procedure also uses stapling tools to reshape the stomach into a tube-like form. The resulting pouch is larger than in the Roux-en-Y method. Then, a part of the small intestine approximately 200 cm from its start is connected to this pouch. The main difference is that the mini bypass involves a simpler surgical technique with a single intestinal connection. The mechanism of weight loss is similar in both types.

What Are the Risks of Gastric Bypass Surgery?

Like other abdominal surgeries, this operation carries risks such as bleeding, infection, postoperative bowel obstruction (ileus), hernia, and anesthesia-related complications.
The most serious risk is leakage at the junction between the stomach and intestine, which may require an additional surgery.
Obesity-related risks such as blood clots in the legs or lungs (embolism) and cardiac issues may also occur.
Around 10–15% of patients experience some of these complications. However, serious complications are rare and most are manageable and treatable.

Who Is a Suitable Candidate for Gastric Bypass Surgery?

This surgery is appropriate for patients with a body mass index (BMI) of 40 or higher. It is also suitable for those with a BMI of 35–40 who suffer from obesity-related health conditions such as type 2 diabetes, hypertension, or sleep apnea.

How Long Is the Hospital Stay After the Surgery?

Patients typically remain in the hospital for 3–4 days after the surgery. However, preoperative evaluations or recovery-related issues may extend this period.

Can Heavy Lifting Be Done After the Surgery?

After discharge, patients should avoid lifting heavy objects for at least 6 weeks. Physical strain should be minimized during recovery.

When Can You Drive After Gastric Bypass Surgery?

Driving should be avoided for at least two weeks after the operation. However, patients may walk, climb stairs, and take showers during this time.

When Can Patients Return to Work?

Patients with desk jobs can usually return to work after 2–3 weeks. Those with physically demanding jobs should wait 6–8 weeks before resuming work.

When Does Weight Loss Begin After the Surgery?

Weight loss starts gradually, with the most rapid decline occurring in the early months. Maximum weight loss typically takes 1.5 to 2 years, during which patients may lose 70–80% of their excess weight.

Post-Gastric Bypass Nutrition Guidelines

Key Points in Postoperative Diet:

• Ensure to eat at least three balanced meals per day.
• Meals should prioritize protein first, followed by vegetables/fruits, and lastly whole grains.
• The first 2 weeks should consist of liquid meals, and weeks 3–5 should transition to pureed/soft foods.
• To avoid dehydration, drink at least 1.5–2 liters of fluids daily (minimum 6–8 glasses of water). Otherwise, symptoms like headaches, dizziness, fatigue, nausea, white tongue patches, and dark urine may occur.
• Choose soft, low-fat foods such as diet/diabetic puddings made with skim milk, mashed potatoes, softened cereals, cottage cheese, soft omelets, and mashed fish.
• Strictly avoid simple sugars (table sugar, sweets, candies, desserts, etc.).
• Chew food thoroughly until it reaches a pureed consistency. Poor chewing can cause blockage, discomfort, and vomiting.
• Ensure adequate daily protein intake. Three glasses of skim milk or soy milk per day can provide sufficient protein and calcium.
• Do not consume solid and liquid foods at the same time. This can fill the small stomach quickly and lead to vomiting or reduce satiety.
• Avoid drinking 30 minutes before and after meals.
• Eat slowly — two plates of food should take at least 20 minutes, preferably 45 minutes.
• Stop eating when you feel full or pressure in the middle of the abdomen.
• Keeping a daily food diary and tracking outcomes is beneficial.
• If vomiting occurs frequently, seek professional medical advice.

Foods to Avoid & Their Alternatives

What Is Dumping Syndrome?

Dumping syndrome occurs when high-sugar foods are consumed excessively, leading to rapid gastric emptying. Symptoms may include palpitations, sweating, dizziness, nausea, and fatigue.
To prevent this, limit sugary foods in your diet and follow a balanced nutritional program.

Sugary foods to avoid:

• Ice cream
• Milk chocolate
• Fruit yogurts
• Fruit syrups
• Commercial fruit juices
• Sugary mueslis
• Sweet buns and cakes
• Gummies, cookies
• Lemonade, sweetened tea
• Instant coffee, sugar cubes
• Honey, jam, sweet gum

👉 If consuming dessert, opt for diabetic alternatives.