Six Stages of Eating After a Gastric Bypass

You are likely to pass through 6 separate stages of eating after your gastric bypass operation.

Recently I saw a patient who had a laparoscopic Roux en-Y gastric bypass by me a few months ago who was quite frustrated that she could not eat and drink what she wanted to consume. She wanted to eat a regular diet but was not yet able to eat as much solid food as she had expected. She seemed to be someone who could not allow the process to proceed in the usual fashion.

The fact is you cannot rush the healing process and trying to speed things up will only make a person frustrated and could be harmful. After performing several hundred of these operations there is a natural progression I have observed after a gastric bypass operation and it usually goes like this:



1). FIRST WEEK

It seems almost impossible to get as much liquid down. The only way to stay hydrated is to sip very small amounts every 15 minutes or so all day long.

2). WEEKS 2 THOUGH 5

Slowly liquids become somewhat easier to go down. This is when a patient starts learning how much they can swallow at one time. If you drink faster than the pouch can empty fluids will back up in the esophagus and cause a pressure sensation in the chest. Slowing down even more will relieve this unpleasant sensation.

3). WEEKS 6 THROUGH 9

The patient often feels they are having more difficulty eating and drinking than they had over the previous few weeks. This is because the connection between the gastric pouch and the intestine is healing and the scar is becoming thicker resulting in a narrower outlet to the pouch. Just as you have observed when you have cut yourself the scar is relatively smooth for the first few weeks but it becomes thicker and more angry looking at about 6 to 9 weeks. As the scar is remolded the scar will slowly become softer over the next several weeks and months. The scar at the connection between the gastric pouch and intestine goes through this same process and the thickened scar is the reason that it takes more time for the food and drink to pass out of the pouch into the small intestine. We frequently call this the “window of misery” and you will find a posting by that name elsewhere in this blog.

4). WEEKS 10 THROUGH 12

The scar that I mentioned above softens and the opening between the gastric pouch and the small intestine starts to slowly open up more and food and drink passes through more easily.

5). BETWEEN 3 and 6 MONTHS Although things continue to improve, usually meat and bread is still difficult unless the meat is ground and the bread is toasted to make the fragments and particles smaller.

6). BETWEEN 6 MONTHS and 1 YEAR Things continue to Improve and sometime during this period patients begin to have less and less difficulty swallowing meats and bread. By this time the diet has returned to normal although many people tell me there food choices have changed considerably and they eat much healthier.

Hopefully this week by week description will help you as you go through the various stages and you will be more patient with yourself since you know better days are coming.

By Stephan Myers, MD, FACS, bariatric surgeon in Columbus, Ohio

Difficulty Eating during the 'Window of Misery'

I had a patient in the office today about 8 weeks out from her laparoscopic Roux en-Y gastric bypass. She had lost about 50 lbs and was concerned about having more difficulty eating some solid foods than she seemed to have just a few weeks ago. I explained the symptoms she is experiencing are fairly common for people 6 to 9 weeks after a gastric bypass. Some people call this time “the window of misery”. Although most patients will not be bothered by symptoms during this period of time, others will experience temporary difficulty.

When a gastric bypass operation is first performed I use a 25 mm circular stapler to make the connection between the gastric pouch and the small intestine so the outlet size is consistent. Initially the connection is about the size of your thumb and there is minimal resistance to food and drink. The connection heals by the body laying down scar tissue. As the healing process continues over the next several weeks, more scar tissue forms and the scar contracts making the outlet of the pouch become smaller. Eventually between 6 and 9 weeks, during the “window of misery”, the size of the outlet is only the size of the tip of your little finger or even less.

Because the outlet is so much smaller there is more resistance to the food passing through the new opening. Therefore to get food to pass it takes longer and the particle size may need to be reduced. In fact if a patient continues to try to eat and drink as they have in the first few weeks after their operation they can make themselves miserable. If they eat faster than the pouch can empty, the food and drink will back up into the esophagus and the will experience a squeezing pressure in their chest from the contractions of the esophagus trying to push the food through the smaller opening. This pain in the chest after eating means the patient is eating faster than the food is able to leave the pouch.

Fortunately, after about 9 weeks the scar will slowly mature. As the scar softens the outlet will become larger again allowing more food to pass more quickly. Over time the symptoms will become less frequent.

Nevertheless, even at 6 months it is likely that a patient will occasionally have difficulty with some foods such as bread, chicken or steak. Sometime between 6 and 12months even these foods will pass more easily.

About once a year in our practice the narrowing becomes so small it is difficult for anything to pass. This is called an anastomotic stricture meaning there is a severe narrowing or stricture at the anastomosis or connection between the pouch and intestine. If this happens the patient should have an upper endoscopy and a special balloon is passed to dilate the opening. After this is done the patient will be able to eat and drink normally the same day. This procedure can be performed without the patient staying in the hospital overnight.

But for most people if they are patient and take liquids with small particles until after 9 weeks following surgery they will not need a dilation and will get through this time without difficulty.

Weight loss in the first year

There is a “Magic Year” after a bariatric operation is your year to get your weight off.

Gastric bypass and gastric sleeve patients will lose nearly all of the excess weight that they will lose from their operation by the end of one year after the operation. (Gastric band patients also lose most of the weight they will lose in the first year but their weight loss is usually slower and it takes about 3 years to reach a stable lower weight.)

In our practice it is common that patients lose about 20 lbs a month for 2 or 3 months then 15 lbs for a couple of months then 12 lbs for a couple of months and so on slowly decreasing the amount of weight they lose over the first year until their weight is stable. Our patients lose about 80% of their excess weight at one year for both of these operations. The most frequent BMI I see from patients having these operations a BMI of 28.

After the one year time period the operation will help the patient to keep the weight off but is unlikely to cause very much more weight loss.

Do not miss your year of opportunity! This is your year to get your weight off.

The weight loss stops because after one year a patient is able to consume enough food to meet their caloric needs and weight loss will probably soon come to a halt.

This is why it is so important to do everything your bariatric surgeon ask of you especially during that all important first year after the operation.

In our practice we ask patients to start their exercise program at 3 to 4 weeks after the operation and avoid liquid calories whenever possible and keep the portion size of each meal at an appropriate level and follow the directions of the dietitian. Other suggestions to lose or maintain weight loss can be found on the June 4, 2010 posting on this blog: “8 Rules for Long Term Success after Bariatric Surgery”.

We want all bariatric surgery patients to obtain their best result so make sure you are determined to make the most of your “Magic Year” after bariatric surgery.

Remember, where your weight is at 1 year is probably where you can expect it to stay if you do what is asked thereafter.

Advice from Steve Myers, MD, bariatric surgeon in Columbus, Ohio

Welcome to Your Gastric Bypass Guide!

I am happy to welcome you to Your Gastric Bypass Guide, a blog that will help to inform and answer all aspects of Gastric Bypass for you. Here you will find helpful information regarding the surgery, tips for success, and a platform for you to ask questions of a Surgeon regarding the surgery. I know that you want to educate yourself on this topic before making the very important decision whether or not to get a Gastric Bypass Surgery.

Please leave any questions that you have about the procedure in the comment section under each posting and I will do my best to answer all questions.

Gastric Bypass Procedure Performed by Dr. Stephan Myers