Implications of bariatric surgery
After an OLB and RYGB the anatomy has been changed due to the transection of the proximal stomach to create the pouch. Therefore the distal stomach cannot be entered with an endoscope (gastroscopy). In case of stones in the bile duct an endoscopy (ERCP) is not possible to retrieve the stones, so if necessary the bile duct may be operated on by using minimal invasive keyhole techniques.
Smoking can promote inflammation of the stomach, which can lead up to a gastric perforation. Therefore, smoking after an OLB and RYGB should be avoided.
Sometimes loose bowel motions are possible and may require oral medication. Also reported are changes of the taste and food intolerances and some temporary hair loss.
It may happen that during a bypass procedure (OLB, RYGB) dense adhesions in between the small bowel loops and the abdominal wall are encountered and the loop of bowel to perform the bypass cannot be moved up and joined to the planned gastric pouch. To still offer a safe bariatric operation the planned bypass procedure needs to be converted to a SG.
Especially after OLB or RYGB deficiencies particularly of iron, protein, calcium, micronutrients and Vitamin B12 are possible. Therefore regular blood tests and an intramuscular vitamin B12 injection every 3 months are required. In most patients these deficiencies are easily preventable by following the diet recommendations and taking daily multivitamin tablets.
The safe use of oral contraception (birth control pills) cannot be guaranteed due to the altered drug absorption from the gastrointestinal tract after all types of bariatric surgery. Pregnancy should be avoided within 24 months after bariatric surgery due to the ongoing weight loss. For all female patients of childbearing age a contraceptive hormone injection is suggested.
Weight regain can occur after all types of bariatric surgery. It is seen more frequently after SG than after OLB or RYGB. If over the time an increasing volume of food is consumed the gastric pouch can slowly dilate, the meal sizes will increase and the procedure loses its effect and weight will be gained. Regular attention to weight gain and a quick responds (e.g. contact dietitian) is necessary.
Postoperative follow up after all bariatric operations: In the first year after the operation regular medical checkups should be done every 3 months, in the second year every 6 month, after that annually. The daily intake of a multi vitamin tablet to prevent vitamin or micronutrients deficiencies is strongly recommended. Furthermore, in order to prevent osteoporosis (bone weakness) you will need a calcium-rich diet. Specifically after any bypass procedure the intake of sweets or high-calorie beverages should be avoided since it can cause discomfort.