GASTRIC BYPASS

In a mini gastric bypass, or loop gastric bypass, a surgeon attaches a loop of small intestine to the gastric pouch, rather than dividing the small bowel and attaching the Roux-en-Y to the gastric pouch.

Doctors on RealSelf strongly caution against the procedure, and the vast majority of bariatric surgeons will not perform it, due to its high likelihood of complications down the road. 

Mini gastric bypass may appear to be a cost-saving, less invasive alternative, but it’s not worth the risk.

Pros

• Gastric bypass surgery can be a lifesaving measure, greatly reducing your risk of dying from obesity-related complications like heart disease.
• The surgery can help patients achieve dramatic weight-loss results over time.
• Research also shows a decreased risk of severe kidney disease after a gastric bypass procedure.
• It’s a favorable long-term solution, if immediate or drastic lifestyle changes are not realistic for you.
• It has a high satisfaction rate among RealSelf members, with 96% saying it’s “Worth It.” Better health, the ability to be more active, and higher self-esteem are some of the benefits reported by RealSelf members who’ve had the surgery.

Cons

• Gastric bypass is typically an in-patient procedure, requiring at least a two-night hospital stay for your initial recovery.
• You’ll need to take about two weeks of downtime and stay on a liquid diet for six weeks post-surgery. 
• You’ll still need to eat a healthy diet and exercise to lose the weight and keep it off, otherwise you may require a gastric bypass revision.
• Following a gastric bypass, you’ll be put on a supplement regimen and need to maintain it long-term.
• Major weight loss can create sagging excess skin, which may require body lift surgery to remove.

• Average Cost:
• $12,650

Gastric bypass surgery cost typically includes fees for your surgeon, hospital stay, and anesthesiologist. 

All or part of this cost may be covered by your health insurance, but some insurance carriers exclude all types of bariatric procedures. Whether your health insurance pays for the procedure will also depend on your current BMI and documented obesity-related health issues. If your insurance won’t cover gastric bypass surgery, there are financing options.

See our complete guide to gastric bypass surgery costs and insurance

The gastric bypass photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

This surgery is generally safe when it’s performed by an experienced, board-certified bariatric surgeon. That said, it does come with risks of potential complications, including:

• excessive bleeding 
• infection 
• blood clots
• breathing issues

In rare cases, these complications can lead to death.

According to the Center for Metabolic and Weight Loss Surgery at Columbia University, “Operative complications such as bleeding or intestinal leakage can occur in less than 2% of patients.” Researchers cited a mortality rate of 0.5%, though the ASMBS reported in 2012 that the 30-day mortality rate for gastric bypass was 0.14%, compared to 0.08% for sleeve gastrectomy and 0.03% for gastric banding. 

Talk with your doctor and weigh these risks against the risks that come with chronic obesity, which has about a 5% mortality rate.

Your life expectancy, health, and quality of life should improve significantly after a gastric bypass procedure. However, long-term side effects can include:

• Gallstones
• Hernias 
• Bowel obstructions 
• Malnutrition 
• Ulcers 
• Hair loss
• Gastrointestinal troubles, like dumping syndrome, which comes with nausea and diarrhea 

Talk with your surgeon about how to mitigate these potential side effects.

Abdominal pain can signal an internal hernia. According to research, this occurs most commonly “within two to three years after primary gastric bypass, often in the context of significant weight loss.” Most internal hernias can be repaired laparoscopically.

The ideal gastric bypass candidate has a body mass index (BMI) of 40 or greater. However, if your BMI is at least 35, you may still qualify for the surgery if you have at least one medical condition related to obesity, such as: 

• Type 2 diabetes
• High blood pressure (hypertension)
• Sleep apnea
• Gastroesophageal reflux disease
• Heart disease
• High cholesterol
• Stroke
• Infertility

One study published in 2016 shows that gastric bypass surgery reduces the risk of dying from obesity and other related diseases by 48% for up to 10 years post-surgery. 

A 2019 study in the journal Diabetologica suggests that gastric bypass can send type 2 diabetes into remission. Dr. Shawn Garber, a bariatric surgeon in Roslyn Heights, New York, explains that “the American Society for Metabolic and Bariatric Surgery [ASMBS] has recently lowered the qualifying criteria, saying that gastric bypass should be an option for people with a BMI of 30 to 35 if they also have type 2 diabetes.” Unfortunately, this criteria hasn’t yet been accepted by most insurance carriers.

To see whether you’re a good candidate for this weight-loss surgery, consult with a board-certified bariatric surgeon.

Here’s what you can expect in the lead-up to your procedure:

• You’ll likely be sent to a cardiologist, a pulmonary sleep physician (to check for sleep apnea), a nutritionist or dietitian, a psychologist, and a gastroenterologist. 
• You’ll have blood work to check your vitamin levels. 
• If a health issue is discovered during one of these exams or tests, it won’t necessarily preclude you from having the procedure, but it will have to be addressed first, says Dr. Garber. “For example, if the cardiologist finds a blockage in an artery of the heart, we’ll send you for a cardiac stent before scheduling your surgery.”  
• You’ll also need to be motivated to change your lifestyle habits and food intake before and after surgery. There’s typically a pre-procedure diet to follow (in fact, some insurance companies require it for coverage), as good nutrition and smaller portions are absolutely essential for long-term weight loss after the surgery.
• Your dietitian will put you on a liquid, high-protein diet for at least three weeks prior, to help shrink your liver and make the stomach below it more accessible.
• You may be required to start a physical activity program, stop any tobacco use, and adjust your medications and supplements.
• It’s also a good idea to prepare for your recovery by arranging a ride to and from the hospital and enlisting lots of help for your initial recovery.

The procedure itself is typically performed in a hospital, under general anesthesia. Here’s how it works.

• First, your surgeon will make five or six small incisions in your abdomen to insert the laparoscope. 
• Then they’ll use titanium staples to shrink your stomach, creating a small stomach pouch about the size of an egg. 
• Next, they’ll cut your small intestine, hooking one end (called the Roux-en-Y limb) up to the stomach pouch and reconnecting the other end lower down on your small intestine. How long or short your surgeon makes it will be based on your BMI and their technique. 
• Your surgeon may also insert temporary surgical drains from your abdomen, to prevent buildup of excess fluids as you heal.
• Finally, they’ll close the small incisions with sutures or surgical glue.

Doctors on RealSelf say you’ll need at least two and possibly three weeks of downtime after this procedure. 

Here’s what to expect—and look out for—during that time.

Follow Up

• Your surgeon’s team will be in close contact with you post-op. 
• Plan for follow up visits at regular intervals (which vary slightly by surgeon): about 2-3 weeks after discharge, and then around 6 weeks, 3 months, 6 months, one year, and two years after surgery.

Discomfort

• Laparoscopic surgery means less pain and recovery time than you would have with an open procedure, but you’ll still feel some soreness at the incision sites. 
• Your doctor will prescribe pain medication to help you manage it. 

A Liquid Diet

• Your doctor will put you on a liquid diet (or order pureed and soft foods only) for six weeks before you can return to solid foods. 
• You’ll also be put on a course of vitamin supplements, to avoid becoming deficient. 
• Your doctor will run blood tests every three months for the first year (and less often after that) to check your vitamin levels. 
• Supplements are generally a lifelong requirement after gastric bypass surgery, in order to prevent nutritional deficiencies caused by malabsorption.

Light Exercise

• You’ll be up and walking within a day, to prevent blood clots.
• Avoid heavy lifting or strenuous activity until you’re ready to begin exercising in earnest (typically within four to six weeks), to avoid hernias in the wounds. 

Gastrointestinal Issues

• You may experience side effects—most commonly, dumping syndrome, which happens when food moves too quickly from the stomach to the small intestines, potentially leading to nutrient malabsorption and malnutrition. 
• Anytime from between a few minutes after eating to a few hours later, you may experience sweating, flushing, nausea, cramping, and diarrhea. 
• These effects are temporary, and you can prevent them by eating smaller meals, chewing food well, and avoiding high-carb, high-sugar foods. Dumping syndrome is especially common after eating carbohydrate-rich foods, so skip the bread, rice, and pasta (as well as alcohol) until you’re fully healed, and consider permanently avoiding these foods, to help reach and maintain your desired weight.

Potential Hair Loss

• Three to six months post-op, you may experience hair loss. 
• The physical stress of the surgery and rapid weight loss can cause a temporary (but sometimes severe) bout of shedding. 

Sagging Skin

• Significant weight loss can leave enough sagging skin that can’t be tightened—only removed with body lift surgery. “Bariatric surgery can create a need for five or six plastic surgeries, to treat the excess skin,” says Dr. Daniel Rosen, a New York City bariatric surgeon. 
• If you develop sagging skin that causes discomfort, irritation, and rashes, discuss it with your surgeon. Your health insurance provider may cover surgical procedures to eliminate excess skin after weight loss.

Your surgeon will give you specific recommendations on exercise, but this is the typical guidance:

• Start walking slowly for 15–20 minutes daily, starting the day after your surgery, to prevent blood clots. 
• Keep this up for four to six weeks, depending on how you’re healing. 
• As you start to feel better, introduce light exercises like leg lifts and arm rotations to build strength and flexibility. 
• Pick up the pace and take longer walks, if your body feels ready.
• Within six to eight weeks, you should be able to introduce more intense cardio into your workouts as well as strength training with weights.

During the first year to year and a half after gastric bypass surgery, patients lose 70% of their excess weight, on average. That being said, some patients start gaining weight back within 12–18 months, degrading their initial results. According to the Cleveland Clinic, this is almost always related to diet.

The ASMBS says studies show that 90% of patients maintain at least 50% of their weight loss for up to two decades. Typically, maintaining 50% of your weight loss five years after surgery is considered a success. 

Surgery is a tool, not a cure for obesity. Dr. Garber recommends that patients stick to a high-protein, low-carbohydrate diet and regular exercise regimen to lose weight and maintain their results. He also suggests avoiding carbs, sugar, and fatty foods and taking supplements, like vitamin B12, iron, and calcium regularly.

Beyond sheer weight loss, gastric bypass patients typically see their cardiovascular health, energy levels, and quality of life improve following surgery.

According to a 2011 study, infertility problems related to obesity tend to improve after significant weight loss from gastric bypass.

You can have a baby following gastric bypass surgery, although doctors strongly recommend waiting to become pregnant until after your weight has stabilized. 

Pregnancy post-surgery is also not without risks: In one documented incident, midgut volvulus (a condition where the intestines become twisted during pregnancy) led to fatal sepsis in a 31 year-old woman who previously had Roux-en-Y gastric bypass surgery.

A sleeve gastrectomy, also called gastric sleeve surgery, is the most common type of bariatric surgery done today. It reduces the size of your stomach by about 80%, physically removing a part of the stomach from your body and leaving what remains in the shape of a narrow tube or sleeve. 

Gastric sleeve surgery is similar to a laparoscopic gastric bypass, but it doesn’t involve bypassing the intestines, which may reduce the risk of complications.

Many bariatric surgeons prefer the sleeve to gastric bypass because it’s less invasive but still very effective. A whopping 98% of RealSelf members say their sleeve gastrectomy was “Worth It.”

Endoscopic sleeve gastroplasty (aka ESG) is also gaining popularity. Unlike a traditional sleeve gastrectomy, this minimally invasive, low-downtime, outpatient procedure does not remove a part of the stomach, but rather reshapes it to limit food consumption and calorie absorption.

An ESG involves guiding a tiny camera and endoscopic suturing device down your throat, into your stomach. By stitching a series of folds into the stomach, your surgeon reduces its size to about that of a banana, dramatically shrinking its capacity while slowing the transit of food to help patients feel full longer.

With an ESG, patients typically lose 15% to 20% of their total body weight after one year.

American Society for Metabolic and Bariatric Surgery staff, 10-year data shows gastric bypass patients significantly reduce risk of dying early from obesity and other diseases (2016)

American Society for Metabolic and Bariatric Surgery staff, Metabolic and Bariatric Surgery (2013)

American Society for Metabolic and Bariatric Surgery staff, Studies Weigh in on Safety and Effectiveness of Newer Bariatric and Metabolic Surgery Procedure (2012)

Baggesen L., Madsen L., Richelsen B., Thomsen R., Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes (2019)

Cleveland Clinic staff, How to Keep the Weight Off After Bariatric Surgery (2019)

Columbia University Department of Surgery staff, Gastric Bypass Surgery (n.d.)

Diaz J., Kaunitz A., Kerwin A., Sanchez-Ramos L., Maternal death caused by midgut volvulus after bariatric surgery (2005)

Eliasson B., Franzén S., Liakopoulos V., et al., Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes (2019)

Greenstein A., O’Rourke R., Abdominal Pain following Gastric Bypass: Suspects & Solutions (2011)

Kominiarek M., Preparing for and Managing a Pregnancy After Bariatric Surgery (2011)