Key Messages

Risks and Benefits of Each Surgery

I need to understand the benefits and risks of each surgery type before I make a decision with my surgeon about the one that makes sense for my health and my life.

Complications

I am aware that complications can happen. For my long-term well-being, I need to learn about possible complications, how to prevent them, and what to do if they occur.

Excess Skin

Excess skin is a very common side effect. Everyone reacts differently to having excess skin, but it’s important to be prepared for it and learn strategies to adjust, cope, or (possibly) remove it.

Surgery as a Tool

I recognize that surgery is only a tool, and my lifestyle changes are the key to getting to and staying at a healthy weight and feeling my best.

Future Health Needs

I understand that living with this surgery is a life-long journey. It’s important that I understand how it impacts my future health, including family planning, medication use, and other health conditions.

Understanding the Basics of Metabolic and Bariatric Surgery

Kaiser Permanente offers two types of metabolic and bariatric surgery: gastric sleeve (sleeve gastrectomy) and gastric bypass (also called Roux-en-Y). There are many other types of surgeries, but Kaiser Permanente focuses on the gastric sleeve and gastric bypass because they are the safest and most effective.

How does surgery change the digestive system?

Hormone changes

The main way the surgery works is through hormonal changes that reduce hunger, decrease desire for food, and increase the feeling of fullness after eating.

Restriction

Surgery makes your stomach smaller. While this is a change, it’s not a significant contributor for keeping weight off.

Malabsorption

Surgery changes how your digestive system absorbs food. However, it is not the primary driver of weight loss—the hormonal changes are.

How is surgery done?

There are two main ways that surgery is done:

Laparoscopic procedure (most common). The surgeon starts with a small cut near the belly button. The belly is then filled with a gas to create space so it’s easier for the surgeon to operate. A thin tool called a laparoscope is inserted through the cut. It has a light and a tiny camera that sends a picture to a TV screen. A few other small cuts are made nearby so other tools can be inserted. The surgeon then performs the whole procedure using those tools.

Open procedure (less common). The surgeon makes one long cut and the operation is done through that opening.

Drawing of the tools needed. A Video Screen, Scope with Camera, Laparoscopic Instruments. Drawing of the front of patient shows instruments going into the stomach. Side view drawing shows intestines and gas bubbles.

The results from laparoscopic and open surgery are the same, but people typically recover faster from laparoscopic surgery and have fewer complications.

Why is it important to lose weight before surgery?

To improve the safety and effectiveness of your surgery, surgeons ask you to lose some weight before surgery. This does three things.

1. Decreases the size of your liver. This makes it easier for the surgeon to operate.

2. Makes the laparoscopic surgery safer. It also makes it less likely to be converted to an open procedure. This is because the gas pumped into your abdomen not only holds up your skin so the surgeon can see but also pushes down on major blood vessels, which can reduce blood pressure. If this happens, the surgeon can’t pump in more gas, which reduces visibility. The less visibility, the higher the risk of complications. Therefore, people with a higher BMI may be asked to lose more weight before surgery.

3. It can make it easier to lose weight after surgery. This varies for each person. In general, losing weight leads to a lower resting metabolic rate (the rate at which you burn calories at rest) and your body will burn fewer calories. Therefore, it can actually be easier to lose weight before surgery and use the surgery as a tool to help you lose and maintain more weight loss long term.

What happens during surgery?

Gastric Sleeve

Gastric Bypass

Sleeve gastrectomy surgery makes the stomach smaller by permanently removing most of it. Once you’re under anesthesia, the surgeon will place a small tube in your mouth and guide it down to your stomach. This tube is about the size and shape your stomach will be after surgery. The surgeon cuts the stomach around the tube’s outline. The part that’s left behind is closed with permanent staples. The tube is then carefully pulled back out.

With gastric bypass surgery, the stomach is separated into two parts. Each part is stapled shut. This leaves a small stomach pouch about the size of an egg. Like gastric sleeve, this small pouch limits (restricts) how much food you can comfortably eat.

Next, the small intestine is cut and reattached to the stomach pouch. This is the “bypass.” The other part of the intestine is reattached to your new digestive system so digestive juices can flow easily. Food now moves from the new stomach pouch directly to the lower part of the small intestine. In gastric bypass surgery, nothing is removed.

Is the surgery permanent?

Gastric Sleeve

Gastric Bypass

The final result is a reduction in the stomach’s size by 60 to 80%. The size of the new stomach is not permanent. It’s normal for the size of the stomach to grow over time, depending on eating patterns after surgery. Therefore, you must be committed to changing the way you eat, including taking vitamin and mineral supplements for the rest of your life. The final result is a stomach that can hold about 2 tablespoons of food (restriction) and a rerouting of the intestines to bypass the first 10 inches of small intestine (malabsorption). The size of the stomach after surgery is not permanent. It’s normal for the size of the stomach pouch and its connection to the intestine to grow over time, depending on eating patterns after surgery. Therefore, you must be committed to changing the way you eat, including taking vitamin and mineral supplements for the rest of your life.

What factors are important to consider in my surgery decision?

Gastric Sleeve

Gastric Bypass

Patients often have a goal weight that may or may not be realistic. Expected weight loss after surgery depends on many factors, including nutrition, physical activity, sleep, and mental health and wellness. A successful surgery gets you to a weight you can maintain with realistic lifelong lifestyle changes.

Patients often have a goal weight that may or may not be realistic. Expected weight loss after surgery depends on many factors, including nutrition, physical activity, sleep, and mental health and wellness. A successful surgery gets you to a weight you can maintain with realistic lifelong lifestyle changes.

 

Together, you and your surgeon will discuss all your options and make a shared decision on the type of surgery you would like to have. Review some of the recent Kaiser Permanente data to help inform your decision, including information on expected weight loss and health condition improvement.

Medication Changes After Surgery

Surgery can change the way you absorb certain medications, and you may need to work with your doctors to make changes.

Before surgery, it’s important to talk to your prescribing doctors about any medication you are on and have a plan for after surgery.

After surgery, it will be important for you to be aware of how you feel and speak up to your health care team if anything changes.

There are four key things to know when it comes to medications.

Medications to Avoid and Medications That Are Safe

After surgery you can no longer take certain common medications, but there are safe alternatives.

Medications to Avoid After Surgery

After surgery, you can no longer take nonsteroidal anti-inflammatory drugs (NSAIDs). These can cause ulcers or stomach irritation. This can lead to serious, long-term pain and additional surgeries. Some prescription medications may have weight gain side effects as well.

Over-the-Counter Medications to Avoid

  • Aleve/Naprosyn (naproxen)
  • Alka Seltzer products
  • Aspirin (including enteric-coated aspirin, baby aspirin, Bayer, Excedrin, etc.)
  • Motrin/Advil (ibuprofen)

Prescription Medications to Avoid

  • Celebrex (celecoxib)
  • Indocin (indomethacin)
  • Mobic (meloxicam)
  • Relafen (nabumetone)
  • Toradol (ketorolac)
  • Corticosteroids (prednisone, cortisone)
  • Bisphosphonates: Fosamax (alendronate), Actonel (risedronate)

Medications That Are Safe After Surgery

For Mild Pain

  • Tylenol
  • Tylenol Extra Strength

For Constipation

  • Colace & Peri-Colace
  • Dulcolax suppositories & tablets
  • Fleet enema
  • Glycerin suppositories
  • Magnesium citrate
  • Milk of Magnesia
  • Mineral oil
  • MiraLAX

For Upset Stomach

  • Maalox
  • Mylanta
  • Gaviscon
  • Rolaids
  • Tums

For Gas

  • Gas-X
  • Mylicon
  • Phazyme

For Cold Symptoms

  • Benadryl
  • Dimetapp
  • Robitussin
  • Safetussin
  • Sudafed
  • Triaminic
  • Tylenol cold products

For Diarrhea

  • Kaopectate
  • Imodium AD

 

IMPORTANT: Talk to your doctor about what is safe for you because some medications may not be suitable if you have other conditions (like high blood pressure).

For a quick reference, print the Metabolic and Bariatric Surgery Wallet Card to remind yourself and any health care professional you see about what you can and cannot have after bariatric surgery.

Family Planning

It’s recommended that you wait 18 to 24 months after surgery to get pregnant. This allows you to have maximum weight loss and reach a stable weight. You will also be able to build your nutrition back up to help make sure you have a safe pregnancy. Fertility improves with weight loss and people often become more sexually active. Therefore, it’s important that women of child-bearing age (still menstruating) actively choose a birth control method before surgery.

Learn more at the links below.

Life Care Planning

Because metabolic and bariatric surgery is a major procedure, it’s important to think about choosing someone to represent your health care wishes in case there is a time in the future when you can’t speak for yourself. At Kaiser Permanente, we have made this process simple and easy through our Life Care Planning program.

What is Life Care Planning?

Life Care Planning is Kaiser Permanente’s name for a process also known as advance care planning. We believe that all adults should plan in advance.

Life care planning involves two major choices

  1. Choosing someone you trust to make your health care decisions if you are incapable.
  2. Giving specific instructions about your care in the event of a sudden injury or illness.

Learn more at the links below.

Research

For detailed information about the statistics of surgery, see:

  • Arterburn D, Wellman R, Emiliano A, Smith SR, Odegaard AO, Murali S, Williams N, Coleman KJ, Courcoulas A, Coley RY, Anau J, Pardee R, Toh S, Janning C, Cook A, Sturtevant J, Horgan C, McTigue KM. Comparative effectiveness and safety of bariatric procedures for weight loss: a PCORnet cohort study. Annals of Internal Medicine. 2018;169:741-750.
  • Courcoulas A, Coley RY, Clark J, McBride CL, Cirelli E, McTigue K, Arterburn D, Coleman KJ, Wellman R, Anau J, Pardee R, Toh S, Janning C, Cook A, Williams N, Sturtevant J, Horgan C, Tavakkoli A for the PCORnet Bariatric Study Collaborative. Interventions and operations 5 years after bariatric surgery in a cohort from the US national patient-centered clinical research network bariatric study. JAMA Surgery. 2020;155:194–204.
  • McTigue KM, Wellman R, Nauman E, Anau J, Coley RY, Odor A, Tice J, Coleman KJ, Courcoulas A, Pardee RE, Toh S, Janning CD, Williams N, Cook A, Sturtevant JL, Horgan C, Arterburn D for the PCORnet Bariatric Study Collaborative. Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass: the national patient-centered clinical research network (PCORNet) bariatric study. JAMA Surgery. 2020 May 1;155(5):e200087. doi: 10.1001/jamasurg.2020.0087.
  • Coleman KJ, Huang YC, Hendee F, Watson HL, Casillas RA, Brookey J. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surgery for Obesity and Related Diseases. 2014;10(3):396-403.

It’s important to be prepared for possible side effects and complications after surgery. Explore Complications and Side Effects to learn how to prevent and manage any surgical complications and common side effects, including excess skin.

Looking for more support?

Explore more resources offered by Kaiser Permanente to help support you after surgery, including support groups, self-care apps, member stories, recipes, coaching, and more.

Options Support Group:

Center for Healthy Living:

Self-Care Apps: