In this procedure, a micro pouch is created from the native stomach by firing staplers that divide and seal the walls of the stomach. The micro pouch is then connected to a small intestine limb, known as the alimentary limb, which basically empties the micro pouch of what you eat and drink. If the small bowel were connected as a loop (if you recall high school biology, the small bowel is one tube that lies in several loops), then the patient would have sever and intolerable bilious vomiting (the small bowel contains the bile from the bile duct). Therefore, a specific procedure is created where the part of the bowel that goes to connect with the new stomach pouch does not contain the bile. At the same time, the part of the bowel that carries the bile from the bile duct side is connected further below to that limb. The bile travels through the biliopancreatic limb to join the alimentary limb to form a common channel and helps in digestion of fat and protein. If you cannot understand this, please ask at your consultation and this will be explained in details.
The bypass results in weight loss due to reduced intake of food (restrictive component) and non-digestion of fat (malabsorptive component). This creates a negative energy balance that helps ensure not just weight loss but also long term weight maintenance. There is, in addition, a massive internal hormonal response to the surgery that leads to remission of diabetes. This is known as the incretin effect. This effect (named after the hormone class called incretins) gives the patient a long term powerful weapon that is effective against metabolic disorders like diabetes mellitus, hypertension, high cholesterol, OSA, Infertility and fatty liver, among several others.
Like other bariatric operations, the RNYGB is done by the lap approach, with no big cuts, stitches, or significant pain after operation. Recovery is typically rapid. Post surgery liquids are started a few hours after the surgery and increased in frequency. After the first week, a high protein diet is started. Routine chores like household work, personal care and walking are encouraged immediately after the operation. Abariatric nutritionist is available to guide you throughout your weight loss journey and beyond.
When can you join office? A week would be good, broadly speaking. When can one go to the gym? A couple of weeks to start mobility or therapy would probably be okay, but heavy lifting or straining when one is very obese is not without its downsides of injuries. It might be better to wait till some more weight is lost. Give it a couple of months!
Travel to other cities or a country is another issue. If you travel, you might have problems with keeping your recommended foods available all the time. You might have junk food easily available when you feel hungry, and that is what you might choose by compulsion. If you are travelling back home after surgery, it is a different story. That should be fine.
Remember, any deviation from smooth recovery is a cause for concern. Vomiting, tummy pain, breathlessness or fever and even general uneasiness should lead to an immediate review by your surgeon. Delay is the danger.