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