Weight loss surgery
Roux-en-Y gastric bypass: the gold standard against which other operations are measured.
Your surgeon: Stefanos Lazaridis MD, FRCS, Director, 11th Surgical Clinic for Obesity & Reflux, Metropolitan General, Athens · formerly NHS Consultant in Upper GI & Bariatric Surgery, London
Short answer
In a gastric bypass a small stomach pouch of about 20 ml is created and joined directly to the small intestine, so food bypasses most of the stomach and the first part of the gut. It works by restricting portions, reducing hunger hormones and changing how the gut signals to the brain. It gives somewhat greater long-term weight loss than the sleeve and is the operation of choice for people with reflux or type 2 diabetes.
Who it suits
How it is done
The operation is done laparoscopically through five small incisions of about 1.5 cm, even when it follows a previous operation, and takes about two to two and a half hours. You will be up and walking, and drinking fluids, on the day of surgery. The hospital stay is about 48 hours. If you are travelling from abroad, plan to stay in Athens for at least seven days after surgery. The stomach is divided to create the small pouch. The small intestine is divided and one end joined to the pouch; the other end is reconnected 100–150 cm further down, so digestive juices meet the food later.
Results
Many people with type 2 diabetes need far less medication, or none, after a bypass. Reflux usually improves markedly.
| Excess weight lost | Gastric bypass | Gastric sleeve |
|---|---|---|
| 5 years (SM-BOSS) | 68% | 61% |
| 10 years (SLEEVEPASS) | 51% | 44% |
| Oesophagitis at 10 years | 7% | 31% |
Sources: Salminen P. et al., SLEEVEPASS 10-year results, JAMA Surgery 2022. Peterli R. et al., SM-BOSS 5-year results, JAMA 2018. Figures refer to the percentage of excess weight lost.
Advantages and risks
Travelling for surgery
Length of stay, flying home, follow-up and emergencies: information for international patients.
We start with a video call. You send your history and any tests, and we decide together whether surgery makes sense before you book a flight.
With your consent I send a full report to your GP or specialist at home. The specialist follow-up stays with us.
Regular follow-up by video call and email, with a clear plan for blood tests and supplements that you can arrange locally.
Questions
Technically it can be reversed, because no stomach is removed, but this is rarely needed or advised.
Short courses as part of pain relief around the operation are fine and reduce the need for opioids. Regular or long-term use of drugs such as ibuprofen is avoided after a bypass, because it increases the risk of an ulcer at the join.
Yes. Conversion is the most common revisional operation, usually for reflux or weight regain after a sleeve. It is also done laparoscopically.
Most people with office jobs return after about two weeks. Heavy physical work usually needs four to six weeks.
At least seven days after surgery, unless you live a short trip away. The hospital stay itself is about 24 hours after a sleeve and 48 hours after a bypass; the rest of the week lets us check your recovery before you travel.
Next step
Send us your details and I will contact you to discuss your options, by phone or video call.