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side effects of surgery

1) Dumping syndrome
Symptoms may occur early (during a meal or within 15 to 30 minutes following a meal) or later.

Early symptoms include:

  • Nausea
  • Vomiting
  • Abdominal pain, cramps
  • Diarrhoea
  • Dizziness, light-headedness
  • Bloating, belching
  • Fatigue
  • Heart palpitations, rapid heart rate

When signs and symptoms develop later, they may include:

  • Sweating
  • Weakness, fatigue
  • Dizziness, light-headedness
  • Shakiness
  • Feelings of anxiety, nervousness
  • Heart palpitations and rapid heart rate
  • Fainting
  • Mental confusion
  • Diarrhoea

Some people experience both early and late signs and symptoms. Dizziness and heart palpitations can occur either early or late or both. No matter when problems develop, however, they may be worse in the aftermath of a high-sugar meal, especially one that's rich in sucrose (table sugar) or fructose (fruit sugar).

Some people also experience low blood sugar (hypoglycaemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Hypoglycaemia is more often related to late signs and symptoms. Insulin influences your tissues to take up the sugar present in your bloodstream.

It is unpleasant, but not dangerous.

It can occur after any surgery in which the pylorus is removed or destroyed.

The normal stomach mills swallowed food into a watery paste. It then delivers small aliquots of this paste, via the pylorus, into the duodenum, where the food mixes with pancreatic juice and bile. It takes 4-6 hours for the stomach to empty a normal meal into the duodenum. Without a pylorus, food can pass directly and rapidly into the duodenum and intestine, without first being churned into a paste.

Dumping syndrome occurs when the undigested contents of your stomach are transported or "dumped" into your small intestine too rapidly. It results from rapid entry of food, especially sugar-rich food, into the small intestine. Gastrointestinal hormones are believed to play a role in this rapid dumping process.

If you dump, you have probably been eating food that contains undesirably high sugar content and / or eating too fast.

Dumping can be avoided by not eating large amounts of sugary food and by eating SLOWLY. Although it is a side effect, it can be viewed as a beneficial side effect, because it will discourage you from undesirable eating behaviour.


Dietary treatment strategies:

  • Eat small meals. Try consuming about six small meals a day rather than three larger ones.
  • Avoid fluids with meals. Drink liquids only between meals.
  • Change the makeup of your diet. Consume more low-carbohydrate foods. In particular, avoid simple carbohydrates such as sugar (found in sweets like candy, cookies and cakes). Read labels on packaged food before buying, with the goal of not only avoiding foods with sugar in their ingredients list, but also looking for (and staying away from) alternative names for sugar, such as glucose, sucrose, fructose, dextrose, honey and corn syrup. Artificial sweeteners are acceptable alternatives. Consume more protein in your diet and adopt a higher fibre diet.
  • Increase pectin intake. Pectin is found in many fruits, such as peaches, apples and plums, as well as in some fibre supplements. It can delay the absorption of carbohydrates in the small intestine.
  • Avoid acidic foods. Tomatoes and citrus fruits are harder for some people to digest.
  • Use low-fat cooking methods. Prepare meat and other foods by broiling, baking or grilling.
  • Consume adequate vitamins, iron and calcium. These can sometimes become depleted in the aftermath of stomach surgery. Discuss this nutritional issue with a registered dietician.
  • Lie down after eating. This may slow down the movement of food into your intestines.
  • Rarely, people continue to experience severe symptoms associated with dumping syndrome, despite dietary changes. These people may require medication.


Medications:
The drugs prescribed aim to slow the passage of food out of your stomach.
They are most appropriate for people with severe signs and symptoms. They don't work for everyone.

  • Acarbose. This medication delays the digestion of carbohydrates. Doctors prescribe it most often for the management of type 2 diabetes, and it has also been found to be effective in people with late-onset dumping syndrome. Side effects may include sweating, headaches, pallor, sudden hunger and weakness.
  • Octreotide (Sandostatin). This drug can slow down the emptying of food into the intestine, and is injected under the skin.


2) Specific Nutritional Side Effects:
After RYGBP your calcium, iron and vitamin B12 absorption will be impaired. You will have to take supplements of these for the rest of your life.

The site of maximal absorption of dietary iron and calcium is the duodenum. As the duodenum is bypassed in the RYGBP and biliopancreatic diversion operations (BPD), absorption of these two essential trace elements will always be reduced after these operations.

Therefore it is essential to take daily supplements of iron and calcium for the rest of one's life after these operations.

Dietary vitamin B12 (cyanocobalamin) is bound in the normal stomach to a co-factor called intrinsic factor, which allows vitamin B12 to be absorbed in the terminal ileum. Because the RYGBP leaves only a tiny portion of stomach, there will be inadequate intrinsic factor binding to dietary vitamin B12 so it will not be absorbed. Vitamin B12 is essential for normal bone marrow function and nerve function and deficiency results in a type of anaemia (megaloblastic anaemia) and neurological disease characterised by balance (proprioception) problems due to damage to the posterior columns of the spinal cord.

Therefore it is essential to take regular supplements of Vitamin B12 by intramuscular injections every 4 months for the rest of one's life after these operations.


3) Loss of Access to the By-passed Stomach and Duodenum:
When people who have not had a gastric bypass suffer from upper abdominal symptoms, doctors often investigate these symptoms by inserting an endoscope into the stomach and duodenum or giving the patient contrast materials to drink for X-ray examinations. Sometimes these routes are also used for treating various problems in the stomach, duodenum, bile duct or pancreatic duct.

After a RYGBP, the bypassed stomach and duodenum are no longer accessible to the above investigations and therapeutic manipulations. Because they have not been removed, there is still the potential for them to become diseased in the future. In order to reduce the risk of that happening, we advise that all patients planning to have a gastric bypass operation have an upper gastrointestinal endoscopic examination and an ultrasound examination of the abdomen before their operations. If any pathology is discovered at these investigations we advise that that pathology be treated effectively before proceeding with the gastric bypass surgery. Similar recommendations apply to patients for whom biliopancreatic diversion operations are planned.