Gastric Bypass Surgery – All You Need to Know

While gastric bypass surgery is costly, the long-term costs of obesity-related health problems for people who don’t get the surgery are even higher.

Compared to morbidly obese people who don’t have surgery, bariatric patients pay off their entire surgery and start getting ahead financially after only 2 years (34).

Fewer prescription drugs alone have been found to save patients $3,000 or more per year (35).

A study published by the American Journal of Managed Care (AJMC) found that bariatric patients pay as much as $900 less per month as soon as 13 months after surgery than similar people who didn’t have surgery (36). That’s almost $11,000 per year in total medical costs saved for bariatric patients versus morbidly obese people who do not have surgery.

Gastric bypass has the 2nd highest average cost out of the 7 available types of weight loss surgery, if you don’t have insurance. It is tied for the lowest cost for patients with insurance.

Free Insurance Check & Cost Quote:Click here to contact a gastric bypass surgeon

See our Types of Bariatric Surgery page for a full comparison.

Gastric bypass financing is available in most locations. With no insurance, patients can obtain financing for the entire cost of surgery. With insurance, patients can get assistance with paying large deductibles or other out-of-pocket expenses.

Options for making surgery more affordable include (follow links for more information):

• Payment Plan Through a Qualified Bariatric Surgeon – This is probably your most realistic and affordable local non-insurance option
• Brokers, Direct Lenders and Credit Cards (Unsecured Medical Loans)
• Friends & Family
• Secured Medical Loans
• Retirement Plan Loans
• Permanent Life Insurance Loans
• Medical travel – having surgery in a location that is less expensive than where you live

Most countries provide tax benefits to gastric bypass patients who qualify.

In the United States, if your specific policy covers bariatric surgery, gastric bypass surgery will be covered.

Whether your policy covers bariatric surgery depends on what kind of plan you have:

1. Individual/Family Plans & Small Group Plans (through Work, under 50 employees) – The Affordable Care Act (Obamacare) requires insurance companies in many states to include coverage for bariatric surgery. Click here for an updated list of states required to cover bariatric surgery.
2. Large Group Plans (through Work, 50+ employees) – Whether bariatric surgery is covered by your insurance is completely up to your company to decide. Talk with your HR department or contact your insurance company to find out if it’s covered.
3. Medicare & Medicaid – Medicare and Medicaid both cover gastric bypass surgery, although not all surgeons accept them.

Click the links below for more information:

Gastric bypass surgery is currently covered in the following provinces:

• Alberta
• British Columbia
• Manitoba
• Newfoundland and Labrador
• Nova Scotia
• Ontario
• Quebec
• Saskatchewan

Wait times range from 2 years to over 10 years, leading two out of every 3 patients to use private-pay clinics instead of public facilities.¹

See our Weight Loss Surgery in Canada Patient Guide for more information.

Click here to find a private-pay clinic in Canada or the United States.

Australian Medicare will provide some reimbursement for gastric bypass surgery, although the rebate amount will still leave the majority of costs up to you and your private insurance.

To determine your rebate amount, Medicare applies a set rate to each covered procedure (that is much lower than the actual surgery costs), then they give you a rebate of 75% of that set rate.

For example, if the total procedure costs $10,000 but Medicare’s set rate is $850, then Medicare will pay $637.50 of the total bill (850 X 0.75), and you and your private insurance will be responsible for the balance.

Click here to access the Medicare Benefits Schedule (MBS) database and type in Gastric Bypass Item Number 31572 for current reimbursement levels.

Private insurance in Australia usually covers bariatric surgery, although you will still have out of pocket fees (between $1,700 and $5,300 after Medicare rebates).

Since obesity is considered a pre-existing condition, you will probably have to wait 12 months between joining a health fund and getting approved for surgery.

To get the specific coverage information and your out of pocket costs from your health fund, contact them directly and provide them with the same Medicare Item Number: 31575.

Click here for a full list of Australian health funds and their contact information.

Click here to find a top bariatric surgeon in Australia or here for our Australia Patient Guide.

During the weeks leading up to gastric bypass surgery, your surgeon’s team will do the following:

• Pre-procedure health assessment, where you will be asked questions about your medical history, medications, and surgical history
• Order certain tests like an ECG, x-ray, and blood tests
• Establish a pre-surgery diet regimen, including:
  • 2 Weeks Before
    • No sugar
    • Lower carbs
    • Increased protein
    • Increased veggies
    • Plenty of fluids
  • 2 Days Before
    • Clear liquids, broth, one protein shake per day only
    • Talk with your surgeon about whether you should stop taking any medications
  • 2 Hours Before
    • No food or drink, no tobacco

Losing as much weight as possible prior to surgery is also critical because:

• The more weight you lose pre-op, the more weight you will lose after surgery
• The lower your pre-op weight, the lower your risk of complications
• Gastric bypass surgery will not work over the long-term if you slip back into old habits. For about 70% of gastric bypass patients, eating unhealthy foods also lead to vomiting, diarrhea and other uncomfortable symptoms (37). The sooner you can start establishing good diet and exercise habits, the more likely you will be to maintain them after surgery

See our Preparing for Weight Loss Surgery page for more information.

The laparoscopic Roux-en-Y gastric bypass procedure takes about 4 hours to complete. Most patients remain in the hospital for 2 to 3 days following surgery.

The procedure serves 2 functions: it limits how much you can eat before feeling full (“restrictive”) and it prevents your body from absorbing as much food (“malabsorptive”).

Following are the steps your surgeon will perform:

1. Cut and staple the stomach to create a small pouch at the end of the esophagus. Your stomach pouch will be about the size of a golf ball and hold around one ounce (28 grams) of food.
2. Leave the remainder of the stomach attached to the top of the small intestines
3. Go further down the small intestine, cut it, and attach it to the pouch. The food will now bypass the remainder of the stomach and top part of the small intestine.
4. Take the end of the small intestine that is still connected with the remainder of the stomach and attaches it to the bottom of the “ Roux limb” of the small intestine. This allows the digestive juices produced by the stomach to meet up with the food in the intestines.

During the procedure, there will be 2 catheters (tubes) used to keep both portions of your stomach clear:

• The first is inserted through your mouth and into the pouch.
• The second is for the larger portion of the stomach and is threaded through an opening in the side of your abdomen.

Take a look at the following two videos for a more in-depth understanding…

You’ll be sore and a feel a little “out of it.” You’ll be on medication to control the pain and will likely have a bedside button to deliver additional pain meds through your IV as needed. To prevent gastrointestinal leaks, the two catheters inserted during surgery will remain in place for a couple of days to keep the stomach fluids drained.

Your surgeon will have you up and walking around as soon as possible – usually within 5 or 6 hours – to reduce the risk of blood clots and jump-start your body’s healing process. You may also be asked to wear compression stockings, use a pneumatic compression device that keeps the blood flowing in your legs, or receive blood thinners. Continue to walk as much as possible, increasing it a little each day.

Before releasing you, your surgical team will run a number of tests to ensure:

• No staple line leaks
• Wounds are healing properly
• You’re able to “pass gass”, indicating that your digestion is working properly

Fever, no improvement or worsening of pain, signs of incision infection (pus, swelling, heat, or redness), difficulty swallowing, and ongoing nausea or vomiting are all a concern. Call your surgeon immediately if any of these happen.

Your smaller stomach pouch will be sensitive, especially at first, so you’ll be on a liquid diet for a couple of weeks before slowly transitioning back to solid foods (read more about this in the Diet section of this page). Since you’ll be eating less, you may feel tired and lethargic until your body adjusts.

Your surgeon will prescribe pain and digestion medication as needed and may adjust your pre-surgery medications until you’re fully healed. Follow their instructions to the letter.

Avoid swimming or bathing until your incisions have fully healed. Many patients return to normal life and work within a couple of weeks, but plan for up to 4 to 6 weeks off to be on the safe side. Full exercise and heavy lifting typically resume within one to two months. Due to your smaller walnut-sized stomach, you will feel full much sooner than you did before surgery. To avoid stretching your new stomach pouch which can lead to weight regain, do not overeat.

Follow-ups with your surgeon’s team will happen about one week post-op, then 4 weeks post-op, then every 3 or 4 months to ensure that everything is on track, including:

• Discuss weight loss
• Encourage regular exercise
• Obtain lab work and make necessary adjustments to medications and dietary supplements
• Understand diet and identify any potential eating disorders
• Determine whether any potential complications may be arising
• Monitor status of obesity-related health issues
• Involve your family physician to help evaluate progress and ensure a successful transition

After you’ve reached your “low point” weight, your surgeon will probably still want to see you at least once per year (38). During those visits you may meet with several team members, including your surgeon, dietitian, and mental health care provider. They will probably request lab work to ensure that vitamin levels and other indicators are where they should be. If you experience any issues in between visits, don’t wait for your next visit… call your doctor right away.

Following surgery, it will take about 6 weeks to transition into your new long-term gastric bypass diet which includes significant restrictions.

For more information, see our Bariatric Diet page.

Vitamins & Supplements: Lifelong & Crucial

Since gastric bypass is a “malabsorptive” procedure by nature, it carries a high risk of malnutrition. Patients must be extremely diligent about taking prescribed vitamins and supplements or risk serious vitamin deficiency.

For more information, see our Bariatric Vitamins page.

Exercise is almost as important as what you eat after gastric bypass surgery for two big reasons:

• Patients who exercise regularly lose more weight over the long-term
• Physical and mental health benefits make you much more likely to keep your new lifestyle requirements in line

How much exercise do you need to for noticeable results?

One study found that exercising 2.5 hours per week leads to 5.7% more weight loss (50). Another showed that gastric bypass patients who exercise at least 30 minutes a day, 3 days per week have a 4+% lower body mass index (51).

Further, regular exercise leads to quicker improvement in obesity-related health problems following surgery (52).

To help you stay on track:

• Block out time to exercise at the same times on the same days of the week.
• Spread your workouts over 3 or 4 days each week rather than having one or two long sessions. In addition to building endurance, this will make working out less intimidating.

When choosing your exercise routine, focus on three aspects: endurance, flexibility, and strength. Here are suggestions for each:

• Endurance:
  • Walking
  • Stationary bike
  • Swimming (best option)
• Flexibility
  • Well-rounded stretching routine, ideally yoga since it incorporates proper breathing and uses your own bodyweight to build strength
• Strength
  • Exercise balls
  • Weights
  • Yoga

See our Exercise After Bariatric Surgery page for more information.

Follow these steps to reduce your risk of gastric bypass complications:

1. Select the surgery that is most appropriate for your situation. Different surgeries carry different risks for different people. Our Types of Bariatric Surgery page compares and contrasts the safest and most effective procedures.
2. Choose an experienced surgeon, since more experienced surgeons tend to have better outcomes. For example, one study evaluated a surgeon over his first 300 laparoscopic gastric bypass patients. Following were his results as he gained experience (55):

   Group Group

   First 100 patients First 100 patients

   Second 100 patients Second 100 patients

   Third 100 patients Third 100 patients

   Group Time in surgery

   First 100 patients 163 minutes

   Second 100 patients 119 minutes

   Third 100 patients 94 minutes

   Group Number of reoperations

   First 100 patients 9

   Second 100 patients 2

   Third 100 patients 1

   Group Number of conversions to open surgery

   First 100 patients 2

   Second 100 patients 1

   Third 100 patients 1

   As you can see, the more procedures he performed, the lower the time it took to perform the surgery and the lower the number of reoperations required.

   A separate and much larger study of over 15,000 patients in Michigan had similar findings (56):

   # of procedures performed by surgeon over 3 years # of procedures performed by surgeon over 3 years

   Less than 100 cases Less than 100 cases

   100 – 249 cases 100 – 249 cases

   Greater than or equal to 250 cases Greater than or equal to 250 cases

   # of procedures performed by surgeon over 3 years Rate of serious complications occuring within 30 days of surgery

   Less than 100 cases 3.8%

   100 – 249 cases 2.4%

   Greater than or equal to 250 cases 1.9%

   Most surgeons offer free seminars that teach you about your weight loss surgery options, their practice’s experience, total procedures performed, and specific results. The seminars also allow you to get to know the surgeon prior to a one-on-one consultation.

   Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

   You can also review our Bariatric Doctors page to learn how to interview multiple doctors and choose the best one.

3. Eat and exercise as directed by your surgeon before, during, and after surgery. Your behavior before and after surgery directly and significantly impacts your gastric bypass complication risk. Read the other sections of this page for more information.

The most common complications, which occur in greater than 1% of patients, include (57):

For a full list of potential issues, see our Gastric Bypass Complications page.

Click below for more information about each gastric bypass side effect:

About half of all gastric bypass patients start to regain weight after two years.

After five years, the average bypass patient gains back about 8% of their weight compared to their 18-month to 2-year “low point.” (62)

Another study found that that up to 20% of morbidly obese patients (40 – 50 BMI) and up to 35% of super obese patients (BMI over 50) gained back more than 50% of their excess weight after 10 years (63).

Equally concerning, the more weight you gain back, the more likely your health problems are to come back. For example, one study showed that after gastric bypass surgery, all patients with Type 2 Diabetes experienced improvement or complete resolution. However, after 3 years, about 1 out of 4 of those patients saw their diabetes worsen or come back (64).

Why do patients gain back weight?

Usually it’s the patient’s fault. They veer off course and consume foods or beverages they shouldn’t, causing their stomach pouch or the connection between their stomach and small intestines (called the “stoma”) to stretch out (65).

If you start to gain back weight, contact your surgeon or dietitian immediately to assess your diet and exercise habits.

See our Weight Regain After Bariatric Surgery page for advice on how to avoid weight regain after gastric bypass surgery.

See the Revision section below for options to surgically address weight regain.

• Weight loss is usually in range of gastric sleeve and much better (on average) than after Lap Band surgery, gastric balloon, or vBloc Therapy (but less than duodenal switch). The AspireAssist needs more research, but initial results show a weight loss potential less than gastric bypass.
• Health Improvement is generally better than after gastric sleeve, Lap Band, gastric balloon, or vBloc Therapy (but not as good as duodenal switch). Intital research shows AspireAssist will have similar health improvements to gastric balloon or vBloc Therapy, but more research is needed to confirm.
• Short-term risk of gastric bypass is similar to that of gastric sleeve and lower than duodenal switch (but higher than Lap Band, gastric balloon, vBloc Therapy, or AspireAssist).
• Long-term risk of gastric bypass is lower than duodenal switch (but higher than gastric sleeve, and Lap Band surgery; long-term data not yet available for balloon, vBloc, or AspireAssist).
• There is no external device left inside the body as there is with Lap Band, gastric balloon, vBloc Therapy, and AspireAssist, so there is no risk of device-related complications. While the risk of device-related complications is relatively low for vBloc Therapy, gastric balloon, and AspireAssist, it is a concern and should be considered for Lap Band.
• If you are on anticoagulation medication (blood thinners), compared with gastric sleeve, gastric bypass surgery is probably a better choice to reduce the risk of marginal ulcers.

• Not reversible – Unlike Lap Band, gastric balloon, vBloc Therapy, and AspireAssist, gastric bypass surgery (along with gastric sleeve and duodenal switch) should be considered irreversible – once your stomach size is reduced and your intestines are rerouted, it is very it is very difficult and uncommon for the procedure to be reversed.
• Weight loss (on average) is usually lower than duodenal switch (but higher or similar to all other procedures).
• Health Improvement is generally not as significant as after duodenal switch (but is generally better than all other procedures).
• While survival rate is extremely high at 998 out of every 1,000 patients, risk of gastric bypass complications is higher than all other procedures except duodenal switch. Early complications occur in about 1 out of 10 patients while late complications occur in about 1 out of 7 (66, 67).
• The two primarily “malabsorptive” procedures, gastric bypass and duodenal switch, are more complicated to perform and include the rearranging your digestive system. As a result, they have a:
  • Longer recovery
  • Higher risk of vitamin deficiency (and therefore require more daily supplements)
  • Higher costs
• Dumping syndrome is experienced by up to 7 out of 10 gastric bypass patients, although many patients report this being a “good thing” since it helps them keep their diet on track (see more in the Downsides section above).

For further comparison of gastric bypass surgery to other procedures, see our Types of Bariatric Surgery page.

Surgeons will help you effectively navigate the various procedure choices, pre-surgery steps, financing, and insurance options:

1. As a first step, many surgeons offer a free initial consultation or a free local seminar or webinar to give you a better understanding of what to expect.
2. Many will also provide a free insurance check to help you figure out how much insurance will cover, and, if necessary, appeal any denials or find additional financing. Most insurance companies require you to complete a medically supervised diet and exercise program before they will approve your surgery, so your surgeon will set this up for you if you haven’t done so already.
3. Your surgeon will also push you towards new habits that will be essential to long-term success after surgery. Many surgeons will recommend that you attend support group meetings so you can listen to feedback from actual patients.

By 2 weeks out you will have completed your pre-op tests, physical, and any other necessary steps required by your surgeon or insurance company. You should have insurance approval (if applicable), and you should be well on your way towards developing your new long-term lifestyle and diet habits. In the week or two leading up to surgery you’ll be seeing the hospital pre-surgery department for an EKG, blood work, and any last minute instructions or other pre-op tests. You’ll see the surgeon one more time for consents, a pre-operative physical, and any last minute details. The night before surgery you’ll be asked to not eat or drink anything starting at midnight.

You’ll be asked to arrive at the hospital at least two hours prior to surgery to allow for prep time. The gastric bypass procedure itself will take about 4 hours to perform. For the first few hours after surgery, you probably won’t be awake to remember it, but you’ll have one-on-one attention from someone on your surgical team to manage your pain and monitor your vitals. Click here for more about what to expect in the hospital.

Most gastric bypass patients are in the hospital for 2 or 3 days total. You will probably not be allowed to eat or drink anything for at least 24 hours after surgery, and your surgeon will want you to get up and walk around as soon as possible to start the healing process. You’ll be discharged as soon as your surgeon is confident that you are well on the road to full recovery. You’ll likely need someone to drive you home from the hospital and care for you for at least a few days following surgery. Full recovery generally happens within 4 to 6 weeks. Click here for more about the recovery process.

Over the course of the first 6 weeks following surgery you will slowly transition from a sugar-free clear liquid diet to your “new normal” gastric bypass diet. You should also continue your transition into a more active lifestyle. You will feel full sooner, you may feel less hungry generally, and you should start to experience significant weight loss within a couple weeks. Your surgeon’s dietitian or nutritionist will help you determine an appropriate diet. See the Diet & Life After section of this page for more information.

Regular weight loss surgery support group participation has been found to lead to the following benefits:

1. Reduce post-op recovery time
2. Lead to as much as 12% more long-term weight loss

Your surgeon will be able to recommend an in-person group near you.

For the first year, your surgeon will most likely schedule follow up visits. Shortly after surgery, they will be weekly then transition to every four weeks, and, later, once every few months to ensure that you are recovering well and to answer any questions you may have. Subsequent doctor visits will be scheduled on an as-needed basis along with annual check-ups.