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Tenemos una experiencia acumulada de más de 700 pacientes intervenidos de Bypass Gástrico por laparoscopia en los últimos 15 años bajo los más altos estándares internacionales de seguridad”

1- Una operación pionera:

Después de años de formación y seguimiento de los últimos avances, realización del “Bypass tipo SADIS”, que aúna las conocidas ventajas del Sleeve o Manga Gástrica, con una derivación duodeno-ileal de una sola anastomosis. Con todo, se consigue una operación más fisiológica y que aporta muy buena calidad de vida. Puede decirse que es la técnica más fisiológica de todas las que existen smn cirugía bariátrica.

2- Una técnica segura y eficaz en nuestras manos:

Nos avala:

  • Una larga formación y experiencia: somos cirujanos con catalogación de expertos en cirugía barbárica.
  • Preparación preparatoria minuciosa.
  • Utilizamos la mejor tecnología: Cirugía Robótica vs  Laparoscopia Mini-invasiva.
  • Protocolo Fast Track de rápida recuperación postoperatoria: Ingreso 24 – 48 horas.
  • Rápida reincorporación a las actividades cotidianas según evolución clínica del paciente.

Nuestra técnica quirúrgica, segura y depurada:

  • Utilizamos la técnica manual, para la confección de las anastómosis o uniones entre intestinos. Es la técnica mas exigente y que requiere mas experiencia y formación como cirujano, pero también la mas segura: Menor incidencia de fugas o fístulas. Menor incidencia de úlceras y menor incidencia de dilatación a largo plazo. (1)
  • Hasta la actualidad, no hemos tenido ningún caso de fuga en nuestra técnica de Bypass Gástrico y 1 caso en el Bypass SADIS, que hubo resolver satisfactoriamente..

3- Un equipo quirúrgico experto y minucioso:

La operación la realiza el Dr. Ferrer, cirujano cualificado como «Experto en Cirugía De la Obesidad», acompañado por un equipo de cirujanos con larga trayectoria profesional en la cirugía de la obesidad, expertos y estable, siguiendo las recomendaciones de la ASMBS.

(1) The single anastomosis duodenal switch modifications: a review of the current literature on outcomes. Surg Obes Relat Dis. 2017 Aug;13(8):1306-1312. doi: 10.1016/j.soard.2017.04.027.

Treatments · Obesity surgery

Gastric bypass

Obesity treatments

Also known as Roux-en-Y gastric bypass. It is a restrictive and malabsorptive technique: it reduces the size of the stomach and bypasses the first part of the small intestine, which helps control hunger and improves glucose metabolism.

  • 90–120 minin theatre
  • 24–48 hhospital stay, no ICU
  • 7–15 daysuntil back at work
  • 24 monthsof multidisciplinary follow-up
Diagram of Roux-en-Y gastric bypass

Treatment overview

Gastric bypass is a restrictive and malabsorptive technique. On the one hand, it reduces the size of the stomach so that less food fits in it; on the other, it bypasses the first part of the small intestine, through which food no longer passes. This reduces absorption capacity, improves glucose metabolism and acts on the metabolic complications of obesity.

In the classic Roux-en-Y configuration, the operation has three components:

  • A small stomach, about 4 × 2 cm, tubular in shape, with the entire suture line reinforced. The rest of the stomach is left isolated.
  • A 2 cm gastro-jejunal connection, which creates an "hourglass effect": food passes through slowly and fullness comes sooner.
  • A loop of intestine brought up in front of the colon, with the gaps in the mesentery closed to prevent internal hernias. Digestive juices join the food further down, forming the "Y".

How it produces weight loss

  • Restriction: the new stomach holds small amounts and the feeling of fullness comes early.
  • Hunger control: hormonal changes, including a reduction in ghrelin, reduce appetite.
  • Controlled malabsorption: as food does not pass through the first section of the intestine, fewer calories are absorbed and blood sugar control improves.

Advantages and disadvantages

Advantages

  • Excellent quality of life: you can eat almost everything.
  • Strong hunger control.
  • More than 25 years of clinical literature support it.
  • Good long-term results.

Disadvantages

  • Lifelong vitamin supplements and annual nutritional check-ups.
  • Slightly higher surgical risk than the gastric sleeve.
  • Complications specific to the technique: ulcers at the connection and internal hernias.
  • Excessive weight loss, although this is rare.

Why it is performed

Gastric bypass is indicated when the patient needs a technique with greater anti-obesity power and metabolic effect than the gastric sleeve. The indication is always made after a multidisciplinary assessment: surgical, nutritional, psychological and cardiological.

Who is a candidate?

  • Patients with a BMI over 45 kg/m², which usually means about 50–60 kg above ideal weight.
  • Patients with a BMI between 40 and 45 who also have metabolic syndrome (diabetes, high cholesterol or triglycerides, hypertension) or an unfavourable metabolic or psychological profile.
  • Patients for whom a gastric sleeve is not advised: hiatus hernia larger than 4 cm or Barrett's oesophagus.
  • People who snack compulsively, have difficulty controlling impulses, or frequently eat sweets or fatty foods without control.
  • Patients with a significant family history of obesity.

Medical conditions it helps to treat

In addition to weight loss, gastric bypass has a marked metabolic effect:

  • Improvement or resolution of type 2 diabetes and prediabetes.
  • Improvement of hypertension and of cholesterol and triglyceride levels.
  • Improvement of sleep apnoea.
  • It is the indicated option when there is a large hiatus hernia or Barrett's oesophagus.
  • Improved fertility: in women, ovulation and menstruation become regular (including in polycystic ovary syndrome); in men, semen quality and erectile function improve, especially in young patients.
  • Improved quality of life, vitality, mood and self-esteem.

How to prepare

Careful preparation reduces the risk of complications by around 25%. It includes:

  • Multidisciplinary assessment and preparation with a dietitian and psychologist.
  • Full pre-operative work-up: gastroscopy under sedation, abdominal ultrasound, blood tests, ECG and chest X-ray, plus any tests each patient requires.
  • Optimisation of medical treatment, especially of blood pressure and glucose.
  • Improving physical fitness: 1 hour of cardiopulmonary exercise a day and breathing exercises with an incentive spirometer.
  • Pre-operative weight loss with a diet lasting 1 to 6 weeks depending on the patient.
  • Appointment with the anaesthetist and with the surgeon.

The pre-operative diet

Always under medical and nutritional supervision. It reduces the size of the liver and abdominal fat and leaves a softer abdomen, which makes surgery easier and helps prevent thrombosis.

  • About 800 kcal a day, based on meal-replacement shakes and liquid meals, in 7 servings roughly every 2 hours.
  • No fizzy drinks, alcohol or caffeine.
  • Target weight loss: around 10% of starting weight.

What to expect

During the operation

  • Admission on the day of surgery.
  • Minimally invasive laparoscopy or Da Vinci robotic surgery, with minimally invasive anaesthesia and 5 small incisions of between 0.5 and 1 cm.
  • Duration: between 90 and 120 minutes in theatre.
  • Hand-sewn connection between stomach and intestine: it is more technically demanding, but is associated with fewer leaks, ulcers and hernias.
  • The titanium staples, less than 1 mm in size, remain permanently and are well tolerated by the body.
  • The operation is performed by Dr Ferrer and his team, with extensive experience in obesity surgery, following ASMBS recommendations.

After the operation (Fast Track protocol)

  1. Private room, no ICU. The patient goes straight up to their room.
  2. After 2 hours they get up and walk.
  3. After 3 hours they drink fluids.
  4. Little discomfort. Oral medication for the first few days, breathing exercises and subcutaneous heparin for 20 days to prevent thrombosis.
  5. Discharge in 24–48 hours in standard cases.

Recovery

The first days and weeks

  • The small wounds heal in 2–3 days and stitches are removed after 7–10 days.
  • Daily walks in the morning and afternoon from discharge.
  • Do not lift more than 15 kg during the first 4–5 weeks.
  • Return to work in 7–15 days; for physically demanding jobs, from 4 weeks.
  • Intense exercise from 4–6 weeks.
  • Telephone contact with one of the surgeons and hospital follow-up during the first 30 days.

How your diet progresses during the first month

  • Days 1–10: liquid phase (broths, herbal teas, juices and protein shakes). Dairy is introduced from day 10.
  • Days 11–17: semi-liquid phase (semolina, tapioca, blended soups with protein, skimmed dairy).
  • Days 18–24: purée phase.
  • Days 25–31: soft diet (cooked vegetables, soft rice or pasta, tender meat and fish, eggs, ripe fruit).
  • After the first month: normal, balanced diet in small amounts.

New eating habits

  • Five meals a day, eating slowly, sitting down and using small plates.
  • Protein at every main meal and a Mediterranean-style diet.
  • Avoid snacking between meals and fizzy drinks.
  • Avoid too many sweets and fats: they are poorly tolerated and cause loose stools.
  • Some lactose intolerance is common.
  • You can eat everything, in suitable portions, and enjoy meals with others.

Lifelong supplements

Because absorption is reduced, it is necessary to take 1 to 3 vitamin tablets a day (iron, B12 and folic acid, among others) and have an annual nutritional check-up. They are considered a food supplement, not medication.

Multidisciplinary follow-up afterwards

The aim of follow-up is to ensure the long-term success of the surgery. For 24 months, three professionals support the patient in a coordinated way:

Bariatric surgeon

Clinical assessment and follow-up. Telephone access during the first 30 days.

Dietitian

Nutrition education, regular blood tests and online support whenever needed.

Clinical psychologist

Cognitive behavioural therapy: relationship with food, impulses and expectations.

This is complemented by a patient support group and training workshops.

Follow-up schedule

  1. First 30 daysHospital follow-up and telephone contact with the surgeon
  2. First monthProgressive diet and removal of stitches
  3. 4–6 weeksReturn to intense exercise
  4. Up to 24 monthsConsultations with surgeon, dietitian and psychologist
  5. For lifeSupplements and annual nutritional check-up

Risks and complications

Complications in the immediate post-operative period

ComplicationPublished averageClínica Obésitas
Deep vein thrombosis0.5%0%
Pulmonary embolism0.5%0%
Gastric fistula1–2%0%
Post-operative bleeding< 1%0.5%
Mortality< 0.35%0%

Medium- and long-term complications

  • Ulcers at the stomach-intestine connection (< 3%): associated with smoking, anti-inflammatory drugs and stimulants. They are treated with medication and rarely require surgery.
  • Internal hernias (3–5%): loops of intestine that slip through gaps in the mesentery. They cause severe cramps or a feeling of obstruction and are resolved laparoscopically, with a very good prognosis if treated in time.
  • Early dumping: discomfort and cramps 20–30 minutes after eating, after consuming too much fat or sugar. It is prevented with a natural, varied diet.
  • Late dumping: weakness 2–2.5 hours after eating due to a drop in blood sugar after consuming simple carbohydrates. It is corrected by having something sweet and prevented with a varied diet.
  • Nutritional deficiencies if supplements are not taken.
  • Possible stretching of the stomach over the years, which may require revision surgery.

Most of these complications are uncommon and, in expert hands, are resolved with medical or surgical treatment.

Results

Expected weight loss

  • Between 70% and 85% of excess weight at 5 years.
  • Most of it is lost in the first 6–8 months.
  • As a guide, a person who is 1.70 m tall usually stabilises at around 80 kg.
  • Younger, more active patients achieve the best results. The quality of the technique and the team's support after the operation also play a role.

Our own 5-year study

  • 221 patients studied, mean age 38.1 years (60.8% women / 39.2% men).
  • Mean initial BMI: 44.7 kg/m².
  • Mean BMI at 5 years: 29.1 kg/m².

Myths and facts

  • "I'll lose weight uncontrollably": false. Weight loss usually stabilises at a healthy weight.
  • "I'll always have diarrhoea": false. With a proper diet, 1–2 bowel movements a day are normal; diarrhoea appears when you overindulge.
  • "I'll be on a diet for life": false. After the first year, you eat a varied, moderate diet.
  • "The surgery does everything": false. It makes change easier, but habits and physical activity are essential.
  • "I won't be able to eat out any more": false. From 6 months, social life returns to normal.

The patient remains ultimately responsible for the result: the operation is a tool that makes a conscious change in habits easier.

Gastric bypass vs. SADI-S bypass

Both are restrictive and malabsorptive techniques, but they are built differently. SADI-S (gastric sleeve + single-anastomosis duodeno-ileal bypass) is a more recent and more physiological technique, although it is technically more demanding and reserved for experienced surgeons.

Diagram of Roux-en-Y gastric bypass

Roux-en-Y gastric bypass

  • Small stomach (pouch), with the rest of the stomach left isolated.
  • Two connections: stomach-intestine and the junction of the digestive juices, forming the "Y".
  • Food no longer passes through the first metre and a half of the intestine.
  • More than 25 years of clinical experience.
Diagram of the SADI-S bypass

SADI-S bypass

  • Tube-shaped stomach (gastric sleeve) that preserves the pylorus, the natural exit valve.
  • A single connection, between duodenum and ileum, below the pylorus.
  • The stomach works normally and remains accessible by endoscopy.
  • More recent and technically more demanding technique.

Point-by-point comparison

AspectGastric bypassSADI-S bypass
Stomach shapeSmall 4 × 2 cm pouchTube (sleeve) with the pylorus preserved
How the stomach worksThe rest of the stomach is left isolatedPhysiological: keeps its entry and exit valves
Number of connectionsTwoOne (duodenum-ileum)
Endoscopic access to the stomachRemaining stomach isolatedYes
Reduction in ghrelinLowerHigher
Malabsorptive powerLowerSlightly higher
Absorption of iron, folic acid and B12Higher risk; lifelong supplementsLower risk of deficiency
Ulcers at the connection< 3%No gastro-jejunal connection
Internal hernias3–5%Risk minimised
Feeling of fullnessIntense and earlyMore physiological
Excess weight lost at 5 years70–85%85–90%
Technical complexityStandard techniqueHigher: only highly experienced teams
Clinical experienceMore than 25 years of literatureMore recent technique

Advantages of SADI-S over the classic bypass

  • Better absorption of nutrients such as iron, folic acid and vitamin B12.
  • Lower risk of ulcers at the connection and lower likelihood of internal hernias.
  • A more physiological feeling of fullness and better long-term quality of life.
  • Because the connection is placed below the pylorus, it avoids the reflux of bile into the stomach that occurs with one-anastomosis (mini-gastric) bypass.

Which one is right for me?

No technique is better in absolute terms: the choice is individual and depends on BMI, metabolic profile (diabetes, hypertension, cholesterol), eating habits, the presence of hiatus hernia or reflux, and the assessment of the multidisciplinary team. At the first consultation, the surgeon will explain which one best suits your case.

Is gastric bypass the right operation for you?

Request a personalised preliminary study. We will provide a medical assessment and recommendation with no obligation.

Start my personalised study

Frequently asked questions

What criteria must I meet to have gastric bypass surgery?
  • BMI over 45 kg/m², or
  • BMI over 40 with metabolic syndrome, an unfavourable metabolic or psychological profile, or a contraindication to the gastric sleeve (hiatus hernia larger than 4 cm, Barrett's oesophagus), or
  • Compulsive snacking or frequent, uncontrolled consumption of sweets, or
  • Significant family history of obesity.

You can check whether your profile is suitable in the section What treatment do I need?

How long does gastric bypass surgery take?

At Clínica Obésitas, about 120 minutes. The duration varies depending on the patient and the team's experience. There are simplified variants, such as one-anastomosis bypass, that take about 60 minutes, but they carry a higher risk of long-term complications and a poorer quality of life.

How much does gastric bypass surgery cost?

The cost of laparoscopic surgery is €13,200, with financing available for up to 60 months. It includes:

  • Multidisciplinary assessment and preparation with a dietitian and psychologist.
  • Full pre-operative work-up (gastroscopy under sedation, abdominal ultrasound, blood tests, ECG and chest X-ray).
  • Hospital stay with all theatre, ward and medication costs.
  • Surgeons' and anaesthetist's fees. In the unlikely event of a complication, the patient does not pay medical fees (hospital costs are still payable).
  • Telephone access to one of the surgeons and hospital follow-up for up to 30 days.
  • Online nutritional support, patient support group and training workshops for 2 years.
How long do the wounds take to heal?

The small laparoscopic incisions heal in 2–3 days and stitches are removed after 7–10 days. The titanium staples remain in the body, which tolerates them well, and stop having any function after 4 weeks.

How long is the recovery?

It is short thanks to the minimally invasive technique: the patient walks on the same day, drinks fluids within a few hours and is discharged in 24–48 hours. They can return to work after 7 days, without lifting more than 15 kg, and to physically demanding jobs from 4 weeks.

What can you eat after a gastric bypass?

During the first month, a progressive diet is followed: liquid, semi-liquid, soft and normal. After that, a normal, healthy diet adapted to the smaller stomach capacity and the controlled malabsorption. All kinds of food are tolerated in suitable portions; too many sweets and fats can cause diarrhoea.

Will I have to take vitamins for life?

Yes. You will need 1 to 3 vitamin tablets a day and an annual nutritional check-up. They are considered a food supplement, not medication.

Can you lose too much weight?

It is rare. Weight loss usually stabilises at a healthy weight or slightly overweight, unless you do extreme exercise or your intake is insufficient.

Can I put weight back on after a bypass?

Yes, if your diet is unbalanced. That is why a lasting change in habits, physical activity and follow-up with the multidisciplinary team are key.

Will I often have diarrhoea?

No. With a proper diet, 1–2 bowel movements a day is normal. Diarrhoea usually appears when too much fat or sugar is eaten.

Can I get pregnant after a gastric bypass?

Yes, with the right precautions. It is advisable to wait at least 1 year, ideally until your weight has stabilised. Before trying to conceive, it is advisable to have blood tests for vitamins, iron, B12, folic acid, calcium and vitamin D to correct any deficiency, and during pregnancy blood tests and ultrasound scans are carried out more frequently.

Why don't you perform mini-gastric (one-anastomosis) bypass?

It is a simplified technique that joins very different structures (the thick wall of the stomach with the small intestine), which encourages ulcers. In addition, the connection lies above the stomach's natural valve, causing chronic bile reflux, gastritis and alkaline oesophagitis that are difficult to treat. SADI-S avoids these problems by placing the connection below the pylorus.

What are the risks of gastric bypass?

In the immediate post-operative period, complications (thrombosis, embolism, fistula, bleeding) occur in less than 1% of cases and published mortality is below 0.35%. In the medium and long term, ulcers at the connection (< 3%), internal hernias (3–5%) or stretching of the stomach over the years may occur. Most are resolved in expert hands with medical or surgical treatment.

Clínicas Obésitas
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