Starting a weight loss journey with bariatric surgery is a big step for your health. This surgery can change your life, but you must follow certain rules to keep the benefits. These rules are essential safeguards for your healing stomach.
Living with a smaller stomach means being careful with what you eat, taking your medicine, and staying active. Prioritizing your recovery means avoiding things like nicotine and keeping up with doctor visits. These steps help keep you healthy and make sure your surgery works well.
At Liv Hospital, we offer caring, science-backed help to guide you. We stress that your doctor’s advice is the most important. By knowing these rules, you empower yourself to stay healthy and full of life.
Key Takeaways
- Following post-operative guidelines is key to avoiding problems and keeping weight off for good.
- Food and lifestyle limits are set to protect your healing body and new digestive system.
- Staying away from nicotine and certain medicines is important for keeping your surgery results.
- Regular doctor visits let our team check on you and make changes to your care plan if needed.
- Getting advice tailored to you from your bariatric surgeon is the most valuable resource for your recovery.
What Recovery Restrictions Mean After Gastric Bypass
Recovering after gastric bypass takes time and understanding your new limits. Knowing things you can’t do after gastric bypass helps protect your health. These rules help your body adjust to big changes.
Why the stomach and intestines need time to heal
Your surgeon makes a small stomach pouch and changes your small intestine during surgery. These areas need adequate time to heal without stress. Pushing too hard can lead to complications.
The healing process is inside and not always visible. Following restrictions helps your tissues heal right. This is key for your weight loss success.
How restrictions change during the first days, weeks, and months
Your recovery has a planned path from liquids to solid foods. Each step is designed to help your digestive system. Here’s a look at how things change over time.
| Recovery Phase | Primary Focus | Key Restriction |
| Days 1-7 | Hydration and healing | No solid foods |
| Weeks 2-4 | Pureed nutrition | No chunky textures |
| Months 2-6 | Soft, balanced meals | No high-sugar items |
| Long-term | Maintenance | No grazing habits |
Why surgeon-specific instructions take priority
General guidelines are helpful, but your doctor knows your situation best. Your specific surgery, health, and healing speed affect what you can do. Always follow your surgeon’s advice over online info.
Consistency is key during this time. If unsure about your limits, contact your clinic. We’re here to help you recover safely and effectively.
Things You Can’t Do After Gastric Bypass With Food and Drinks
Learning about the things you can t do after gastric bypass is key to your recovery. These rules help protect your stomach and support your weight loss journey. Think of them as guidelines for your comfort, not strict rules.
Eating large portions or eating too quickly
Your stomach pouch is much smaller now. It can’t handle the food you used to eat. Eating fast can also cause discomfort or vomiting. Take small bites and chew your food until it’s soft.
Advancing food textures before the bariatric team allows it
It’s important to follow the food stages your doctor sets. Moving too fast to solid foods can hurt your stomach. Always wait for your doctor’s okay before trying new textures.
Drinking fluids with meals
Drinking and eating at the same time is a big no-no. It can make you hungry too soon and cause digestive distress. Wait at least thirty minutes after eating before drinking anything.
Consuming sugary foods and beverages that can trigger dumping syndrome
High-sugar foods can cause dumping syndrome. This leads to nausea, dizziness, and other symptoms. Avoiding these foods helps you stay on track with your weight loss goals.
Why You Must Avoid Alcohol After Gastric Bypass
One of the most critical things you can’t do after gastric bypass is consume alcohol. It poses unique physiological risks to your healing body. The chemical changes in your digestive tract make alcohol consumption significantly more dangerous than it was before your procedure.
How gastric bypass can change alcohol absorption and intoxication
After surgery, your stomach capacity is much smaller. The bypass alters how your body processes substances. Alcohol enters your bloodstream much faster than it did previously, leading to rapid spikes in blood alcohol concentration.
You may find that you become intoxicated after only a small amount of liquid. This sudden impairment can lead to poor decision-making and accidental injury during your recovery phase.
Why alcohol can interfere with weight loss and nutritional health
Alcohol provides what nutritionists call empty calories. These calories offer no nutritional value while potentially stalling your weight loss progress. Because your body is focused on healing and processing essential nutrients, alcohol places unnecessary strain on your liver.
Regular consumption can also lead to malabsorption issues. Prioritizing nutrient-dense foods is vital. Alcohol consumption often displaces the healthy proteins and vitamins your body desperately needs.
The risks of drinking while taking prescription pain medication or sedatives
Combining alcohol with postoperative medications is extremely dangerous. Many patients are prescribed pain relievers or sedatives during the initial recovery period. These drugs interact poorly with alcohol.
Mixing these substances can lead to severe respiratory depression, extreme drowsiness, and impaired motor function. It is one of the most dangerous things you can’t do after gastric bypass. It significantly increases the risk of life-threatening complications.
Questions to ask the bariatric surgeon about long-term alcohol use
We encourage you to have an open and honest conversation with your medical team regarding your future habits. Your surgeon is the best person to provide personalized guidance. Every patient has a unique recovery path.
Consider asking the following questions during your next follow-up appointment:
- Is it ever medically safe for me to consume alcohol in the future?
- How long should I wait before even considering a social drink?
- Are there specific types of alcohol that are more harmful to my new anatomy?
- What are the long-term risks of alcohol use regarding my specific surgical outcome?
Medications and Supplements You Should Not Take Without Approval
Changing your medications after gastric bypass surgery is a big no-no. Your body’s digestive system has changed a lot. Safety must always be your top priority when managing your health.
Avoiding nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen
NSAIDs like ibuprofen and naproxen are risky for your new stomach pouch. They can irritate your stomach lining and increase the risk of ulcers. These common drugs are often off-limits to protect your healing.
Why aspirin and blood thinners require individualized medical guidance
Aspirin or blood thinners might be needed for heart health. But, they should only be taken with your doctor’s okay. Your surgeon will decide if the benefits are worth the risks, based on your health history. Never start or stop these medications on your own, as it could be dangerous.”The path to recovery is paved with careful adherence to medical advice, ensuring that every step you take supports your long-term wellness and safety.”
Never crushing, splitting, or changing extended-release medication without instructions
Extended-release medications are made to release slowly over time. Crushing or splitting them can cause your body to absorb too much at once. This might not work well or could be harmful. Always check with your pharmacist or doctor to see if you can take a different form of your medication.
Preventing drug interactions and absorption problems after surgery
Your changed digestive tract might affect how your body absorbs vitamins and medicines. It’s key to review all your medications with your bariatric team. This helps avoid any bad interactions. Being careful about this ensures your body gets the right support during recovery.
Smoking, Vaping, and Nicotine Restrictions After Surgery
One of the biggest things you can’t do after gastric bypass is avoid nicotine. Your body needs good blood flow and oxygen to heal well after surgery. Even a little nicotine can hurt your recovery and cause long-term problems.
Why smoking increases the risk of ulcers, poor healing, and breathing complications
Smoking puts carbon monoxide in your blood, cutting down oxygen for healing. This can slow down wound healing and raise the chance of painful ulcers. It also irritates your airways, making it hard to breathe well during early recovery.
Why vaping and nicotine replacement products require surgical approval
Some people think vaping or nicotine patches are safer than smoking. But nicotine narrows blood vessels and cuts off blood to healing tissues. Always talk to your bariatric team before using nicotine products, as they can cause the same risks as smoking.
Avoiding secondhand smoke during recovery
Being around secondhand smoke can also harm your recovery. We advise avoiding places where smoke is present, mainly in the first few months. Keeping your environment smoke-free helps your body focus on healing without fighting off toxins.
When to seek help for cravings or difficulty staying nicotine-free
If you’re struggling with cravings, contact our support team right away. We have resources and tips to help you stay nicotine-free without risking your health. Remember, avoiding nicotine is key to your success after gastric bypass.
| Nicotine Source | Impact on Healing | Risk Level |
| Cigarettes | High (Oxygen deprivation) | Severe |
| Vaping | Moderate (Vasoconstriction) | High |
| Nicotine Patches | Moderate (Systemic absorption) | High |
| Secondhand Smoke | Low to Moderate | Moderate |
Physical Activities to Avoid While Your Body Heals
It’s natural to want to get back to normal quickly after surgery. But, your body needs time to heal. Knowing what you can’t do after gastric bypass is key to avoiding problems and a smooth recovery. We guide you back to your daily activities slowly, based on how well you’re healing.
Lifting heavy objects before abdominal incisions have healed
Your stomach muscles and internal tissues take time to heal after surgery. Lifting heavy things can put too much stress on your incisions. We tell patients to avoid lifting anything over ten pounds in the first few weeks to avoid complications.
Returning to driving while taking opioid pain medicine or experiencing limited mobility
Driving needs quick reflexes and the ability to react fast. If you’re on pain meds, your reaction time may be slower. Also, if you can’t move easily or check blind spots, wait until your doctor says it’s okay.
Resuming strenuous exercise, running, or abdominal workouts too soon
It’s tempting to start exercising again, but high-impact activities can be bad early on. Running, heavy lifting, and intense stomach exercises can harm your surgery site. We suggest starting with light walking until your doctor says it’s safe for more intense workouts.
Using swimming pools, hot tubs, and baths before incisions are cleared
Getting in water can introduce bacteria to your healing wounds, raising infection risks. Stay out of bathtubs, hot tubs, and pools until your doctor says it’s safe. Keeping your wounds clean and dry is critical to your health after gastric bypass.
Behaviors That Can Undermine Long-Term Gastric Bypass Results
Keeping your health on track means watching out for habits that can set you back. Even if you feel good after surgery, some things you can’t do after gastric bypass are about long-term habits. It’s important to be mindful of your daily choices to keep your success going.
Grazing, binge eating, and regularly choosing calorie-dense foods
Eating small amounts all day can make your stomach work too hard and lead to weight gain. Binge eating, even with small portions, messes with your fullness signals. Foods high in calories but low in nutrients, like processed snacks, can fill up your calorie needs fast.
Relying on liquid calories, sweetened coffee, or frequent snacking
Liquid calories move through your body quickly without making you feel full. Drinks like sweetened coffee, sodas, and juices can cause blood sugar spikes. Snacking too much between meals can slow down your metabolism.
Ignoring protein, hydration, and meal-planning recommendations
Your body needs protein to keep muscles strong and heal. Not drinking enough water can make you tired and feel hungry. Here are some tips to stay on track:
- Plan your meals ahead to avoid bad choices.
- Use a food journal to track protein and water.
- Choose whole, nutritious foods over quick, unhealthy ones.
Using food to cope with stress without building alternative support strategies
Turning to food for comfort can harm your surgery results. It’s better to find other ways to deal with stress. Here are some professional tips:
- Try regular exercise or meditation.
- Get help from a bariatric counselor or support group.
- Find non-food rewards to celebrate your wins.
By finding healthy ways to cope, you protect your health long-term. Remember, these things you can’t do after gastric bypass are just tips for a healthier life.
Appointments, Testing, and Pregnancy Planning You Should Not Skip
One of the most critical things you can t do after gastric bypass is neglect your ongoing medical appointments and laboratory testing. The surgery is a powerful tool for weight loss. But, your long-term health depends on regular check-ups by your bariatric team. These check-ups are like safety nets, keeping your body balanced as it changes.
Missing postoperative visits and scheduled laboratory tests
Your surgical team schedules follow-up visits to track your progress and identify any complications early. Skipping these appointments means your doctor can’t catch early signs of nutritional deficiencies or metabolic shifts. Regular blood work is key to monitor levels of iron, vitamin B12, and other essential nutrients.
Discontinuing bariatric vitamins because you feel well
Stopping your prescribed supplements just because you feel healthy is a mistake. Even if you have no symptoms, your body needs specific, lifelong supplementation to prevent health issues. Bariatric vitamins are not optional; they are essential to maintain your metabolic health and prevent anemia or bone density loss.
Ignoring changes in weight, eating tolerance, or medication response
Always report sudden changes in your weight, food tolerance, or medication response to your healthcare provider. Sometimes, a change in how you digest food can signal a need for a dietary adjustment or a medical intervention. Ignoring these signals is among the things you can t do after gastric bypass if you want to maintain your results safely.
Delaying contraception and pregnancy planning discussions
Rapid weight loss significantly impacts your hormonal balance and reproductive health. We strongly advise patients to discuss contraception and pregnancy planning with their medical team early in the process. Proper timing is essential to ensure that your nutritional status is stable enough to support a healthy pregnancy for both you and your baby.
| Follow-up Category | Primary Goal | Frequency |
| Laboratory Panels | Monitor nutrient levels | Every 3-6 months |
| Clinical Consults | Assess weight trends | Annual check-ups |
| Vitamin Compliance | Prevent deficiencies | Daily for life |
| Pregnancy Planning | Ensure maternal safety | As needed |
Symptoms You Should Never Ignore After Gastric Bypass
It’s key to spot warning signs early after bariatric surgery. Most patients do well, but knowing the red flags is vital. This knowledge is as important as knowing what not to do after gastric bypass to stay healthy.
Severe or persistent abdominal pain
Some soreness near your incision sites is normal in the first few days. But, sharp, stabbing, or worsening pain that doesn’t go away with meds is not okay. If you can’t rest because of intense pain, call your surgical team right away.
Repeated vomiting or inability to keep fluids down
Dehydration is a big risk early on. If you can’t keep down even a little water or broth, get medical help. Vomiting a lot can cause serious imbalances that need a doctor’s care.
Fever, rapid heart rate, fainting, or increasing weakness
A fever over 101°F (38.3°C) might mean an infection or other problems. If your heart beats fast when you’re resting, or you feel dizzy and faint, your body is trying to tell you something. Don’t wait for your next appointment if you’re feeling weak or unstable.
Black stools, bloody vomit, or other signs of internal bleeding
Internal bleeding is rare but serious and needs emergency care. Look out for black stools or tarry-looking stools, which mean blood in your digestive tract. Also, if you see bright red blood in your vomit, go to the emergency room right away.”Patient vigilance is the cornerstone of a safe recovery. When in doubt, always choose to communicate with your surgical team instead of waiting for symptoms to resolve on their own.”
— Bariatric Surgical Care Guidelines
We’ve made a quick guide for when to seek help. Remember, these guidelines are part of the broader list of things you can’t do after gastric bypass to keep you safe.
| Symptom | Urgency Level | Recommended Action |
| High Fever (>101°F) | High | Call Surgeon Immediately |
| Inability to drink fluids | High | Contact Clinic/ER |
| Black or bloody stools | Critical | Go to Emergency Room |
| Persistent sharp pain | High | Call Surgeon Immediately |
Conclusion
Life after bariatric surgery is a journey towards wellness. Knowing what you can’t do after gastric bypass is key. It helps your body heal and get the nutrients it needs.
Your bariatric team is your best ally. Keep talking to your surgeons and dietitians. They give you the advice you need to stay healthy and reach your goals.
Following these safety tips helps you avoid problems and keeps your results lasting. By sticking to your appointments and listening to your team, you’re on the path to a healthier life. We’re here to support you every step of the way, helping you build a bright future.
Weight loss surgery is a big step towards a healthier life. But, it’s important to protect your new stomach pouch while it heals. Knowing what not to do after gastric bypass helps keep your body safe and healthy.
General guidelines are helpful, but your bariatric team’s advice is most important. Every person’s recovery is different. These rules help prevent serious problems like leaks or nutritional issues.
What Recovery Restrictions Mean After Gastric Bypass
Why the stomach and intestines need time to heal
During a gastric bypass, we make a small pouch and reroute part of the small intestine. This creates new connections that need time to heal. Restrictions help ensure these connections heal without problems.
How restrictions change during the first days, weeks, and months
Recovery is a gradual process. In the first days, you can only have clear liquids. As you get better, we introduce pureed foods, then soft solids, and eventually a variety of textures. Trying new foods too soon can cause pain or damage.
Why surgeon-specific instructions take priority
Your surgeon knows your specific situation best. They understand your operation, medical history, and surgical techniques. Their advice is tailored just for you.
Things You Can’t Do After Gastric Bypass With Food and Drinks
Eating large portions or eating too quickly
Your new stomach pouch is small, about the size of an egg. Eating too much or too fast can stretch the pouch or cause food to get stuck. This leads to pain and vomiting. Take at least 20 to 30 minutes to finish a small meal.
Advancing food textures before the bariatric team allows it
It’s tempting to try solid foods before your team says it’s okay. But, eating too soon can irritate the healing tissues. Stick to the stages we recommend for a smooth recovery.
Drinking fluids with meals
Stop drinking 30 minutes before eating and wait 30 minutes after. Drinking while eating can make you feel hungry sooner and may cause dumping syndrome.
Consuming sugary foods and beverages that can trigger dumping syndrome
High-sugar foods and drinks can cause rapid gastric emptying, or dumping syndrome. This leads to uncomfortable symptoms like heart palpitations, cold sweats, and severe diarrhea. Avoid sugary foods and drinks for your comfort and success.
Why You Must Avoid Alcohol After Gastric Bypass
How gastric bypass can change alcohol absorption and intoxication
After surgery, alcohol is absorbed faster and in higher concentrations. Even a small amount can lead to dangerous intoxication.
Why alcohol can interfere with weight loss and nutritional health
Alcohol provides “empty calories” and can stall weight loss. It can also lead to deficiencies in essential vitamins, like Thiamine (Vitamin B1), which is important for nerve function.
The risks of drinking while taking prescription pain medication or sedatives
Combining alcohol with pain relief medications is dangerous. This can cause respiratory depression, excessive sedation, and even fatal overdose.
Questions to ask the bariatric surgeon about long-term alcohol use
We recommend avoiding alcohol for at least the first year. Many teams suggest avoiding it permanently due to the risk of addiction.
Medications and Supplements You Should Not Take Without Approval
Avoiding nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen
NSAIDs like Advil (ibuprofen), Aleve (naproxen), and Motrin can increase the risk of ulcers. These ulcers can bleed or perforate, requiring emergency surgery.
Why aspirin and blood thinners require individualized medical guidance
Aspirin or blood thinners like Plavix may be necessary for heart health. But, they must be managed carefully by your team. We will work with your cardiologist to find the safest dosage and timing.
Never crushing, splitting, or changing extended-release medication without instructions
The bypass changes how your body absorbs drugs. Extended-release (ER or XL) formulations may not work correctly. Never alter your medication without consulting your pharmacist or surgeon.
Preventing drug interactions and absorption problems after surgery
We must review all your supplements. Certain forms of calcium, like Calcium Carbonate (Tums), are not absorbed well after bypass. We usually recommend Calcium Citrate instead.
Smoking, Vaping, and Nicotine Restrictions After Surgery
Why smoking increases the risk of ulcers, poor healing, and breathing complications
Nicotine reduces blood flow to healing tissues. Smoking can cause life-threatening ulcers and “leaks” in gastric bypass patients.
Why vaping and nicotine replacement products are also prohibited
Even if you’re not smoking traditional cigarettes, nicotine in vapes, patches, or gums carries the same risks. Nicotine abstinence is essential for surgical safety.
Avoiding secondhand smoke during recovery
Exposure to secondhand smoke can impair lung function and slow healing. We encourage patients to maintain a smoke-free environment.
When to seek help for cravings or difficulty staying nicotine-free
If you struggle with cravings, please reach out to us. We can provide resources or refer you to smoking cessation programs to help you stay on track for a safe recovery.
Physical Activities to Avoid While Your Body Heals
Lifting heavy objects before abdominal incisions have healed
In the first 4 to 6 weeks, avoid lifting anything heavier than 10 to 15 pounds. Straining can cause a hernia at the incision sites or internally.
Returning to driving while taking opioid pain medicine or experiencing limited mobility
You cannot drive as long as you are taking narcotic pain medications like Tylenol with Codeine. Also, you must be mobile enough to perform an emergency stop safely before getting behind the wheel.
Resuming strenuous exercise, running, or abdominal workouts too soon
While we encourage walking immediately after surgery, avoid strenuous activities, heavy weightlifting, and abdominal exercises for at least 6 weeks or until your surgeon gives you specific clearance.
Using swimming pools, hot tubs, and baths before incisions are cleared
To prevent infection, your incisions must be fully closed and healed before submerging them in water. Stick to showers until we confirm your wounds are healed.
Behaviors That Can Undermine Long-Term Gastric Bypass Results
Grazing, binge eating, and regularly choosing calorie-dense foods
“Grazing”—snacking on small amounts of food throughout the day—can bypass the “fullness” sensation of the pouch. This can lead to weight regain. Success requires structured meal times.
Relying on liquid calories, sweetened coffee, or frequent snacking
It’s easy to “drink” your calories through sweetened lattes or high-calorie smoothies. These liquids slide right through the pouch without making you feel full. They are some of the most dangerous things you can’t do after gastric bypass if you want to maintain weight loss.
Ignoring protein, hydration, and meal-planning recommendations
Protein is key for maintaining muscle mass and healing. We emphasize hitting your protein goals and drinking at least 64 ounces of water daily.
Using food to cope with stress without building alternative support strategies
Surgery changes your anatomy, but not your psychology. We highly recommend counseling or support groups like Overeaters Anonymous to develop new coping mechanisms that don’t involve food.
Appointments, Testing, and Pregnancy Planning You Should Not Skip
Missing postoperative visits and scheduled laboratory tests
Follow-up care is essential for detecting nutritional deficiencies before they become symptomatic. We need to monitor your iron, Vitamin B12, and Vitamin D levels regularly for the rest of your life.
Discontinuing bariatric vitamins because you feel well
Feeling “fine” does not mean your nutrient levels are adequate. Bariatric-specific multivitamins, such as those from Celebrate Vitamins or Bariatric Advantage, are a lifelong commitment.
Ignoring changes in weight, eating tolerance, or medication response
If you suddenly find you can no longer tolerate foods you once could, or if weight loss stops prematurely, you must contact us. These can be signs of a treatable surgical or nutritional issue.
Delaying contraception and pregnancy planning discussions
Rapid weight loss can increase fertility. But, we strongly advise against pregnancy for the first 12 to 18 months after surgery to ensure both mother and baby receive adequate nutrition.
Symptoms You Should Never Ignore After Gastric Bypass
Severe or persistent abdominal pain
While some discomfort is normal, sharp or worsening pain can indicate a bowel obstruction or an internal hernia. This requires immediate medical evaluation.
Repeated vomiting or inability to keep fluids down
If you cannot stay hydrated or keep liquids down for more than 12–24 hours, you are at risk for severe dehydration and electrolyte imbalances.
Fever, rapid heart rate, fainting, or increasing weakness
A fever over 101°F or a heart rate consistently above 100 beats per minute can be early warning signs of an infection or a leak. Do not wait for your scheduled appointment to report these.
Black stools, bloody vomit, or other signs of internal bleeding
Dark, tarry stools (melena) or vomiting blood are signs of a bleeding ulcer or other internal complications. These are medical emergencies that require an immediate trip to the emergency room.
FAQ
Q: What are the most important things you can t do after gastric bypass in the first month?
Q: Why is smoking listed as one of the things you can’t do after gastric bypass?
Q: Can I ever drink soda or carbonated beverages again?
Q: When can I resume exercise after surgery?
Q: Is it okay to take a bath or swim a week after surgery?
Q: What happens if I accidentally eat too much or too fast?
Q: Why must I wait 18 months to get pregnant after gastric bypass?
References
Q: What are the most important things you can t do after gastric bypass in the first month?
A: In the first month, avoid solid foods, lifting objects heavier than 15 pounds, and NSAID medications like Advil. Also, don’t drink liquids while eating to prevent putting unnecessary pressure on your healing stomach pouch.
Q: Why is smoking listed as one of the things you can’t do after gastric bypass?
A: Smoking and nicotine use are strictly prohibited because they significantly reduce blood flow to the surgical site. This increases the risk of “marginal ulcers,” which can lead to bleeding, perforation, and the need for emergency surgery.
Q: Can I ever drink soda or carbonated beverages again?
A: Most bariatric surgeons include carbonated drinks in the list of things you can’t do after gastric bypass. The gas from the carbonation can cause painful bloating and may potentially stretch the small stomach pouch over time.
Q: When can I resume exercise after surgery?
A: We encourage walking immediately after surgery to prevent blood clots. But, avoid strenuous activities, heavy weightlifting, and abdominal exercises for at least 6 weeks or until your surgeon provides specific clearance.
Q: Is it okay to take a bath or swim a week after surgery?
A: No. Avoid submerging your incisions in baths, hot tubs, or swimming pools until they are completely closed and healed, which usually takes 3 to 4 weeks. This prevents the risk of serious infection.
Q: What happens if I accidentally eat too much or too fast?
A: Eating too quickly or in large quantities often results in “plugging,” where food gets stuck in the narrow opening of the pouch. This causes intense pain, pressure, and vomiting. If this happens, stop eating immediately and contact your team if the pain does not subside.
Q: Why must I wait 18 months to get pregnant after gastric bypass?
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