| Dr. Niazy Selim is a Member of the American Society of Metabolic and Bariatric Surgery. Here the Doctor has answered some of the common questions Bizymoms visitors have about Bariatric Surgery.
Q. After the surgery, what support will a patient receive in adjusting to new daily habits?
A. We provide a full integrated bariatric program. We have a Bariatric program coordinator, a physician assistant, psychologist, dietitian who are dedicated to the program. We also have a fitness center.
Q. How long is the recovery period?
A. The recovery period can vary according to the procedure performed. A Laparoscopic Adjustable gastric banding procedure is usually performed as an outpatient and it takes the patient few days to recover. On the other hand, the laparoscopic gastric bypass patient usually stays in the hospital 2 days and it takes a week or two to recover completely.
Q. What is Roux-en-Y gastric bypass surgery?
A. The Roux-en-Y gastric bypass is a highly technical procedure that involves both restrictive and malabsorptive actions. Nowadays, it is usually performed laparoscopically. It is the most common performed bariatric operation in the USA and it is considered the gold standard operation to which all other bariatric operations are compared.
The restrictive component to this operation entails creating a 20- to 30-ml gastric pouch in the proximal part of the stomach. The remainder of the stomach is left behind nonfunctional. The small bowel is divided to create the Roux limb, which will be brought up and connected to the gastric pouch.
I usually refer to this operation as "a procedure with a brain" as the physiology associated with it helps modifying some of the patient’s behavior.
Q. What types of bariatric surgeries are there?
A. There are numerous options for bariatric surgeries. As I always tell my patients, the reason for the presence of these options is that there is No Absolute Perfect Option. The choice of the procedure should be tailored to each individual. The procedure can vary from a pure mechanical solution (Laparoscopic Adjustable gastric banding ) to restrict food passing to the stomach to a severe malabsorbative procedure like the biliopancreatic bypass.
There are intermediate options in between the previously mentioned procedures like the Roux-en-Y gastric bypass and sleeve gastrectomy.
The decision for choosing one of these procedures should be shared between the patient and his/her bariatric program. At KU, we offers all options to the patient without any bias. We educate the patient about each procedure, its advantages and disadvantages, negative outcomes, expected weight loss and life style accommodation for the best success any given procedure. Patients in our program usually choose the correct procedure for them depending on extensive education and meeting patients who had different types of surgical procedures.
Q. Does Bariatric Surgery Typically Lead to Major Weight Loss?
A. Short answer is YES. There are more important aspects than major weight loss to bariatric surgery. Evidence continues to show that bariatric surgery is the only treatment currently available with significant cure rate for diseases such as diabetes, hypertension, heart failure and myriad of other diseases associated with morbid obesity. On the other hand, there is no significant improvements have occurred in the dietary approach to long-term consistent weight loss over the past years. One can argue that dietary medication may help but their success for long term weight loss has been disputed.
Q. What is the average level of weight loss of each type of surgery?
A. First of all, I would like to inform the reader that when we measure weight loss after bariatric procedures we refer to the Excess Body Weight (EBW). EBW is the amount of weight difference between the current weight of the patient and his/her ideal body weight. The amount of weight loss is measured in a percentage to the EBW of the patient.
The Roux-en-Y gastric bypass patients approximately lose 75% EBW over the first 18 months. Resolution of comorbid factors, in a meta-analysis of 22,000 patients showed improvement is fasting blood glucose and hemoglobin A1C in 83% of patients. Resolution of hypertension in 67.5%. Sleep Apnea has resolved in 94% of patients.
Laparoscopic adjustable gastric banding, on the other hand, has less weight loss. Patients can expect to lose 50% of their EBW over 3 years. Long term studies showed that 83% of these patients have good success in maintaining weight loss. Resolution of diabetes occurs in 47.9% of patients, hypertension in 55%, sleep apnea in 94%.
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