| Dr. Carson Liu is a member of the American Society for 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. After lap band surgery, patients are in close contact with my office staff and me for many years. Successful weight loss needs to have a few clinic appointments where the band is adjusted and customized to ensure good weight loss for the particular patient. We have psychologists and dieticians available, but more importantly the adjustments of the band should occur at least 3 to 5 times in the first two years. There are also support group meetings and online support site on the internet to help track and monitor weight loss.
Q. How long is the recovery period?
A. Most patients undergo a Lap Band procedure in 30 to 45 minutes and go home one and a half hours after recovery from general anesthesia. Most of my patients have taken 2-5 days off from work, but there have been some patients who return to work the next day! I’m not sure that it is the discomfort that keeps people off of work. It seems to be that most people take sick time off thinking that this procedure will work some time to recover. The reality is that the band is placed around the outside of the stomach and there is no major re-routing of the organs. Most patients are out shopping or walking about the next day.
Q. What is Roux-en-Y gastric bypass surgery?
A. The gastric bypass is the old fashioned bypass of the stomach and first part of the small bowel. A new small stomach is created from the old stomach by stapling and dividing the old stomach and fashioning the new stomach to the size of your thumb. An intestinal bypass is then constructed to empty the stomach pouch. Dr. Roux first did this procedure for peptic ulcer disease and realized people were losing weight. (Surgeons have a healthy ego and name procedures after themselves. Psychiatrists like to name things after their patients...)
Q. What types of bariatric surgeries are there?
A. The most common procedure being performed is the laparoscopic adjustable gastric banding (LAP-BAND from Allergan and Realize Band from Johnson and Johnson). These are the only two FDA approved bands in the U.S.
The second most common procedure is the gastric bypass Roux en Y (RYGB). It is losing popularity as decided by the patient.
Then there are the other procedures such as a sleeve gastrectomy where 4/5ths of your stomach is amputated and removed.
A duodenal switch is a bypass of most of the small bowel and it is the most mal-absorptive of all procedures.
There are very few surgeons performing the old fashioned vertical banded gastroplasty (VBG) and there are hybrid procedures of the VBG and RYGB, banded Roux en Y gastric bypass.
There are all kinds of names to different procedures, but they fall into either being Restrictive (i.e. lap band) or Mal-absorptive (i.e. duodenal switch, biliopancreatic bypass) or a hybrid of the two (i.e. RYGB)
Q. Does Bariatric Surgery Typically Lead to Major Weight Loss?
A. Yes. There is a 9 percent failure rate with both procedures if the patients choose not to change their diet or exercise. It still comes down to making the correct food choices and exercising a little bit everyday. There is no short cut to burn off fat. These procedures are a powerful tool to help the patient lose weight, but we are also trying to change their entire lifestyle to maintain the weight loss.
Q. What is the average level of weight loss of each type of surgery?
A. Both procedures can induce 50-70 percent excess weight loss in the majority of patients by two years after surgery depending on the person’s motivation to change their lifestyle. It is dependent on the patient’s personal goal, and I tailor the adjustments to achieve their goal. The surgical procedures do not automatically cause weight loss. There is no substitute for learning how to eat healthy and walk 30 minutes everyday. I always suggest diet and exercise as the first means of weight loss, and surgery should be used as a last resort. It doesn’t mean that the person is a failure because they can’t get the weight off by diet alone. Actually, patients need to diet and exercise to ensure a healthy weight loss with minimal loss of muscle mass.
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