| Dr. David Podkameni 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 daily habits?
A. Our program is very comprehensive and includes a registered nurse, registered dietician and an exercise physiologist along with the surgeons. Staff actively supports patients from their first visit to the program through their journey to a healthier life. We also offer a variety of bariatric support groups each month led by a dietician, exercise physiologist or psychologist. It is important to ensure that you have this type of support when selecting a program.
Q. How long is the recovery period?
A. Recovery periods can vary based on the medical condition of the patient and the type of surgery selected. On average, patients can return to work after one week if they receive an adjustable gastric band or 2-3 weeks if they have a gastric bypass or sleeve gastrectomy.
Q. What types of bariatric surgeries are there?
A. Currently, the most common bariatric surgery procedures are the gastric bypass and placement of the adjustable gastric band (LabBand® or Realize® band). Another procedure recently approved by Medicare and increasingly by other insurers is the sleeve gastrectomy. Bilio-pancreatic diversion with or with out duodenal switch is another recognized procedure. These procedures can be done laparoscopically requiring only about 6 or 7 small incisions.
Q. What is Roux-en-Y gastric bypass surgery?
A. Gastric bypass is both restrictive and malabsorptive surgery. In other words, it both reduces the size of your stomach and limits the amount of nutrients your intestines can absorb.
It is called "Roux-en-Y" because the two new connections form a Y. The restrictive part of Roux-en-Y surgery involves making the stomach smaller. The surgeon will cut the stomach, leaving a pouch about the size of a small egg. This will make you feel full very quickly. The malabsorptive part of the surgery involves rearranging the small intestine so that it absorbs fewer calories and nutrients. The surgeon will cut the first section of
the small intestine (the duodenum) loose from the second section (Roux). The surgeon will pull the Roux up and attach it to the new stomach pouch. Finally, the surgeon will attach the bottom of the duodenum to the small intestine. From now on, nutrients will totally bypass both the larger stomach and duodenum. This means that the body absorbs fewer calories and nutrients than before.
Advantages:
People who have gastric bypass have a higher initial weight loss than those who have purely restrictive procedures like placement of an adjustable gastric band. However, studies show that over time weight loss for these procedures tends to even out. Gastric bypass does not involve placing a foreign object (like a gastric band) inside your body, so you do not have to worry about having a reaction to the object or being allergic to it. You will not need additional adjustments to make your stomach smaller, as with the band, in order to lose more weight. You can maintain good health as long as you:
- Eat a healthy diet and take the right vitamin and mineral supplements,
- Work with our dietitian to develop a healthy eating plan, and
- Continue your follow-up diet, exercise and behavioral program.
Risks:
Anytime you have anesthesia or surgery, there is a risk of bleeding, blood clots, other complications or death.
Gastro-intestinal surgery can cause leaks, ulcers, perforations and internal hernia, bowel obstruction and fistulas.
Gastric surgery puts you at higher than normal risk of developing gallstones and gallbladder disease.
Do not smoke. Smoking would put you at high risk for infection, blood clots, slow healing and other life-threatening complications.
You will have to eat differently for the rest of your life. Foods that you eat now may cause discomfort, nausea or vomiting after your surgery. If you eat sugars and sweets, you can trigger dumping syndrome - symptoms can include nausea, weakness, sweating, anxiety, and heart palpitations after eating. This is not usually a serious health risk, but it can be painful.
Bypassing part of your intestine limits your body’s absorption of some important vitamins and minerals: iron, calcium, Vitamin B12 and folic acid. You will need to take daily supplements for the rest of your life.
If you over eat, you can stretch your stomach opening (stoma) or pouch. You will not lose weight or maintain your weight loss unless you eat a healthy diet and exercise regularly. This is the reason we stress long-term follow-up with our center and your doctor.
Q. What is the Adjustable Gastric Band (LapBand® or Realize® band)?
A. This restrictive surgery reduces the size of your stomach without cutting it.
During your surgery, the surgeon will insert an open band around the top part of your stomach, then click it shut when it is in place.
This band now divides your stomach into two (2) parts:
- The pouch, smaller part, will hold your food and make you feel full quickly.
- The rest of the stomach will still secrete digestive juices that aid digestion.
The tube attached to the band leads to a "port" that lies flat against the muscle wall, below the fat and skin of your abdomen. Later, your doctor will use this port for follow-up adjustments to the band:
- To tighten your band, your doctor will add salt water (saline) through the port.
- To loosen your band, the doctor can draw saline out of the band through the port.
The adjustable gastric band is designed to stay in place for life to help you maintain your weight loss over time.
Advantages:
The adjustable gastric band is the least invasive and only adjustable obesity surgery option in the U.S.
If you have a hiatal hernia, your surgeon can correct this at the same time you have your gastric band surgery.
It does not involve dividing, moving or stapling internal organs, so it is less likely to bleed or leak. Because it is a less complicated surgery than gastric bypass, you will probably spend less time under general anesthesia, in the operating room and in the hospital.
You’ll have less pain and shorter recovery time, and you’ll be able to return to work more quickly.
The LAP-BAND® is designed to stay in place for life, but in case of illness or in the early stages of pregnancy, your doctor can remove saline from the band, which will loosen the band.
Because all of your digestive organs stay intact, your body still absorbs all the nutrients in your food.
Risks:
Anytime you have anesthesia or surgery, there is a risk of blood clots, other complications or death.
Do not smoke. Smoking would put you at high risk for infection, blood clots, slow healing and other life-threatening complications.
It is extremely rare but possible that your body could reject or react to the band as a foreign object.
- The band may slip or erode into the stomach.
- The smaller portion of the stomach may stretch.
- You may not feel satisfied that you have had enough to eat.
- Some foods may cause nausea and vomiting.
- Some types of food can block the outlet from the top to the bottom of the stomach.
- An infection can form around the band or at the port.
- Problems with the band or port may require another operation.
- The stomach can lose its blood supply if the band slips.
- Bleeding or blood clots can form after surgery.
Gastric surgery puts you at higher than normal risk of developing gallstones and gallbladder disease.
You will not lose weight or maintain your weight loss unless you eat a healthy diet and exercise regularly. This is the reason we stress long-term follow-up with our center and your doctor.
Q. Who is a candidate for bariatric surgery?
A. The NIH (National Institutes of Health) has determined that those with a Body Mass Index (BMI which measures weight and height) of 40 or greater or a BMI of 35 or greater with one or more co-morbidities (such as high blood pressure, diabetes, sleep apnea, high cholesterol) would be candidates for bariatric surgery. Most health plans follow the NIH criteria if they offer a bariatric surgery benefit.
Q. What are the benefits of bariatric surgery?
A. There are a number of significant obesity-related health conditions. The aesthetic improvements with weight loss surgery are obvious. The most significant improvements are never seen, but have the greatest impact on the patient’s quality of life. Morbidly obese patients are likely to have one or more of the following conditions: diabetes, high blood pressure/heart disease, sleep apnea, gastroesophageal reflux (GERD), fatty liver disease, dyslipidemia, infertility and/or depression. Following surgery, patients previously on medications for these conditions are generally able to significantly reduce the number of medications they are taking or stop taking them all together. There has also been an identified link between obesity and cancer. While obesity does not cause cancer, those predisposed to certain cancers such as breast and gastrointestinal are more likely to develop cancer if they are obese. Losing weight helps to reduce the chance of developing these cancers.
Q. Does bariatric surgery typically lead to major weight loss?
A. In simple terms, yes. The success rate of substantial and sustained weight loss following surgery when compared to that of medical management is significant. Bariatric surgery is a tool to assist morbidly obese patients lose a sufficient amount of weight to improve their overall health. Diet and exercise are also important to facilitate and maintain weight loss. A combination of these three is very effective in achieving a significant reduction in weight.
Q. What is the average level of weight loss of each type of surgery?
A. The pace with which weight is loss procedure is different. Weight loss if faster with the gastric bypass and sleeve gastrectomy procedures, when compared to band surgery. Ultimately, it is anticipated that patients can expect to lose 60 – 75% of excess body weight.
|
