Richmond Bariatric Surgery

 

A. Approximately 80 percent of patients undergoing bariatric surgery are women many of whom are in the child-bearing ages.  Many women suffer from polycystic ovarian syndrome as well as other forms of severe menstrual irregularities secondary to the estrogen effect of increased number and size of fat cells.  Weight loss has been exceptionally beneficial to reversing many of the menstrual problems associated with obesity and has been shown to enhance women’s fertility following significant weight loss.  It has also been recently shown that children born to mothers who were obese at the time of conception and delivery have significantly poorer health than children born to those same mothers after they have undergone successful bariatric surgery.  We also know that weight loss has significantly beneficial effects on urinary incontinence and getting up at night to urinate.  We frequently have patients who get up especially ladies who get up five to six times per night and ladies who following even modest weight loss, sleep through the night and no longer are troubled with stress incontinence.

 

 

A. The short answer is rather simple.  As much as possible.  As with or without bariatric surgery, exercise is an important aspect of a healthy lifestyle.  We recommend that people exercise to what’s comfortable, fun and goal oriented at least four to five times per week. Exercise is tailored to each individual’s need and ability.  We have many patients who come in wheelchairs, using walkers and other assist devices.  These people are frequently completely rehabilitated including patients who on occasion have had prior strokes.  I personally have done approximately l0 patients with multiple sclerosis and significant mobility issues who have had excellent rehabilitation without any adverse impact or acceleration to their multiple sclerosis.  

 

 

A. First of all, sleeve gastrectomy was originally designed as one part of an operation called biliopancreatic diversion with duodenal switch.  That is considered the most, I hate to use the word radical but say complex of all bariatric surgery procedures.  The sleeve gastrectomy part reduces the capacity of the stomach by 75 to 80 percent.  When the food then empties out of the newly created stomach through the preserved pylorus and duodenum, it then goes into a rearranged intestinal tract where it goes into the last 40 to 50 percent of the small intestine and the digestive juices that come from the liver and pancreas and enter into the duodenum are then diverted to the very end of this shortened small intestine.  This combination of actions decreases intake of food which we call restrictive and then because of the manipulation of the small intestine length as well as the diversion of the digestive juices, this produces significant malabsorption.  The sleeve gastrectomy is the gastric part alone of the more complex duodenal switch procedure.  In the largest sickest patients early on in the development of this operation of the biliopancreatic diversion they decided to do it two-step, do the stomach portion (sleeve gastrectomy) as stage one, let the patient lose weight and then come back to do the intestinal part as stage two.  They found many people didn’t want or need step two; therefore, large series have now been done and followed for over five years which show that sleeve gastrectomy is probably going to be well accepted as a stand alone procedure that has fewer potential complications of the gastric bypass and biliopancreatic diversion.  It is a little bit more complex than the adjustable gastric band because of the stapling and removal of part of the stomach.  It however seems to have better weight loss, comorbidity resolution and long-term success than the adjustable gastric band.  

 

 

A. We at Commonwealth Surgeons have no specific financing options; however, BLIS is developing a product that will be available probably in less than six months that will serve as an option for financing.  

 

 

A. It is dependent on which of the procedures chosen.  The procedure of adjustable band is what we call a restrictive procedure and that’s a silastic collar around the upper part of the stomach which has balloons on the internal surface that are then connected to a reservoir that is under the patient’s skin that can however be punctured through the skin to blow up the balloons or partially or completely deflate them (adjustments).  This restrictive procedure works solely by limiting the amount of food that one can comfortably eat at any given point.  That amount can be altered by these through the skin adjustments of how much volume is contained by the balloons.  The gastric bypass has a small stomach pouch that empties directly into almost the complete intestinal length with a diversion of the digestive juices away from approximately 25 percent of the first portion of the small intestine.  This produces a mild interference with the digestive process (malabsorption).  So the gastric bypass is a combination of restriction (small gastric pouch) and malabsorption (diversion of digestive juices away from the first 25 percent of the small intestine).  This diversion of digestive juices limits the digestion of food so that not all the calories taken in by mouth actually get into your digestive system.  The bilio-pancreatic diversion has very mild restriction by reducing the stomach volume 80 percent but very significant malabsorption by significantly delaying the onset and the completeness of the digestive process.  The sleeve gastrectomy is a matter of some controversy as to whether or not it works simply by restricting your food intake or by a combination of that and significantly reducing your appetite so that your desire to eat is significantly affected as with the gastric bypass and biliopancreatic diversion.  To rate the surgeries by complexity, the least complex is the adjustable gastric band, the gastric bypass and sleeve gastrectomy are moderately complex and the biliopancreatic diversion is considered the most complex.  The degree and durability of the weight loss is directly dependent on the complexity of the operation.  The patients lose more weight with the biliopancreatic diversion, keep it off the most predictably but yet have more in the way of potential complications.  The resolution of the illnesses that are associated with bariatric surgery are dependent upon weight loss which occurs as the sole mechanism in the adjustable gastric band as well as weight loss and metabolic consequences that are independent of weight loss which occur in the other operations – the gastric bypass, sleeve gastrectomy and biliopancreatic diversion.  Some resolution of diabetes is 50 to 55 percent with the adjustable gastric band, 75 to 90 percent in the gastric bypass and almost 98 percent with the biliopancreatic diversion.  There is still some controversy about the sleeve gastrectomy but it appears to be close to the gastric bypass.  The striking thing about bariatric surgery in general is the tremendous reduction in the person’s chance of dying.  Morbidly obese people only have a one in seven chance of reaching life expectancy.  Following a successful bariatric surgery, approximately 90 percent of that reduction in life span is restored.  The mortality reduction of Type 2 diabetes is 92 percent, heart disease 56 percent, cancer 60 percent and overall life expectancy at least enhanced by 60 percent or more.  It is therefore my opinion and that of many others that bariatric surgery is the most health restorative procedure there is in modern medicine.