| Dr. Vafa Shayani is a bariatric surgeon and has answered some of the common questions Bizymoms visitors have about Bariatric Surgery.
Q. How successful is bariatric surgery?
A. All bariatric procedures require 4 key components for success:
a. A surgeon/surgical practice that not only performs a safe and effective surgical procedure but that also remains involved with the care of the patient post-operatively with a lot of attention given to the "details". An abandoned patient is much more likely to fail.
b. A patient’s self realization of where their weight problem might have originated from. Patients who struggle with a chronic state of denial (about their weight problem) will often not be our most successful patients.
c. A patient’s full understanding of how the specific bariatric procedure works and what they might be able to expect from the procedure and what the procedure might not be able to provide them with.
d. The patient’s willingness to "comply with instructions" and to "make good choices" following their bariatric procedure. Certain compromises such as "going to bed hungry" are not acceptable. Others such as eliminating regular intake of soda pop and daily intake of a six pack of beer are a must.
Depending on how much a patient is willing to commit themselves to "following instructions", there is potential for every patient to succeed. This is obviously wishful thinking! I know that in my practice, I have somewhere between 75-80% success but the challenge is to figure out what defines success. There are many different methods of "measuring success" and one that we used at Loyola and subsequently published as a manuscript (in 2006) incorporated
i. Weight loss,
ii. Improvement in health conditions, and
iii. The patient’s perception of improvement in quality of life.
Q. How does the Predominantly Restrictive procedure work?
A. A predominantly restrictive procedure essentially works through "portion-control." Portion control by itself would rarely work (based on our experience with many fad diets), but add to that the "elimination of hunger" and the "adjustability of the pace of weight loss", based on the needs of the individual patient, and you will be talking about adjustable gastric banding. In brief, adjustable gastric banding restricts the capacity for food to approximately 1/10 of the original stomach’s capacity (about the size of 2 chicken nuggets). Due to the restriction from the band, it will take a substantial length of time for food to travel into the small intestine, resulting in several hours of satisfaction with an amount of food equivalent to 2 chicken nuggets, The adjustability of the band allows us to tailor the restriction to each individual at any given moment in time. As the patient loses weight and as the band exerts pressure onto the underlying stomach, the band will typically feel looser around the stomach over time. Accordingly, the patient will need an adjustment (additional tightening of the band) every several weeks or months.
Q. How Important is Patient Attitude Towards the Success Of Bariatric Surgery?
A. It is really more than the attitude towards bariatric surgery that is needed to succeed. It is also important to understand the patient’s attitude towards food in general. If a patient mostly eats out of hunger, they will do terrifically with gastric banding. If on the other hand a patient mostly eats out of "boredom", or out of "emotion", or simply due to "craving", they may have a tougher time.
Q. Do you do the Panniculectomy procedure for your patients after the surgery?
A. Many patients will benefit from a panniculectomy or abdominoplasty once they have lost a substantial amount of weight. Abdominoplasty is a fairly sophisticated procedure and my own highly specialized and busy practice, I rather refer my patients to reconstructive surgeons that I know personally and I am familiar with their results.
Q. Do you recommend any alternatives to Bariatric Surgery?
A. I certainly wish for every patient that I meet for the first time to reach their desired weight without subjecting them to a surgical procedure. For many patients, with appropriate long-term coaching, they might accomplish similar results. The majority, however, would tell you that they need "something" to jump-start the process and that if they could have succeeded without surgery, that they would have done it already. Having said that, I maintain a fairly positive attitude towards non-operative approaches to weight loss and will rarely operate on an individual until I am convinced that they have already "given it their best".
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