| Dr. Michael Peters, 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. What can one do to prepare for surgery?
A. The most important thing one can do to prepare for bariatric surgery is to become educated. The typical bariatric patient takes between one and two years to seek a consultation with a surgeon. Seek out others who have had the procedure, talk to your family physician. A well prepared patient, one who is committed to the lifetime of changes that will be necessary after surgery gets better results, less pain and better weight loss than one who is not prepared. For any surgical procedure, research the topic before your meeting with your surgeon and bring a list of questions. Ask any question you like and if something is not clear ask for a more thorough explanation. Finding the most experienced surgeon is no more difficult than calling our practice, no one in Delaware has done more weight loss surgery than CHRIAS.
Q. Can you brief us a bit about the 'Endoluminal Sleeve' treatment?
A. Endoluminal sleeve treatment is a gastrointestinal liner that is implanted and removed through the mouth without surgery. Endo means using an endoscope, luminal means staying within the lumen or space of the gastrointestinal tract and this results in a procedure which is done without cutting the skin or stomach. The device currently available is called the EndoBarrierTM and it lines the upper part of small intestine. It lines the duodenum and the first part of the jejunum. This mechanical bypass may alter hormonal responses in the body, which result in metabolic changes that lead to weight loss and a potential solution for type 2 diabetes. The liner is typically removed after 3 months.
While some individuals may opt for the EndoBarrierTM as their sole method of weight loss, others may use it as a presurgical weight loss tool. In this scenario, the liner is used prior to weight loss surgery such as gastric bypass, gastric banding, duodenal switch or gastric sleeve. This may make the second, more radical surgery that much safer. The heavier you are, the more risky surgery can be.
Transoral gastroplasty (TOGA) is a variation of an operation that we currently perform called the laparoscopic sleeve and can be confused with the endoluminal sleeve. Your stomach is capable of holding almost 2 liters of food and after sleeve surgery the stomach is narrowed like a tube/sleeve so that you feel full after a very small amount of food. TOGA is also performed as an incisionless endoscopic procedure. TOGA and endoluminal sleeve procedures are currently offered at only a select number of institutions and because of their experimental status they are not typically covered by insurers.
Q. Are The Health Risks Of Bariatric Surgery Greater Than The Risks Of Obesity?
A. In a word, No. Bariatric surgery has progressed rapidly over the last 15 years. Because of the creations of Centers of Excellence and the devotion of surgeons to specialize in the treatment of obesity mortality rates are lower than gallbladder or hip surgery. In an article published in the New England Journal of Medicine in 2007 it was found that people undergoing bariatric surgery reduced their adjusted long-term mortality from any cause by 40% and for diabetes the risk was reduced by over 90%. Bariatric surgery is now performed on an outpatient basis and the average hospital stay is less than 48hrs. Study after study shows that bariatric surgery improves overall quality of life and increases longevity.
Q. Are there any restrictions on Eating after bariatric surgery
A. It must be appreciated that obesity and eating are intimately related. Not only will the amount of food be affected but also the type of food. All weight loss operations will decrease the amount of food you can take in at any one time and some of them cause a degree of malabsorption. Obviously, eating less will result in some weight loss. However if the quality of that food does not change then weight loss will not be as successful. The surgeons and the nutritionists will see to it that food choices are addressed and support is offered throughout the period of transition. Follow up is lifelong in our practice and we have a circle of support staff to assist patients who are challenged by the changes.
Q. How do you advice your clients to prepare for Bariatric Surgery?
A. Bariatric surgeons are a lucky group because our patients often come to a consultation with a thorough knowledge of their options. If they are interested in a procedure that we do not perform I recommend they seek out a practice that can help them realize their weight loss goals and we will help them find an experienced surgeon. If they are interested in gastric bypass, banding or sleeve surgery I advise them that they will need a thorough medical and psychological evaluation. I advise them to attend one of our educational seminars where we attempt to address the major educational points and clear up misinformation. We thoroughly evaluate whether a patient has any contraindications to surgery and review their medical information to make certain there are no medical or genetic issues that could contribute to their obesity. I advise my patients to attempt to lose weight prior to surgery as this will enhance their recovery, make surgery easier and promotes the healthy eating and exercise patterns that are necessary for postoperative success.
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