When should a person consider bariatric surgery?
Bariatric surgery should be considered after conservative treatment of morbid obesity including diet, exercise, drugs and behavioral modification has failed. Surgery for morbid obesity is the only successful method of long-term weight reduction, as well as, significant improvement or complete resolution of co-morbidities (associated diseases – like Type 2 diabetes, sleep apnea, cardiovascular disease).
What type of patients turn to Orange Regional for help?
Patients seek out Orange Regional’s Bariatric Surgery Center of Excellence Program after failing to lose weight through traditional means or when attempts at non-surgical treatment for morbid obesity has failed. Some have already begun researching the idea of bariatric surgery via the internet or other means, and others have heard from existing patients to attend one of our free informational seminars.
What criteria determine whether a person is a candidate for bariatric surgery?
At Orange Regional, we follow the National Institutes of Health (NIH) guidelines which indicate the following:
- Body Mass Index (BMI = weight divided by height in meters squared) of ≥40 (@ 100 pounds overweight), or ≥ 35 to 39.9 with at least one other obesity-related disease; i.e., Type 2 diabetes, sleep apnea, severe osteoarthritis, cardiac disease including high blood pressure and high cholesterol, polycystic ovary disease, etc. Those with BMI ≥ 30-34.9 can be considered for a gastric Lap-Band ® only and must also have at least one other obesity-related disease to qualify for bariatric surgery.
- Must have tried and failed conservative treatment and be overweight for a minimum of 5 years.
- Must be 18 years of age or older.
- Must be mentally prepared for the procedure without having an eating disorder such as bulimia.
How successful is the surgery?
Results at Orange Regional correspond to the national average. In the majority of cases, bariatric surgery patients lose anywhere from 45% to 83% of their excess body weight and improve or resolve 90% of their obesity-related health conditions within one year post-operatively.
Is there more than one weight loss surgical option?
At Orange Regional we offer three bariatric surgery options:
Gastric Banding – A procedure where the surgeon places an inflatable and adjustable band around the upper part of the stomach, partitioning it into two parts. The band creates a small opening that allows limited food to pass through each section, resulting in controlled food intake. This means the patient feels full more quickly, while eating less and absorbing fewer calories. This procedure is reversible, but not advisable. If the gastric band is removed, the stomach size reverts back to the size it was prior to the surgery and the patient may regain weight lost.
Gastric Bypass – A procedure that involves the reorganization of the digestive system. The surgeon creates a small pouch in the upper part of the stomach by stapling it together. The surgeon then attaches part of the small intestine to the new pouch, effectively “bypassing” the part of the stomach that has been sealed off. The patient eats less, which causes the body to absorb fewer calories and lose weight. This surgery should be viewed as permanent. Although a bypass can technically be “reversed”, the anatomy is never the same as it was prior to the gastric bypass procedure.
Sleeve Gastrectomy – A procedure that removes approximately seventy-five percent of the stomach and results in less food consumption, causing the patient to eat less and lose weight. Following the surgery, a narrow tube or sleeve of stomach remains which connects to the intestines. There are no nutritional deficiencies as a result of this procedure because it does not affect the absorption of food and the intestines are not affected by the surgery. This procedure is not reversible.
Are there risks with weight loss surgery?
There is always a certain degree of risk involved with any surgery. At Orange Regional, all bariatric surgeries are performed as minimally invasive, laparoscopic procedures which decrease risks and complication rates. Risk of mortality has been reduced from 2% with open gastric bypass to 0.5%, the same rate if the patient were having a laparoscopic gall bladder removal. Laparoscopic gastric banding is ten times safer than gastric bypass with a mortality rate of 0.05%. The laparoscopic sleeve gastrectomy mortality rate is also low at 0.39%. Other risks (long-term post-surgical complications) are as follows:
anastomotic leak: This is a leak that occurs at the anastomosis (connection between the new proximal pouch or the small intestine). Leaks may require an operation (in some cases an emergency operation) to correct.
marginal ulcer: After gastric bypass, stomach acids produced for digestion are still present and patients can be predisposed to ulcers. Antacid medications are required for a period of time following surgery to prevent ulcers. Smoking and non-steroidal anti-inflammatory agents (NSAIDS) also increase the risk of ulcers and must be avoided.
vitamin/mineral deficiencies: The gastric bypass causes food to bypass the sections of the digestive tract where most iron and calcium are absorbed. Vitamin B12 deficiency can develop quickly and with little warning. Menstruating women may develop anemia when not enough vitamin B12 and iron are absorbed. It is important to have vitamin/mineral levels checked regularly by your medical team.
hernia: an incisional hernia occurs when tissues at the site of your incision become weak creating a pocket for underlying structures. Your surgeon will take care to suture these underlying tissues as well as your skin layers.
gall stone formation: There is a predisposition to develop gallstones after gastric bypass surgery. As a preventative, a medication to prevent gall stone formation will be prescribed by the bariatric surgeon upon hospital discharge and will be required for a period of time following surgery to prevent gall stones.
stomach slippage: This occurs when the portion of the stomach below the gastric band, slips up above it causing discomfort, pain, inability to eat, and regurgitation of food eaten days prior. This requires loosening of the band by removal of fluid, or band repositioning or removal in some cases.
stoma obstruction: Obstruction can occur from tissue manipulation or edema (swelling) from surgery. In some cases, obstruction will require surgical removal.
gastric band erosion: In <1% of cases (patients who are usually genetically pre-disposed to erosions) the band can erode into the stomach. An erosion requires band removal. The stomach must have time to heal well before the patient considers any future revisional bariatric surgery.
access port problems: Blunt force trauma to the stomach after gastric banding can cause the sutures to loosen and the port to flip. This requires a surgical fix as the reverse side of the port does not provide access for future adjustments (fills) to the band.
suture line bleeding and leakage: This procedure requires the surgeon to staple off 60-75% of the stomach. The sleeve of stomach remaining must be stapled closed and could potentially bleed or leak. A double stapling technique can prevent bleeding and leakage complications.
gastric remnant dilatation: The narrow sleeve of stomach or stomach remnant after sleeve gastrectomy will dilate over time and become wider, enabling more volume of food to pass through the stomach than before. Adherence to diet modifications from immediate post-op to latent post-op will prevent potential weight regain.
gastric stricture: a stricture is a narrowing of the intestinal tract which can be caused from scar tissue formation. The stricture can block passage of food and needs to be relieved. An endoscopy can diagnosis; as well as, treat the stricture successfully.
What are the most common side effects?
Some of the more common side-effects after bariatric surgery are fatigue; surgical pain (mild to moderate); nausea; weakness; light-headedness; sleeplessness; loss of appetite; gas pain; constipation or lose stools; emotional ups and downs and dumping syndrome (sugar intolerance after gastric bypass).
What kind of diet regimen is required before surgery?
Pre-operative diet is also important. It is strongly recommended and sometimes required by insurance companies that bariatric surgery candidates attempt to lose five percent body weight prior to surgery. This is recommended so the liver shrinks in size, making the surgery safer and because research has shown better outcomes for patients who have already started to lose weight prior to surgery. Orange Regional’s bariatric dietitian educators work closely with each bariatric surgery candidate to help to achieve this goal.
What kind of diet regimen is required after surgery?
At Orange Regional, all bariatric surgery patients are required to remain on bariatric clear liquids for a few days and then advance to a bariatric full-liquid diet including protein shakes for 2 weeks post-surgery. During week three, the diet varies depending upon the procedure. Gastric Bypass and sleeve gastrectomy patients advance to a puree diet, and gastric band patients advance to soft solids. All patients eventually consume well-balanced and portion -controlled solid foods. The “slow, small, moist, and easy” eating techniques are critical for patients to follow:
- Set aside 30 minutes to consume each meal
- Chew food 28 to 30 times before swallowing
- Take small bites and use a saucer in place of a plate to aid in portion control
- Stop eating as soon as you feel full
- Eat all of your protein first to ensure adequate amounts before feeling full
- Stop drinking 30 minutes before eating; do not drink during your meal; wait 30 minutes after eating to resume drinking
Can a person still overeat?
Attempts to overeat immediately after surgery will cause the patient to regurgitate. Over time, with the gastric bypass and sleeve gastrectomy, the pouch will expand slightly and allow more food to be ingested at one time. As a result, patients must be educated pre-operatively to the difference in rules of their stomach pouch to prevent weight regain. Moreover, it is very important that patients continue to attend support groups after surgery to learn behavior modification techniques necessary to prevent weight regain.
What kind of follow- up is there after surgery?
A follow-up is conducted at the surgeon’s office during the following intervals:
1 wk/1 mo/3 mo/6 mo/9 mo/1 yr and once per year for life. For gastric banding patients, add additional follow-ups for adjustments of the band – once every 6 weeks to 3 months within the first year.
Follow-up is also provided by the bariatric dietitian educator from Orange Regional; as well as, physical and behavioral health therapists and other physicians/ancillary staff representing the multidisciplinary approach to care at our bariatric support groups provided throughout the month.
What are the benefits of weight loss surgery?
Open Surgery vs Laparoscopic Surgery?
The benefits are for the laparoscopic approach. The open approach is antiquated and requires a much larger incision, extended hospital stay and requires the surgeon to handle internal organs. During the laparoscopic approach, there are usually very small incisions (approximately five), less pain and a shorter hospital stay.
Bypass Surgery vs Banding Surgery?
Volume eaters benefit greatly from gastric banding surgery. This option provides volume restriction, gradual weight loss at @ 1-2 lbs per week and resolves co-morbid conditions.
Benefits for gastric bypass include rapid weight loss at @ ½ lb. to 1 lb. per day, significant improvement or resolution of Type 2 diabetes even before weight loss occurs, resolution of other co-morbid conditions, avoidance of sweets which is necessary or dumping syndrome will occur (intolerance to sweets). The benefit of avoiding sweets is to prevent the side effects of dumping syndrome; i.e., rapid heart rate, sweating, feeling faint and severe diarrhea.
The Benefits for sleeve gastrectomy are significant weight loss without bypassing the intestines or introducing a foreign object (like a gastric band) and no need for post-surgery adjustments of a foreign object periodically and resolution of co-morbidities.
Overall Benefits of Bariatric Surgery?
The Benefits of bariatric surgery in general are improvement or resolution of Type 2 diabetes, reduction in high blood pressure, resolution of sleep apnea conditions and other sleep disturbances, diminished swelling and pain of legs and joint; many infertile women become pregnant and have a safer pregnancy and delivery; changes in cholesterol and other blood lipids reduce the risk of heart attack and strokes.
Overall, patients improve the quality of their life and increase the amount of years to live.
Are any of the Bariatric Surgery procedures performed using Robotic Surgery?
Certain bariatric procedures can be performed using the robotic-assisted da Vinci Surgical System, however it may not be appropriate for every individual. Always ask your physician about all treatment options, as well as their risks and benefits.