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Bariatric Surgery Options

We offer three types of weight loss surgery; the adjustable gastric band, the gastric bypass (also named Roux-en-Y gastric bypass), and the vertical sleeve gastrectomy. All three procedures limit the amount of food you can eat, resulting in weight loss. The adjustable gastric band surgery is minimally invasive, and performed using laparoscopic techniques. The gastric bypass and vertical sleeve gastrectomy are also minimally invasive, and both performed laparoscopically utilizing the latest Davinci Xi Robot. The proper treatment varies from person to person, and when meeting with your surgeon you will have a better idea which of these procedures is right for you.

Adjustable Gastric Band or Lap Band

In this procedure, a soft plastic band is placed at the top of your stomach, dividing it into two compartments. The band is adjustable as it can be filled with saline to alter the size of the outlet between the two parts of the stomach. The size of the outlet helps control the passage of food from the upper part of the stomach, also called the pouch, to the main stomach. As the outlet is made smaller by filling the band, you will feel full sooner. The stomach and intestines are not rerouted, and food will still travel through all parts of your digestive tract. Because of this, there is less of a chance for nutritional deficiencies.

Immediately after the surgery, the band will not be filled. However, due to swelling at the surgical site, you will feel some restriction. The outlet between the pouch and the main stomach will be very small. Because of this, we will maintain you on a high-protein liquid and soft-solid diet during the first two weeks after surgery, and medications will be small enough to pass through the outlet. It is very important not to overeat early after surgery, as it can result in slippage of the band, limiting its effectiveness.

Your will first be filled 4-6 weeks after surgery. Most often the fills can be done in the office. If the port is hard to locate, you might be asked to have your fill performed in a radiology suite. There is an optimal amount of fluid that each band should hold, which varies from patient to patient. If the band is under filled, it will lead to poor weight loss because the outlet will be too big and food will pass too quickly into the main stomach, limiting the feeling of satiety. If the band is too tight, you might develop maladaptive eating behaviors to compensate. You might also turn to high-calorie liquid foods which will be easier to tolerate, but will undermine your weight loss efforts. The success of this procedure will depend on your commitment to following the post-op program that we will plan for you.

Gastric Bypass

In this procedure your stomach will be made smaller by stapling and dividing it into two compartments. The smaller compartment is called a pouch. The larger part of the stomach is bypassed, with food is going around it, rather than passing through it. An outlet is made in the newly formed pouch and is connected to a limb of intestine. Due to the small size of the pouch you will feel full quicker. The food will empty directly from the pouch into the intestine, taking several hours and making you feel full longer. With food bypassing the upper part of your intestines, it will reduce your absorption of food, also helping to control your weight. However, you will need vitamin and mineral replacements because the main stomach and the first part of the small intestine will be bypassed.

After the procedure, all food and medication must be small enough to fit through a straw in order to allow your stomach to heal. You will be placed on a special liquid diet immediately following surgery and only liquids and soft solids should be eaten during the first two months, and all non-liquid or non-chewable medications should be crushed. All of this information will be written and provided for you by your dietician. It is very important that you do not overeat, especially during the first two months following the surgery when the stomach is healing. If you eat more than your stomach can hold, you risk vomiting.

Dumping syndrome, a possible side effect of the procedure, may include one or all of the following symptoms: light-headedness, dizziness, heart palpitations, sweating, nausea, cramps, and/or diarrhea. This condition is the result of eating the wrong food, overeating, drinking with meals, or drinking too soon after eating. It is caused when food or liquid enters the intestines quickly and causes it to distend. Highly concentrated foods such as sweets and high-fat foods can cause dumping, so these foods should be avoided. Your dietitian will work with you to lower the chances of this occurring.

Vertical Sleeve Gastrectomy or Gastric Sleeve

In this procedure, your stomach will be made smaller by stapling and dividing the majority of your stomach and removing it from your body. The remaining stomach is shaped like a long narrow tube with a small reservoir for food at the end of the tube. This reservoir only holds about 3 ounces of food, allowing you to feel full quickly.

The sleeve gastrectomy retains the normal valve (pylorus) that allows food to exit your stomach. Because of this, the stomach is able to move food into the small intestines at a normal rate, which avoids the dumping syndrome that is common with the gastric bypass procedure. Additionally, the acids and digestive enzymes that help absorb vitamins and minerals are not bypassed during a sleeve gastrectomy, which places you at lower risk for vitamin deficiencies. However, since your stomach is smaller, it will absorb these substances less efficiently, meaning you will need to take vitamin replacements.

After the procedure, there will be some swelling of the tube, making it difficult for solid food to pass through it. All food and medication must be small enough to fit through a straw in order to allow your stomach to heal. You will be placed on a special liquid diet immediately following surgery and only liquids and soft solids should be eaten during the first two months, and all non-liquid or non-chewable medications should be crushed. All of this information will be written and provided for you by your dietician.

Minimally Invasive Surgery

Laparoscopic surgery, or minimally invasive surgery, has many advantages over the more common open procedure. The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. A recent study shows that patients having had laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and lung function and higher overall oxygen levels. All three of our surgical weight loss procedures are performed using laparoscopic techniques.

Important Considerations

The proper approach to weight-loss surgery requires discussion and careful consideration of the following with your doctor:

  • These procedures are in no way to be considered as cosmetic surgery.
  • The surgery does not involve the removal of adipose tissue (fat) by suction or excision.
  • A decision to elect surgical treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure.
  • These weight loss surgical procedures (approved in the United States) are not reversible.
  • The success of weight loss surgery is dependent upon long-term lifestyle changes in diet and exercise.
  • Problems may arise after surgery that may require reoperations.

Success of surgical treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.

Complications and Risks

As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures that should be discussed with your doctor. Possible risks include, but are not limited to:

  • Bleeding
  • Complications due to anesthesia and medications
  • Deep vein thrombosis
  • Infections
  • Leaks from staple line breakdown
  • Marginal ulcers
  • Pulmonary problems
  • Stenosis
  • Internal Hernia
  • Band slip/erosion
  • Failure to lose weight

If surgery is performed laparoscopically and complications occur during the operation, your doctor may choose to perform open surgery. At ECHN all surgeries are scheduled as laparoscopic and fewer than

Surgery Preparation

Weight loss surgery is like other major surgeries. The best preparation is to understand the risks and potential benefits and to closely follow your doctor's instructions.

To mentally prepare yourself:

  • Understand the surgical process and what to expect afterwards.
  • Talk to people who have had weight loss surgery. Attend informational sessions and support groups.(hyperlink words to schedules)
  • Write a letter to yourself and your surgeon explaining your reasons for having the surgery and outlining your plans to maintain your weight loss after surgery.
  • Start a journal about your experience. Record how you feel now, the obstacles you encounter, the things you hope to be able to do after surgery.
  • Get a letter of support from your family. It helps to know you have people behind you, waiting to help.

To physically prepare yourself, strictly follow your doctor's guidelines. These usually include, but are not limited to:

  • Restricting yourself to a clear liquid diet 12-24 hours before surgery.
  • Pursue and complete all necessary pre-surgery testing and procedures. Stop smoking for at least two months before surgery. Resuming smoking after surgery is very dangerous and predisposes gastric bypass patients to ulcer formation that can be very difficult to treat.
  • Be certain to follow your surgeon's instructions regarding any medications you may be taking to control other health conditions.
  • Follow all hospital instructions for arrival on day of surgery

After Surgery

Post surgical commitment to doctor-provided instructions is crucial to proper healing. These include instructions in different areas.

Diet
The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Your surgeon will provide you with post-surgery dietary guidelines. It is important to remember that every surgeon does not perform the exact same weight loss surgery procedure and that the dietary guidelines will be different for each type of procedure. What is most important is that you adhere strictly to your recommended guidelines provided by the dietician.

When you leave the hospital, you will be on a __________ diet.
Some general guidelines are as follows:

  • Don't drink fluids while eating. They will make you feel full before you have consumed enough food and may trigger the dumping syndrome.
  • Omit foods containing simple sugars.
  • Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
  • Avoid alcohol.
  • Limit snacking between meals.

Going Back to Work
Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity, and the type of weight loss surgery you had. Most patients return to full pre-surgery levels of activity within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.

Birth Control & Pregnancy
It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 12 months after weight loss surgery. The added demands pregnancy places on your body makes this an important requirement.

Long-Term Follow-Up
Although the short-term effects of weight loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. You will receive a written schedule listing your appointments with your surgeon and dietitian. During the first year, your appointments will be fairly frequent. After the first year you will be seen at 18 months and then 2 years. After that you will be seen yearly. It is critical to continue to see your surgeon on a yearly basis to check for nutritional deficiencies and follow your weight.

Weight Loss Surgery Support Groups
The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. ECHN has support groups in place to assist you with short-term and long-term questions and needs, and you should never hesitate to ask for assistance. Ongoing post-surgical support helps produce the greatest level of success for patients.