truthaboutgastricbypass.com

This operation is the most common gastric bypass procedure. It was first performed for weight loss 30 years ago. First, a small stomach pouch is created by stapling or by vertical banding. This causes restriction of food intake. Next, a section of the small intestine is attached to the pouch, to allow food to pass to the intestines. However, the initial portion of the intestines is “bypassed” and the stomach pouch is attached to the lower portion of the intestines. This causes mildly reduced calorie and nutrient absorption.

You will certainly eat differently. Patients experience significant lack of hunger after the gastric bypass. This is most significant immediately after the operation, but improves some with time. Patients also become very full (satiated) after eating small amounts of food. After a gastric bypass people generally are satisfied with the foods that they eat, they generally can eat regular food (with the exception of sweets) and many of their previous cravings are gone. In the first several months of the operation, patients have to adapt suddenly to their new eating style. There is a lot of trial and error in food selection. Within a few months, eating is much easier.

Dumping usually occurs when concentrated sugar, or highly concentrated carbohydrates enter the upper intestine without being broken down by pancreatic juice and bile. Since these fluids mix with ingested food further downstream than usual after the gastric bypass, dumping generally occurs if a patient eats concentrated sweets. The syndrome typically involves 15 minutes to one hour of intestinal cramping, diarrhea, sweating, a fast heart rate and other side effects. Dumping can sometimes happen with other foods as well. Dumping does not occur after gastric band placement or the BPD-DS. We view dumping a good side effect that improves patient’s weight loss.

On average, after a gastric bypass, patients will loss about 70-80 percent of their excess weight during a 2-year period. Weight loss is extremely rapid after the first 6 months and then tapers down. Some patients will regain 5-10 percent of their excess weight during the two to five year marks. The reason for this weight regain in some patients is complex and poorly understood. Long-term studies have consistently documented the persistent of weight loss over a ten- to twenty-year follow-up. This is one of the best-studied operations for weight loss.

The most common late complications after a gastric bypass is iron deficiency anemia. Menstruating women will need to take an iron supplement. All other patients can have a multivitamin with iron. Osteoporosis may occur at a higher frequency in gastric bypass patients, calcium supplements are recommended in some patients. Rarely, hernias can occur long after a gastric bypass. These may require operative interventions.

In the first several months after a gastric bypass, two percent of patients develop strictures. This is scarring between the stomach and the intestine. People notice that liquids “go down” easily, but solids tend to stick. This complication can be easily remedied by an endoscopy performed by the gastroenterologist in the office. Ulcers occur in some patients – especially smokers and patients that take NSAIDS (Motrin, Aleve, Advil, Naproxen, etc…) Ulcers can cause bleeding or pain. Medications often help ulcers heal.

In the first week of a gastric bypass several potential complications are possible. Death is a very rare event in experienced centers. We have never had a death. The death rate is about 1/500 – 1/1000. The most common cause of death is a pulmonary embolism (PE). PE’s can occur after any general anesthesia and major operation. Early mobilization and the use of blood thinners can decrease the likelihood of this serious complication. We have never had a PE after a gastric bypass. A “leak” is when intestinal fluid spills out from where the stomach and intestines are connected. This complication can result in peritonitis. This complication occurs in 0.5% of patients in experienced hands. We have not had an anastomotic leak in several years. Leaks can be managed by a number of methods – sometime requiring a re-operation. Bleeding is a complication that requires transfusion in 1 percent of patients. Bleeding rarely requires re-operation. Nausea that lasts for more than several days is uncommon. Rarely nausea lasts for several weeks. Nausea always resolves with a little time. There are numerous potential complications (some serious and some not) that can occur after any operation. A complete listing cannot be anticipated.

The mortality risk associated with GBP appears to be about 0.5%. Because of the increasing popularity of the procedure, some surgeons have been tempted to perform the operation without adequate training or an environment supporting the long-term follow-up care. Several studies have shown that the mortality rate from hospitals with a low experience with the procedure is far higher than the 0.5%. The American Society of Bariatric Surgeons fully supports the initiative of the Surgical Review Committee to establish rigid criteria to certify that hospitals with quality programs will be designated as a “center of excellence.” The most important questions to ask your surgeon: How many surgeries have you performed? Have you had any deaths?

The two most common causes of death after a gastric bypass are an anastomotic leak and a pulmonary embolism. An anastomotic leak can be rapidly deadly if not recognized and treated early. A “leak” occurs when intestinal fluids leak out freely into the abdomen. Symptoms of a leak may include, severe chest pain, shortness of breath, anxiety, heart palpitations and abdominal pain. Prompt treatment is critical. A pulmonary embolism is caused from a blood clot that forms in the leg that breaks off and gets lodged in the lungs. Prevention is the key to this complication. Blood thinners, leg compression devices and early walking are measures used to prevent blood clots.

Other complications include bowel obstruction, strictures, ulcers, bleeding and prolonged nausea. The open operation generally has a higher frequency of wound problems such as infections and wound hernias than the laparoscopic approach. Please see the written consent form for a more detailed written listing of complications. A frank discussion with your bariatric surgeon about the risks and benefits of surgery is critical to understanding the operation.

Post-Surgery Expectations

The length of hospital stay after the surgery varies, but usually lasts 2–7 nights. Gastric bypass is overwhelmingly successful, with many patients losing over 100 pounds within the first 18 months following surgery. Gastric bypass surgery should always be accompanied by an exercise regimen.

Undergoing a gastric bypass requires patients to commit to a new lifestyle. They will no longer be able to eat large portions of food at one sitting, nor will they be able to eat foods high in sugar or fat, which often result in gastric dumping syndrome, an unpleasant feeling of faintness caused by the sudden absorption of these foods in the shortened digestive tract. Other symptoms of “dumping” include feeling and looking flushed and some patients may feel jittery. Due to the limited amount patients can take in at any one time, they must constantly drink small amounts of water or risk dehydration.

Weight loss after bariatric surgery is described as Percent Excess Weight Loss (%EWL). Excess weight is defined as a person’s actual weight minus their ideal body weight (IBW). IBW can be estimated by the formula:

• Men: 106+6*(height in inches-60)
• Women: 100+5*(height in inches-60)

After a gastric bypass, the reported long-term weight loss varies from person to person. We can only estimate the amount of weight loss. Also, keep in mind that many weight loss operations, including the gastric bypass have significant weight loss in the short term. Long-term weight loss is much more important. On average, the %EWL after 6 months, 1year and 2 years will be 50, 70 and 80 percent. The average patient is female with a BMI of 48. There is significant variation, such that 95% of people will have lost between 95% and 60% of excess weight at 2 years.

So, a woman who weighs 325 pounds who is 5’5″ has a gastric bypass. She would be expected to lose 160 pounds at 2 years. However, she could lose as much as 190 pounds, or as little as 120 pounds. There is one predictive factor in guessing how much weight a person will lose. Patients who are very heavy and patients that are only slightly overweight, often lose weight at a predictably different rate. For instance, a patient who weighs 600 pounds, will never achieve a weight close to ideal with any bariatric operation. That person may lose 300 pounds, losing 60% of excess weight. Furthermore, a patient who weighs only 220 pounds would be expected, on average to lose a higher percentage of excess weight that a person weighing 320 pounds. That is, the skinnier you are, the more likely you can achieve a weight closer to your ideal.

It is normal and expected to gain some weight back after 2 years. The amount of weight regain is difficult to predict. One person may not regain any weight; another may regain 30 or more pounds. On average, patients regain 10-15% of their excess weight back in the long term.

Risks

The operation has a mortality rate of approximately 2% overall: 1% suffer immediate complications and death; another 1% will commonly have post-operative complications that lead to death within one month of surgery. This can be mitigated by compliance with the surgeon’s post-operative plan and using a doctor who has performed more than 200 procedures.

A full 25% of people undergoing this operation will have some form of post-operative complication (hernia, gall stones) either requiring a further procedure or change in habits. In some instances, the normal production of intrinsic factor in the stomach wall to aid in vitamin B₁₂ absorption is decreased. This may call for either B₁₂ injections or sub-lingual tablets for life to aid in the breakdown of food for energy.

Body Contouring After Gastric Bypass Surgery

With the growing popularity of bariatric, or gastric bypass, surgery as a treatment for obesity, body contouring after significant weight loss has become a field of special interest for many plastic surgeons.

By applying the latest techniques in body sculpting individualized to each patient’s specific needs and priorities, your plastic surgeon can help you realize the new shape that is hidden beneath the excess skin that remains after your goal weight has been achieved.

With significant weight loss over a relatively short period of time (usually 15-18 months), the remaining skin often does not retain the elastic qualities necessary to “shrink back down” to your new underlying shape. This often leaves patients with excessive amounts of hanging skin that creates a multitude of problems such as daily hygiene and finding clothes that fit properly.

A comprehensive approach to the bariatric patient is necessary to achieve the optimal figure following weight loss. One of the most important considerations for a plastic surgeon to realize is that a bariatric patient must be treated differently from non-bariatric body contouring patients. What has worked well for many years on other patients simply does not provide adequate shaping and contouring for the bariatric patient.

Patients who have undergone gastric bypass surgery and the subsequent significant weight loss may have numerous but similar areas of concern. These areas include:

-Breast ptosis, or droopiness, as well as a loss of breast volume (Mastopexy is a procedure to lift the breasts and may be performed with or without the addition of breast implants to improve shape, fullness and cleavage.)
-Sagging of the facial skin (Facelifting, forehead lifting and eyelid surgery may be necessary to achieve complete facial rejuvenation, or you may be a candidate for endoscopic or minimally invasive techniques)
-Excess abdominal skin and a laxity of the muscles of the abdominal wall, sometimes with an accompanying hernia. (Abdominoplasty or a lower body lift procedure can contour the abdomen, hips and buttocks)
-Hanging skin under the arms (Brachioplasty is a technique to lift the arms)
-Wrinkling and excessive bagginess of the thighs (A medial thigh lift can lift the inner thighs)

The cornerstone of a successful approach to body contouring is to individualize treatment to your specific circumstances and goals and to ensure that you have an adequate understanding of the issues involved so that you are able to make a fully informed decision. This will help you achieve the appearance you desire with the least invasive procedure available, thus creating a mutually rewarding experience.

Depending on the combination of procedures you choose, surgery will probably last between four and eight hours. After you are properly anesthetized, your plastic surgeon will make the incisions necessary for removal of excess skin and fat. After the incision has been made, he or she gently elevates the skin and fat off of the underlying structures. For a tummy tuck, the muscles of the abdominal wall are usually tightened using strong, permanent internal sutures. Some patients have hernias in the abdominal wall, and these may also be repaired during a tummy tuck.

After removing the excess skin and fat, your plastic surgeon will redrape the skin over the underlying structures. One or more drains may be placed beneath the incisions. These slender, rubber tubes assist in draining any fluid that may accumulate beneath the incisions and delay your healing. Your plastic surgeon may also chose to use a new product called Tissue Glue. This product helps your body heal and minimizes the fluid that may empty into your drains, allowing the drains to be removed earlier.

At the completion of the operation, a sterile dressing is applied to the incisions, and a compression garment is applied to the region of the body being treated. This compression garment helps support your incisions during healing, decreases postoperative swelling, and helps decrease any bruising that may occur.

You will notice an improvement in your body contour immediately. However, your shape will continue to improve in the following weeks as the mild swelling subsides. You should be up and walking the day following surgery, although you will be sore for several days. You should be able to resume your normal daily activities within several days following surgery, and you should be able to resume all of your physical activities within three to four weeks of surgery.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS): is a Malabsorptive Procedure. A Malabsorptive Procedures reduces the size of the stomach. However, the pouch of the stomach remains a bit larger than other gastric reduction procedures. The stomach pouch is connected to the lower part of the small intestine. Since the stomach pouch connects to the lower part of the small intestine, the result is the absorption of calories and nutrients are reduced greatly. There are three types of  Malabsorptive Procedures. The first type is called Biliopancreatic Diversion with a Duodenal Switch. The second type of Malabsorptive Procedure is termed the Biliopancreatic Diversion. Finally, the last method is the Extended Roux-en-Y Gastric Bypass Surgery.

Bariatric surgery is not a quick fix. It’s an ongoing journey toward weight loss incoherence with lifestyle changes. After surgery, the difference in your body makes it physically easier to adjust your eating and lifestyle habits. Positive changes in your body, your weight, and your health will occur, but you will need to be patient through the recovery process.

In the early days after surgery, you may not feel much different. In the recovery room, you can expect to have some discomfort (this can last for several days). Unfortunately, you may feel worse before you feel better.  Some doctors will provide a Patient Controlled Analgesia (PCA), or a self-administered pain management system, to help control pain. Other doctors prefer to use an infusion pump that provides a local anesthetic directly to the surgical site to control pain without the side effects of narcotics.

The changes made to your gastrointestinal tract will require permanent changes in your eating habits that must be followed in order to achieve successful weight loss. Post surgery dietary guidelines will vary by Bariatric surgeon. What is most important is that you follow your surgeon’s guidelines. The following are some of the generally accepted dietary guidelines:

• When you start eating solid food, it is important to chew your food thoroughly and eat very slowly. It is important to wait two to three minutes after swallowing before putting the next bite of food in your mouth. You will not be able to digest steaks or other chunks of meat if they are not ground or chewed thoroughly.
• Don’t drink fluids while eating. They will make you feel full before you have eaten enough food. Fluids consumed with meals can cause vomiting and dumping syndrome, and can lead to feeling hungry sooner after a meal.
• Don’t eat desserts and other items with sugar if they have more than 3 to 5 grams per serving size.
• Avoid carbonated drinks, high-calorie nutritional supplements, milk shakes, foods high in fat, and foods that have no nutritional value.
• Avoid alcohol.
• Limit snacking between meals.

Most patients are instructed to eat 1/4 cup, or 2 ounces, of food. As time goes on, you can eat more (as instructed by your medical team). Most people can eat approximately 1cup of food after a year or more post-surgery.

The guidelines are designed to improve the chance of long-term success in weight loss. If you don’t follow the guidelines, you may not lose or maintain the loss of the estimated 70 to 90 percent of excess weight. You may experience complications such as vomiting, diarrhea, or malnutrition after surgery.

It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after Bariatric surgery.

Finally, it is important to follow the advice of your physician at all time.

A recent survey conducted by the Center for Disease Control found that the most likely users of alternative therapy for weight loss are women. Their socio backgrounds were that of high education. They also had been hospitalized in the past year, and were former smokers. The leading ills people try to cure according to the survey are back, neck, and headaches; colds; insomnia; stomach problems; anxiety; and depression, due to their weight gain. The survey also found that other, less popular ills people use alternative therapy for include high blood pressure, high cholesterol, and symptoms of menopause, asthma, diabetes and cancer.

Fifty five percent of people that use alternative therapy for weight loss tend to combine the therapy with conventional medicine. Thirteen percent have tried alternative therapy because they think conventional medicine is too expensive. Twenty-eight percent of the peopled in the study believed that conventional medicine does not help their health problems. Outside of conventional medical treatments, the survey found that prayer is the most popular way sick people seek help with forty-two percent saying that they pray for their own health and twenty-four percent saying they pray for others.

Many people agree that this survey argues the need for more research to figure out which of these therapies work and which don’t, which are safe and which are not, and what effect access to these therapies will economically have on people. Other people argue that this survey and alternative therapies for weight loss, in general, are a waste of money because there is no evidence that any of these treatments work and a growing amount of evidence that they can cause harm. An example of this point, the Food and Drug Administration statement on the use of ephedrine. This over the counter popular herbal weight-loss product was taken off the market in late 2003 because it presents an unreasonable risk of illness or injury.

While most of the alternative therapies in the Center for Disease Control’s survey are being used for the treatment of ills other than obesity and the promotion of weight loss, they all are being used to promote health and well being in general. When people do turn to alternative therapies for the promotion of weight loss, they usually turn to things like herbal teas and medications, hypnosis, acupuncture, or thought field therapy (TFT). While many people claim these treatments are effective in promoting weight loss, many times they have been shown to be harmful to the person’s health. Also, most of these alternative therapies lack strong studies to support their claims of promoting weight loss so at this point it is hard to say which are effective and which are not.