What do you take into consideration when choosing an operation?
In general, the more weight loss someone wants, the more risk they have to be willing to accept, so the right surgery depends on what their goals are for weight loss. For example, Gastric Bypass Surgery is associated with a 1 in 50 risk of death. Adjustable gastric banding is a safer operation. That operation probably has a less than 1 in a 1000 risk of death.
In patients who are older or sicker, physicians generally tend toward either the banding or sleeve procedure. Those operations are good for people who are unwilling to accept the risk of the Gastric Bypass Surgery, as well as volume eaters.
How can people choose a good Bariatric surgeon?
The surgeon should have extensive experience in Bariatric Procedures. There is a learning curve with these operations, especially if done laparoscopically. Choose a surgeon who has performed an excess of 200 operations. Also make sure he/she answers your questions honestly and takes the time to evaluate and educate you carefully on the procedure.
Patients habe a tendancy to rush into surgery. They make a decision in their head and then it’s wherever they can have the surgery performed at the earliest time. However, the goal should always be for long-term health and quality of life in addition to weight loss.
How much weight loss can people expect to see with surgery and how quickly does that happen?
With Lap-Bands, people can expect to lose approximately 50 percent of excess weight. So if they are 100 pounds overweight, they can expect to lose 50 pounds. That weight loss takes approximately two years. With the Gastric Bypass Surgery, patients with a BMI under 50 seem to lose 70 percent of their excess weight or more. Patients who have a BMI over 50 tend to lose about 50 percent of their excess weight with a Gastric Bypass procedure. Approximately, three-quarters of the weight loss happens in the first six months and almost all of it by a year to 18 months.
Is there a risk of becoming undernourished?
Nobody should go to a surgeon who does Bariatric surgery without a program that delivers pre-operative and post-operative nutritional support. With Lap-Bands, there’s almost no risk of becoming undernourished as long as chronic vomiting doesn’t become a problem. With Gastric Bypass, there are certain vitamins and minerals (iron, calcium, vitamins B12 and D) that can be poorly absorbed after the surgery, so we recommend supplements.
With Biliopancreatic Diversion, 2 to 10 percent of patients can end up with protein malnutrition that requires intravenous nutrition and then further surgery to allow the patient to absorb more of their proteins. Up to a third of patients can end up with vitamin or mineral deficiencies. These patients have to be even more carefully followed and even stricter about their diet.
What are other surgical options?
A new surgical option is a Gastrectomy. This is when only the first portion of the Biliopancreatic Diversion is performed. Three-quarters of the stomach is removed, leaving a sleeve of stomach. Some surgeons are using that as a first stage to get higher-risk patients to lose weight and then come back and do the rest of the operation at a second stage so they can lose more weight.