Weight Loss and Obesity
Bariatric Surgery ;
Gastric bypass and other weight-loss surgeries — known collectively as bariatric surgery — involve making changes to your digestive system to help you lose weight. Bariatric surgery is done when diet and exercise haven’t worked or when you have serious health problems because of your weight. Some procedures limit how much you can eat. Other procedures work by reducing the body’s ability to absorb nutrients. Some procedures do both.
While bariatric surgery can offer many benefits, all forms of weight-loss surgery are major procedures that can pose serious risks and side effects. Also, you must make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of bariatric surgery.
Why is there a need for bariatric surgery ?
Bariatric surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:
Heart disease and stroke
High blood pressure
Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
Type 2 diabetes
Bariatric surgery is typically done only after you’ve tried to lose weight by improving your diet and exercise habits.
Who is eligible ?
In general, bariatric surgery could be an option for you if:
- Your body mass index (BMI) is 40 or higher (extreme obesity).
- Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.
Bariatric surgery isn’t for everyone who is severely overweight. You may need to meet certain medical guidelines to qualify for weight-loss surgery. You likely will have an extensive screening process to see if you qualify. You must also be willing to make permanent changes to lead a healthier lifestyle.
You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and your medical conditions.
And keep in mind that bariatric surgery is expensive. Check with your health insurance plan or your regional Medicare or Medicaid office to find out if your policy covers such surgery.
How to prepare & what to expect
If you qualify for bariatric surgery, your health care team gives you instructions on how to prepare for your specific type of surgery. You may need to have various lab tests and exams before surgery. You may have restrictions on eating and drinking and which medications you can take. You may be required to start a physical activity program and to stop any tobacco use.
You may also need to prepare by planning ahead for your recovery after surgery. For instance, arrange for help at home if you think you’ll need it.
The specifics of your surgery depend on your individual situation, the type of weight-loss surgery you have, and the hospital’s or doctor’s practices.
Today, most types of bariatric surgery are performed laparoscopically. A laparoscope is a small, tubular instrument with a camera attached. The laparoscope is inserted through small incisions in the abdomen. The tiny camera on the tip of the laparoscope allows the surgeon to see and operate inside your abdomen without making the traditional large incisions. Laparoscopic surgery can make your recovery faster and shorter, but it’s not suitable for everyone.
Surgery usually takes several hours. After surgery, you awaken in a recovery room, where medical staff monitors you for any complications. Depending on your procedure, you may need to stay a few days in the hospital.
Types of bariatric surgery
Each type of bariatric surgery has pros and cons. Be sure to talk to your doctor about them. Here’s a look at common types of bariatric surgery:
Roux-en-Y (roo-en-wy) gastric bypass. This procedure is the most common method of gastric bypass. This surgery is typically not reversible. It works by decreasing the amount of food you can eat at one sitting and reducing absorption of nutrients.
The surgeon cuts across the top of your stomach, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Normally, your stomach can hold about 3 pints of food.
Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. Food then goes into this small pouch of stomach and then directly into the small intestine sewn to it. Food bypasses most of your stomach and the first section of your small intestine, and instead enters directly into the middle part of your small intestine.
Sleeve gastrectomy. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can’t hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen your desire to eat.
Advantages to this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than most other procedures.
Biliopancreatic diversion with duodenal switch. This is a two-part surgery in which the first step involves performing a procedure similar to a sleeve gastrectomy. The second surgery involves connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing the majority of the intestine.
This surgery both limits how much you can eat and reduces the absorption of nutrients. While it is extremely effective, it has greater risk, including malnutrition and vitamin deficiencies.
Which type of weight-loss surgery is best for you depends on your specific situation. Your surgeon will take many factors into account, including body mass index, eating habits, other health issues, previous surgeries and the risks involved with each procedure.
After bariatric surgery
After weight-loss surgery, you generally won’t be allowed to eat for one to two days so that your stomach and digestive system can heal. Then, you’ll follow a specific diet for a few weeks. The diet begins with liquids only, then progresses to pureed, very soft foods, and eventually to regular foods. You may have many restrictions or limits on how much and what you can eat and drink.
You’ll also have frequent medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, blood work and various exams.
Gastric bypass and other bariatric surgeries can provide long-term weight loss. The amount of weight you lose depends on your type of surgery and your change in lifestyle habits. It may be possible to lose half, or even more, of your excess weight within two years.
In addition to weight loss, gastric bypass surgery may improve or resolve conditions often related to being overweight, including:
High blood pressure
Obstructive sleep apnea
Type 2 diabetes
Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
Gastroesophageal reflux disease (GERD)
Osteoarthritis (joint pain)
Gastric bypass surgery can also improve your ability to perform routine daily activities, which could help improve your quality of life.
Gastric bypass and other weight-loss surgeries don’t always work as well as you might have hoped. If a weight-loss procedure doesn’t work well or stops working, you may not lose weight and you may develop serious health problems.
Keep all of your scheduled follow-up appointments after weight-loss surgery. If you notice that you are not losing weight or you develop complications, see your doctor immediately. Your weight loss can be monitored and factors potentially contributing to your lack of weight loss evaluated.
It’s also possible to not lose enough weight or to regain weight after any type of weight-loss surgery, even if the procedure itself works correctly. This weight gain can happen if you do not follow the recommended lifestyle changes, such as getting regular physical activity and eating healthy foods.
Some patients may choose to have plastic surgery, but this depends on many factors. These type of surgeries are also known as “post-bariatric surgeries”.
Most groups advise waiting 12-18 months after surgery before getting pregnant.
Most women are much more fertile after surgery, even with moderate weight loss.
Birth control pills do NOT work as well in patients who are overweight. Birth control pills are not very reliable during the time your weight is changing. For this reason, having an IUD or using condoms and spermicide with ALL intercourse is needed. Menstrual periods can be very irregular, and you can get pregnant when you least expect it!
Gastric Sleeve ;
The Gastric Sleeve Surgery (or Vertical Sleeve Gastrectomy) is a bariatric procedure that removes 75-80% of the stomach. It is now the most commonly performed bariatric procedure in United States and worldwide.
Gastric Sleeve Surgery brings profound changes to life!
Overall improved quality of life
Excess weight loss of about 60-70% within one year of surgery
Remission or improvement of obesity-related health conditions such as diabetes mellitus type II, hypertension, sleep apnea, fatty liver disease, joint pain, and hyperlipidemia
Desire to eat decreases
Reduction in hunger sensation
So, what exactly is gastric sleeve surgery?
Gastric sleeve surgery is a type of weight-loss surgery. Weight-loss surgery is also called bariatric surgery. This surgery also known as sleeve gastrectomy or vertical sleeve gastrectomy (VSG). Gastric sleeve surgery restricts your food intake, which leads to weight loss. You may lose from 50 to 90 pounds.
It’s done as a laparoscopic surgery, with small incisions in the upper abdomen. Most of the left part of the stomach is removed. The remaining stomach is then a narrow tube called a sleeve. Food empties out of the bottom of the stomach into the small intestine the same way that it did before surgery. The small intestine is not operated on or changed. After the surgery, less food will make you full when eating.
Who is eligible for this procedure ?
Gastric sleeve surgery is used to treat severe obesity. It’s advised for people who have tried other weight loss methods without long-term success. Your doctor may advise gastric sleeve surgery if you are severely obese with a body mass index (BMI) over 40. Your doctor may also advise it if you have a BMI between 35 and 40 and a health condition such as sleep apnea, high blood pressure, heart disease, or type 2 diabetes.
Your healthcare team will need to make sure that gastric sleeve surgery is a good option for you. Weight-loss surgery isn’t advised for people who abuse medicines or alcohol, or who are not able to commit to a lifelong change in diet and exercise habits.
Before having surgery, you’ll need to enroll in a bariatric surgery education program. This will help you get ready for surgery, and life after surgery. You’ll have nutritional counseling. And you may have a psychological evaluation. You’ll also need physical exams and tests. You will need blood tests. You may have imaging studies of your stomach, or have an upper endoscopy.
If you smoke, you will need to stop several months before surgery. Your surgeon may ask you to lose some weight before surgery. This will help make your liver smaller, and make surgery safer. You’ll need to stop taking aspirin, ibuprofen, and other blood-thinning medicines in the days before your surgery. You shouldn’t eat or drink anything after midnight before surgery.
The surgery is performed under general anesthesia. This will cause you to sleep through the surgery. Your surgeon will use laparoscopy and make several small cuts (incisions) in your upper abdomen. Then a laparoscope will be inserted and small surgery tools will be put into these incisions.
The anesthesiologist will pass a sizing tube through your mouth down into the stomach. The surgeon will then use a laparoscopic stapler to divide the stomach, leaving a narrowed vertical sleeve. The part of the stomach that was removed is then taken out of the abdomen through an incision. Your surgeon may then test for any leaks in the sleeve using a dye study or an upper endoscopy.
You’ll likely go home the day after surgery. You will be on a liquid diet for the first week or two. Your surgery team will give you a schedule of types of meals over the next weeks. You’ll go from liquids to pureed foods, then soft foods, and then to regular food. Each meal needs to be very small. You should make sure to eat slowly and chew each bite well. Don’t move too quickly to regular food. This can cause pain and vomiting. Work with your healthcare team to figure out what’s best for you to eat. After your stomach heals, you will need to change your eating habits. You’ll need to eat small meals for your small stomach.
People who have weight-loss surgery may have trouble getting enough vitamins and minerals. This is because they take in less food, and may absorb fewer nutrients. You may need to take a daily multivitamin, plus a calcium-vitamin D supplement. You may need additional nutrients, such as vitamin B-12 or iron. Your medical team will give you instructions.
You’ll need to have regular blood tests every few months in the year after surgery. This is to make sure you don’t have low blood iron (anemia), high blood glucose, or low calcium or vitamin D levels. If you have heartburn, you may need to medicine to reduce stomach acid.
After losing weight, it’s possible to regain some of the weight that you lose. To avoid this, make sure to follow a healthy diet and get regular exercise. The sleeve may widen (dilate) over time. This will let you eat more. But keep in mind that if you eat all you can, you can regain weight. You may want to join a weight-loss surgery support group to help you stick with your new eating habits.
Recovery after Surgery
The surgery takes approximately 40-70 minutes
Discharge from the hospital typically occurs after 1-2 nights
All patients are encouraged to walk as early as 3-4 hours after surgery
In general, the pain is easily manageable after surgery. Most patients take less than the recommended pain medication
Most patients go back to work and/or school after 2-4 weeks. Fatigue is common the first 2 weeks due to low calorie intake from liquid diet. However, the majority of patients do not feel hungry during this stage of the diet. The energy level improves quickly after the introduction of the soft diet, which is approximately 2 weeks after surgery. On occasion, patients are allowed to work from home 2-3 days per week after surgery.
Patients can begin exercising 4 weeks after surgery.
- There is a reduction in stomach volume, causing people to feel full much quicker after the surgery
- Hormonal changes such as reduced secretion of hunger hormones cause people to feel less hungry
- Increased stomach motility, which allows food to pass stomach and intestine quicker after surgery
Over the past decade, with the improvement of surgical techniques and surgeons’ experience, the gastric sleeve has become an overall safe bariatric surgical procedure. However, complications can still occur during and after surgery. Below are the main complications and risks of the gastric sleeve surgery:
* Leakage from the staple line – this is a rate complication of the gastric sleeve surgery. The stable line opens after surgery. Most leaks can be treated with endoscopic procedure.
* Stricture/stenosis – another rare complication with narrowing of the stomach after sleeve gastrectomy. Most stricture/stenosis can be treated with endoscopic dilation.
*Heart Burn – This is a very controversial topic in bariatric surgery and the data from different centers is inconsistent. In our experience, most patients with heartburn before surgery see improvement of symptoms after surgery due to weight loss. Some patients may develop new heartburn, which is treatable with over-the-counter anti-acid medications, in most cases.
*Nutrient or vitamin deficiency
*Weight Regain – After 1-2 years, slight weight regain is common among all bariatric procedures and about 10-20% of patients can have significant weight regain after gastric sleeve surgery. After 5 years of follow up, many centers collected data to show that the majority of patients can maintain their weight loss after the Gastric Sleeve Surgery.
*Excess skin, in some cases, insurance will cover excess skin removal
Day 1: Clear liquid diet. Some surgeons allow patients to drink water a few hours after surgery
Day 2-14: Full liquid diet including protein shakes, yogurt, broth, milk, and juice
Weeks 3-5: Soft food diet
Patients can begin introducing regular food 5 weeks after surgery. They are encouraged to eat a small amount of food each time and have meals that are more frequent.
All patients must take multi-vitamin and B complex after surgery
On average, people lose about 60-70% of their excess weight
- The first 2 weeks: 10-20 pounds; most patients lose about one pound a day
- The first 3 months: 35-45% of excess weight loss
- The first 6 months: 50-60% of excess weight loss
- The first year: 60-70% of excess weight loss
- Most people reach their lowest weight 12-24 months after surgery
- The Gastric Sleeve success rate is approximately 80-90%