Bariatric Surgery

Bariatric surgery is a surgical procedure performed on the stomach and/or intestines to induce weight loss. It has been known to “cure” multiple medical conditions, such as high blood pressure, type II diabetes, sleep apnea, and PCOS (Polycystic Ovarian Syndrome).

There are many types of bariatric surgery, also known as weight loss surgery. The three most common types are the gastric bypass, the gastric sleeve, and the lap band. Each procedure restricts food intake and, in some cases, limits the absorption that your body can perform.

Gastric bypass, also known as Roux-en-Y, is the most commonly performed bariatric surgery today. This is almost always performed laparoscopically. It is called the gastric bypass because the surgeon can design a new stomach “pouch” that bypasses the original stomach. This ensures that only a small amount of food may be ingested. However, along with little food, means fewer nutrients. Multivitamins, including calcium, are an essential part of a patient’s life after gastric bypass.

Some possible complications are:

• Blood clots. Walking helps to prevent them
• Change in bowel function or nausea
• Bowel obstruction
• Indigestion, GERD, or gallstones
• Dehydration due to only being able to take small drinks at a time.
• Gallstones due to your body’s new way of absorbing food and nutrients
• Leaks within the stomach and at the staple line. This is always checked the day after surgery before discharge.
• Nutritional insufficiency
• Intolerance to certain foods. This will be different for each patient.

The gastric sleeve, also called the banana surgery, is a bit simpler than the bypass. In most cases, this is performed laparoscopically. The surgeon will create a small, banana shaped stomach, often called a pouch. This is done by cutting and removing 70-80 percent of the patient’s original stomach. Titanium staples are used to seal up the remaining “pouch.” The excess stomach is removed through one of the 6-7 incisions in the abdomen. Your stomach creates and holds the hormone Ghrelin. This hormone produces the hunger feeling. This is thought to be removed during this surgery. So, it’s the hope of the surgeon (and patient) that they will lose that constant feeling of hunger.

The possible complications, which are rare, are the same as with the gastric bypass surgery.

• Blood clots
• Changes in bowel function
• Diarrhea
• Nausea
• Bowel obstruction
• Indigestion, GERD, and gallstones
• Dehydration
• Hypoglycemia
• Leaks within the stomach and at the staple line
• Nutritional insufficiency
• Intolerance to certain foods

Laparoscopic adjustable gastric band is also known as the Lap-Band. This is a restrictive surgical procedure. This procedure inserts a band around the top part of the stomach. This is designed to do the same as the gastric sleeve but it's not permanent. The band creates a small pouch at the top of the stomach so that the patient feels fuller quicker and for longer. The band is adjustable. If the patient feels that they can eat too much or too little, it can be adjusted to allow more or less food at once. Like with all bariatric surgeries, there are possible complications to include:

• Constipation
• Difficulty swallowing
• Nausea or vomiting
• Bowel perforations
• Food trapping
• Acid reflux (GERD)
• Port issues
• Hiatal hernia

Bariatric surgery is not an easy thing. Careful consideration must be taken in your decision to move ahead. Gastric bypass and gastric sleeve are irreversible and a complete life change. Insurance companies, along with your surgeon, want to make sure that you are making an informed decision and you are physically and mentally prepared for the surgery. Each insurance company has their own set of requirements, if they will cover the surgery.

Pulmonary consult and PFT’s (pulmonary function tests) are required.

You will need to meet with the lung doctor to discuss your history and he will order the PFT’s which tests how air enters and leaves your lungs (Pulmonary Function Test). If you snore, you will also need to have a sleep study performed to check for sleep apnea. If the results are negative- the doctor will give clearance.

Cardiology consult and an echocardiogram is required.

You will need to meet with the heart doctor and discuss any pertinent issues. Then they will order an echocardiogram, if the examination warrants one. If everything shows up good, the doctor will clear you for surgery.

Gastroenterology Consult and an Upper Endoscopy

This will check for ulcers or abnormalities. You will meet with the stomach doctor who will speak to you about your history and will schedule the upper endoscopy. An endoscopy is a test that sends a tube down your throat to see all the way to your stomach. This is usually required for gastroenterology clearance.

A psychiatric consult is important.

The licensed professional that you meet with (must be licensed) will ask for a history as well as your current situation and supports available to determine if you are mentally prepared for this permanent life change.

Endocrinology consult is only required if you have diabetes.

This is to make sure that you are stable on your treatment of diabetes.

Attendance to at least one bariatric support group is necessary.

It is also helpful to see others in all stages of progress, before and after.

Nutrition consult is required.

Along with three to six months of a highly supervised diet. Some insurance companies require a pre-surgery weight loss of 5-10 percent of your excess body weight. The nutritionist will prepare you for life after surgery.

“Eat slow, chew well, and no drinking for 30 minutes after eating”—Words to live by.

Nutrition is a major factor of this new life that you’re creating for yourself. Pre-op and post-op, your nutritionist will be your biggest support. Protein and portions are important. Post-op, you will have regrets and think, “what have I done?” There will be two weeks of eating strictly liquids and protein shakes. Your stomach is brand new and still healing and you can’t overwhelm it. Then there will be two weeks of puree and soft foods (low calorie, low fat, low sugar, and low carb). Then you will slowly be able to introduce a normal diet. One new food at a time, just like a baby’s tummy. Eventually, you will be able to eat three to four ounces of food at each meal, if you eat slowly, chew well and wait 30 minutes after meals to drink any fluids. If you drink with meals or too soon after, you are washing the food from your stomach and not allowing absorption of the protein and vitamins. You will be hungry again sooner than you should. Protein is so important. Always eat protein first, then veggies and then carbs. Carbs should be little to none.

Its about a new lifestyle. Everything changes. Eating will not be a hobby or a party event anymore. Bariatric surgery gives you a new lease on life. Most people say, "Why didn't I do this sooner?"