The amount of stomach that is removed during a sleeve gastrectomy is a very important factor in both short-term and long-term patient success.
In the past year we have had several patients come to us who had surgery done elsewhere. These patients complain of inadequate weight loss. When we order x-rays, we invariably find the stomachs are much too large for having been sleeved. Surprisingly, one stomach was only half sleeved! These patients then undergo another surgery with us to remove more stomach in order to correct what had been previously done poorly.
We are particularly sensitive to this issue and take great care in removing an appropriate amount of the stomach, leaving only a small portion of the lesser curvature. This will ensure lasting effects of satiety and therefore adequate permanent weight loss. Surgery like this should really only be done once.
Cutting corners to save money usually comes at the cost of patient safety and results.
One of the most serious and difficult to correct complications of gastric bypass surgery is a gastro-jejunal ulcer.
This is an ulceration that can appear after a gastric bypass at the junction formed between the stomach pouch and the intestine to which it’s connected. Reasons for this complication are difficult to pinpoint however it is believed they are partly technical and partly life style related.
Symptoms include recurrent episodes of nausea, vomiting and abdominal pain that appear typically a few months after a gastric bypass. But sometimes they can appear catastrophically with severe bleeding or acute abdominal pain due to a perforation of the ulcer.
Treatment always includes strong antacids and other medications, but these ulcers are difficult to heal and one of the first things we ask of patients is that exposure to smoking should be completely avoided.
There is a particular association between these ulcerations and smoking, be it first or second hand, to the point that there are several bariatric centers that screen the urine of their patients ensure there has not been any recent exposure to cigarette smoking. Surgery will be canceled if they find a positive result. To take this one step further, some centers will not perform gastric bypass procedures on patients who smoke, even though they are making efforts to quit. Instead the patient will be offered a gastric sleeve surgery.
So if you are a smoker or anybody in your household smokes, and you are considering bariatric surgery, it may be better to have a sleeve gastrectomy or make absolutely sure that you can quit smoking and any exposure to it.
I can’t count how many times I’ve heard this panicked cry from my patients. All patients who have bariatric surgery will experience periods of time when their weight loss suddenly stops for no logical reason. This is called plateauing or coming to a flat line in an otherwise progressive decline on their weight loss journey. It may happen after a couple of months following weight loss surgery and it is a very common source of anxiety.
We try to tell patients not to weigh themselves daily but it’s probably not advice that is easy to follow. I’m pretty certain my patients don’t. The excitement of seeing the number on the scale go down every day after weight loss surgery is one of the rewards that justifies what you have just endured and you accustom to seeing the pounds dropping almost every time you step on the scale and you start to expect it. It puts a smile on your face and I don’t blame you.
Then suddenly you see no change for a few days and sometimes a few weeks. The horror!
Metabolic efficiency is different among all of us. It is the amount of energy that our bodies spend to go through an average day. Some of you are genetically better at using fewer calories. You have become very good at acquiring and preserving energy. Thank your ancestors.
In a July, 2007 article by Dokken in the journal Diabetes Spectrum of the American Diabetes Association called ‘The Physiology of Body Weight Regulation: Are We Too Efficient for Our Own Good?’ the mechanisms of set point theory that regulates our comfortable body weight (and therefore weight loss and gain) are discussed.
There is no question that if we eat fewer calories and expend more energy we will lose weight. But it’s much more complex than it sounds and yes, there are many explanations for plateauing. Try not to worry about it; it really is a natural way of your body and your programmed metabolism to say “you are not going to change me that easily.” Keep doing the correct things: choose foods wisely, add a little more exercise, keep an eye on your liquid calorie intake and you will return to seeing drops in your weight.
A recent article from Laval University published in the prestigious Proceedings of the National Academy of Science compared the genetic health of babies born to mothers before and after weight loss surgery.
Continue reading “Can Your Weight Influence the Health of Your Unborn Baby?” »
The recent recognition by the American Medical Association that obesity is actually a disease has important implications for the treatment of this ailment which has become a world epidemic in the past few years. Continue reading “Obesity is a Disease” »
We are honored to be part of a new general surgery book about to be published, in Spanish, in the very near future. The book, authored by Dr. C. Alvarez and Dr. L. Franco, will be covering all aspects of General Surgery.
Dr. Alvarez, who was a colleague of Dr. Joffe’s during his many years of practice in Toronto, asked Dr. Joffe to contribute to the book with a chapter on obesity and bariatric surgery.
We’re happy to have contributed to this book and want to congratulate doctors Alvarez and Franco for their perseverance and dedication and wish them great success in the launching of their book.
We recently performed an adjustable laparoscopic band (Lap-Band) in combination with anterior gastric plication on a patient who was very interested in the band but also wanted something additional to give her some initial satiety and a little extra push.
The procedure is not technically difficult and did not add too much operating room time. We were impressed that the patient reported early sensation of satiety with no side effects. We feel that adding some form of plication may increase the positive results in the banded patient and could even decrease the incidence of band slippage. We are going to start a series to evaluate this accurately. It may very well be a worthwhile addition to laparoscopic band surgery.
A new article appearing in the May issue of Annals of Surgery from the University of Michigan compared results from the three most common bariatric surgeries we perform at AMBI.
They looked at complications, weight loss, quality of life and comorbidity remission at 30 days and then 1, 2 and 3 years after having one of these three procedures.
The results support our own thoughts: sleeve gastrectomy or gastric sleeve is a good surgical alternative, demonstrating similar results in terms of comorbidity resolution and weight loss as gastric bypass. It also pointed to the superiority of the surgery over the adjustable gastric band, although there is no question that when it comes to serious complications, the band is far less risky than the other two procedures.
It’s important when a patient is looking for surgery to compare results and outcomes. This will help them make the right decision. Ultimately, the success of the surgery depends on two important factors: the physical effects of the procedure and how the patients use them to adopt a new and healthier lifestyle.
A recent survey of professions and obesity confirmed what we have suspected for some time. A recent Gallup analysis comparing rates of obesity in 14 different types of occupations demonstrated that people in the transport business such as truck drivers suffer from a higher rate of obesity compared to people in other occupations. 36% of all transportation workers polled suffered from obesity and related problems. This is not a surprise. They have stressful jobs, long and irregular work hours, sedentary working conditions and junk food stops readily available all along the roads and highways.
We have noticed this trend on our patients but now we have hard data to substantiate this assumption. Unfortunately this can be a more serious issue when you recognize the connections of sleep apnea to the problem. This should be an indication to address the source of the problem and maybe bariatric surgical intervention early rather than late.
You have struggled with your weight for years. Recently your Doctor has told you that you are borderline diabetic or that your blood pressure is high. You finally say to yourself “this is it. I am having weight loss surgery.” You get on your computer and start researching. After some consideration, you have decided to go out of country for your bariatric procedure.
So far, so good… but there are so many possibilities. How to make the appropriate decision?
Remember that the gastric band requires close follow up and adjustments. Do you have access to a service that is ready to do this? If the answer is no, you will not achieve the success you desire with the laparoscopic band.
The surgery that requires less intense follow up is sleeve gastrectomy or gastric sleeve and it produces very good results. Gastric bypass is also a very good and time proven option, but you will require more intense nutritional and medical follow up. Gastric plication is relatively new and may be a less expensive alternative to the sleeve gastrectomy.
The other issue is cost. You see a wide range of prices and this is a case of ‘you get what you pay for.’ Are you willing to gamble with your safety?
This is one of the most important decisions you are going to make in your life and spending a few thousand dollars less may not be worth the risk. Would you have complex surgery somewhere that has no real hospital facilities? Would you let re-sterilized equipment that is meant to be used only once enter your body? What if something goes wrong? Why are some places much cheaper than other places? Unfortunately you may only find out after it’s too late.
This is a decision to make with your head; not with your wallet.
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