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Considering a surgical solution to your weight concerns? Join us to learn about this life-changing surgery.
If you are considering weight loss surgery, we require you to view our free information session prior to making an appointment with our surgical staff. These on-line sessions include a presentation by our surgical staff on causes and complications of morbid obesity and the types of surgeries available.
To sign up for a session, please create an account by following the instructions provided on the link below. Once you create an account, please search “weight loss surgery” to locate and view the webinar. You will be required to take a short test and pass with a score of 70% or better to complete the session.
The Adjustable Gastric Band – often called the band – involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.
The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin. Reducing the size of the opening is done gradually over time with repeated adjustments or “fills.” The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged by studies that show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. What is known is that there is no malabsorption; the food is digested and absorbed as it would be normally. The clinical impact of the band seems to be that it reduces hunger, which helps the patients to decrease the amount of calories that are consumed.
The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.
This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control. Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.
The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery and is the most commonly performed bariatric procedure worldwide.
There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food. The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients. Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
It depends on the surgery you have. For the laparoscopic adjustable gastric band, most people are able to return to work within a week. For the gastric bypass, sleeve gastrectomy, or duodenal switch, you should consider being off work for two to three weeks. If you have a desk job, you are likely to be able to return to work earlier. If your job is physically demanding and requires heavy lifting or physical activity, a longer period off work may be necessary. If there are questions, patients should consult with their surgeons.
Walking is encouraged early post-surgery and, thereafter, on a regular basis to increase your physical activity level. Aerobic activities such as brisk walking, stationary biking, elliptical machines, etc. may be engaged almost immediately after surgery and are limited generally by the degree of discomfort that these activities cause. You may engage in swimming once your surgeon has determined that the wounds have healed sufficiently. Activities that are more strenuous or that involve lifting weights are generally discouraged for three weeks after surgery. This can vary so consult with your surgeon first.
The general answer to this is yes. Most of the commonly performed abdominal operations such as C-section, gall bladder surgery, appendectomy, tubal ligation, hysterectomy and minor hernia repair of the belly button rarely impact the ability to have bariatric surgery. However, if you have had prior surgery for hiatal hernia or reflux, intestinal surgery involving removal of a portion of the small intestine or colon, or have had a major hernia repair with a large mesh, it could impact the type of surgery you can have or the ability to do it laparoscopically through small incisions. It is important to recall all prior surgeries and let your surgeon or nurse know about them during the evaluation process. If you have had a major abdominal surgery, it is very helpful if you can obtain the operative reports as well.
Yes, bariatric surgery has been shown to improve or cause remission of type 2 diabetes. There is evidence that procedures such as gastric bypass, sleeve gastrectomy and duodenal switch work through pathways such as gut hormones as well as through the weight-loss these procedures produce to cause the improvement or remission of type 2 diabetes. Studies find a greater than 95 percent of patients have improvement of type 2 diabetes with bariatric procedures and up to 85 percent have remission of their diabetes with these surgeries. Some studies have even reported improvement of type 1 diabetes mellitus following bariatric procedures. The adjustable gastric band also results in improvement or remission of diabetes; however, this results solely from the weight-loss that results from the band. Therefore, the improvement or remission of type 2 diabetes seen with the band tends to be slower and occurs in a smaller percentage of patients compared to the other surgeries.
Yes, surgery leads to significant improvement in conditions associated with or contributing to heart disease, including lipid abnormalities, an enlarged heart, vascular and coronary disease and hypertension. However, if you have heart disease, you will need medical clearance for bariatric surgery from your cardiologist.
Bariatric surgeons generally recommend that patients wait approximately 18 months after surgery to become pregnant due to the possibility of nutrient deficiencies during the weight-loss period. Obesity is a major cause of infertility and with weight-loss you fertility levels may increase. It is important to practice effective contraception other than birth control pills during this period in avoid getting pregnant. With appropriate nutrition and vitamin/mineral supplementation, bariatric surgery does not cause growth or development problems for offspring. In fact, studies find that women who had bariatric surgery have improved pregnancy and offspring outcomes than those who are affected by severe obesity and have not had bariatric surgery. These improvements include a reduced rate of preeclampsia (an increase in blood pressure leading to chronic high blood pressure) and gestational diabetes, a lower incidence of stillbirths, and fewer miscarriages. The offspring of bariatric surgery patients are also less likely to be underweight or overweight at the time of birth.
Whether or not your skin will sag after surgery depends upon several things including how much weight you lose, your age, your genetics and whether or not you exercise. Generally loose skin is well hidden by clothing. Some patients will choose to have plastic surgery, which is the only solution for removing the excess skin. Most surgeons recommend waiting at least 18 months before having plastic surgery, but you should consult with your surgeon before doing so. Plastic surgery for removal of excess skin is rarely covered by insurance because it is generally considered cosmetic. In some instances, removal of excess skin is necessary for medical reasons, i.e. skin irritation, ulceration or infection, pain, sexual function problems or hygiene issues; although it is more likely to get insurance to pay for the plastic surgery in these cases, it is still unlikely that insurance will pay. Many post-operative patients utilize compression garments to help with the appearance of excess skin. Many different types of compression garments can be found online.
Some hair loss is common following surgery and typically occurs between the third and sixth months following surgery. This is a result of several factors including the physiologic stress, the emotional stress of the adjustments and the nutritional stress following surgery. This is temporary, and adequate intake of protein, vitamins and minerals will help to ensure hair re-growth.
Vitamin and mineral supplements are necessary in the weight-loss period and certain vitamin/mineral supplements are needed life-long, depending upon the type of surgery you have. Insurance typically does not pay for vitamin and mineral supplements. However, you can pay for vitamins and minerals out of a flex medical account, which is a pre-tax account from your income that can be used for medical expenses.
There are loan programs available to cover the cost of health expenses, including loans for metabolic and bariatric surgery. Furthermore, metabolic and bariatric surgery is a health expense that you can deduct from your income tax. If you are not able to qualify for a loan, the Obesity Action Coalition (OAC) produces a helpful guide, titled “Working with Your Insurance Provider – A Guide to Seeking Weight-loss Surgery.” This guide can help you work with your provider and advocate for the treatment to be covered. You can view the OAC guide on their website.
Often the complication is reported under a separate code and the insurance company will pay. However, this may not always be the case.
Yes. Most bariatric surgeons put their patients on a pre-operative diet, generally for 2-3 weeks prior to surgery, in order to shrink the liver and reduce fat in the abdomen. This greatly helps with the surgery and makes the surgery safer. Additionally, some insurance companies require a physician-monitored diet three to six months prior to surgery as part of their coverage requirement.
Yes. Surgery is just a tool that will enable you to lose weight. Although surgery does produce changes in your body that help with the initial weight-loss and maintenance of the weight-loss, it is ultimately up to you to make lifelong changes to be successful. This includes making right food choices, controlling portions, taking vitamin and mineral supplements as directed, getting plenty of fluid, rest and regular exercise. In addition, sufficient sleep and stress control may help to improve long-term weight-loss success and maintenance. Without these lifelong changes weight regain is likely to occur.
To qualify for insurance coverage, a letter of necessity from your primary care physician is required. The letter will need to include information pertaining to current weight, height, body mass index, the co-morbidities associated with your obesity, your past diet history and why the physician feels it is medically necessary for you to have bariatric surgery. Your bariatric surgeon will often have a sample letter of necessity for you to take to your primary care physician.
With weight-loss you may be able to go off or reduce the dosage of many of the medications you take for obesity-associated co-morbidities, such as blood pressure, heart disease, arthritis, lipid abnormalities, and type 2 diabetes. If you have a gastric bypass, sleeve gastrectomy or a duodenal switch, you may even be able to discontinue using or to reduce the dosage of your diabetes medications in the early period following surgery.