Gastrointestinal Surgery (Bariatric Surgery)

Please note: weight loss surgery is not a cure for obesity. Surgery is a resource to help you reduce your weight. Behavioral, physical and psychological changes are required for you to maintain a healthy quality of life. Continued positive weight loss relies upon your desire and dedication to change your lifestyle with a proactive approach.

• Clinical guidelines for consideration suggest that a patient have a Body Mass Index (BMI) of 40 or greater, or weigh more than 100 lbs. over ideal body weight. In addition, a patient with a BMI of 35 or greater with one or more obesity related co-morbidities.

• Patient must have a history of documented dietary weight loss attempts.

• Patient must undergo psychological evaluation. The patient must be prepared to utilize the tool that surgery provides for them.

• Patient must be aware of and accept the risks associated with surgery.

• After surgery, patient must be able to commit to frequent doctor visits, support groups and behavior modification.

*Note: Consult your physician and insurance provider to see if you are a candidate for gastrointestinal surgery (bariatric Surgery). If your insurance provider does not cover the surgery, please visit the Advocacy section of this Web site to find out how you can advocate for coverage.

Weight loss surgeries are typically categorized into one of the two following types:

• Restrictive: restrictive procedures decrease food intake by creating a small upper stomach pouch to limit food intake.

• Malabsorptive: malabsorptive procedures alter digestion, thus causing the food to be poorly digested and incompletely absorbed.

Vertical Banded Gastroplasty (Restrictive)

• In this surgery, the upper stomach, near the esophagus, is stapled vertically for about 2-1/2 inches to create a small pouch. Next, the outlet from the pouch is restricted by a band or ring that slows the emptying of food and thus creates a feeling of fullness. Food digestion occurs through the normal digestive process.

Lap Adjustable Gastric Banding (LAGB) (Restrictive)

• With the LAGB surgery, a band is placed around the upper most part of the stomach; therefore, separating the stomach into one small and one large portion. Digestion and absorption is normal. The band can be adjusted to increase or decrease restriction, and the surgery can be reversed.

Biliopancreatic Diversion (BPD) (Malabsorptive)

• In this surgery, approximately 3/4 of the stomach is removed. This surgery restricts food intake and reduces acid output. The small intestine is divided, and one end is attached to the stomach pouch to create an alimentary limb. Food moves through the alimentary limb with little absorption of food.

Biliopancreatic Diversion with Duodenal Switch (Malabsorptive)

• This surgery combines a lower level of restriction with a higher degree of malabsorption. Stapling is used to create a sleeve of stomach retaining the natural stomach outlet. The majority of the small intestine is bypassed causing nearly complete malabsorption of food contents.

Gastric Bypass Roux-EN-Y (Combined Restrictive/Malabsorptive)

• In this surgery stapling is used to create a small, upper stomach pouch which restricts the amount of food able to be consumed. A portion of the small bowel is bypassed thus delaying food from mixing with digestive fluids to avoid complete calorie absorption.

Laparoscopic Sleeve Gastrectomy (Restrictive)

• Sleeve gastrectomy is a restrictive procedure. It greatly reduces the size of the stomach and limits the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass the intestines.During the sleeve gastrectomy, about 75 percent of the stomach is removed leaving a narrowgastric tube or “sleeve.” No intestines are removed or bypassed during the sleeve gastrectomy. This procedure takes one to two hours to complete. This short operative time is an important advantage for patients with severe heart or lung disease.

Open

• The Open approach procedure involves a long incision that opens the abdomen, which provides the surgeon access.

Laparoscopic

• In Laparoscopic surgery, a small video camera is inserted into the abdomen allowing the surgeon to conduct and view the process on a video monitor. Both camera and surgical instruments are inserted through small incisions made in the abdominal wall.

*Note: All major surgeries contain a certain level of risk. The content of this Web site is provided for informational and viewing purposes only. Please consult with your physician to find out which type of surgery satisfies your medical needs.

Laparoscopic Sleeve Gastrectomy - A Newcomer to Bariatric Surgery
By Stacy Brethauer, MD and Philip Schauer, MD

Weight-Loss Surgery Treatment Options
By Robin Blackstone, MD, FACS, Melissa Davis, RN MSN, APRN,BC, NP-C, CNS,
Lloyd Stegemann, MD and Debra Salvatore, RN, BS, CNOR, CFN

Surgical Excellence Involves More than Just the Surgeon
By Gary M. Pratt, CEO of the Surgical Review Corporation

Understanding the Risks of Bariatric Surgery
By Lloyd Stegemann, MD

A Look at the Studies of the Risks of Bariatric Surgery
By Harvey Sugerman, MD

The Post-Surgery Diet for Bariatric Patients: What to Expect
By Denise Addorisio, RD, CDN

I am a Bariatric Surgery Patient. Which medications are recommended and which ones should I avoid?
Answer provided by Ralph L. Guatelli, RPh, BSPH

Preparing for Lap-Band ® Surgery: Nutritional Information to Know
By Felicia Cordier, RD, LD

What is dumping, and why am I experiencing it?
Answer provided by Taghreed Almahmeed, MD, FRCSC, and Michel Murr, MD, FACS

• What types of weight loss surgery procedures have you performed?

• How many of each type of weight loss procedure have you performed?

• What professional organizations do you belong to that relate to weight loss surgery?

• Can this surgery be performed using minimally invasive techniques such as laparoscopy?

• Can I be considered a candidate for surgery even though I have one or more associated health conditions (co-morbidities) related to my weight problem?

• Can I be considered a candidate for surgery even though I have no health conditions (co-morbidities) related to my weight problem?

• If I’ve had an ulcer, will that make a difference whether or not I can have weight loss surgery?

• Does your practice have age limitations on patients choosing a surgical solution?

• Does your practice have weight limitations for patients choosing a surgical option?

• Why might I need to have a gastrointestinal (GI) evaluation?

• Do I have to lose weight before having surgery? Why? How much?

• Will I be asked to stop smoking?

• Which weight loss procedure is best for me? Why? What are the risks and potential complications involved?

• What pre-operative tests or evaluations will you perform? Why?

• Is this a multidisciplinary practice?

• What is the immediate follow-up care plan for your practice? Long-term follow-up?

• If I am from out of the practice’s geographic area, how will my follow-up be managed?

• What role does my primary care doctor play in this process?

• How long will I be in surgery?

• What is the anticipated length of my hospital stay?

• Will I need a naso-gastric tube?

• Will any drains have to be left in after surgery?

• Is a blood transfusion required?

• What precautions do you undertake to prevent deep vein thrombosis (DVT) or pulmonary embolism?

• What is an incisional hernia, and what is the probability of having one after surgery?

• What type of staple line reinforcement do you use?

• How will my pain be managed?

• How long will I be off solid foods?

• What type of protein supplement will I be on? What does it taste like? What are the nutritional aspects of it?

• How will my eating habits have to change?

• Will I have to take a vitamin supplement following surgery?

• Will this procedure complicate the ingestion of any of my current medications?

• Will I be able to take oral contraceptives after surgery?

• Is sexual activity restricted?

• How long will it be before I can return to pre-surgery levels of activity?

• How soon will I be able to drive?

• How much will I have to exercise after surgery?

• Do you have any information about weight loss surgery costs and payment options?

• What is the typical excess weight loss and improvement of associated health conditions for your other patients?

• Do you have patients who are willing to share their experiences, both positive and negative?

• What information can you give me to help family and friends better understand this surgery?

• Does your practice provide support groups and/or counseling services?

• What are the patient expectations if I decide on a surgical solution?

• After receiving an insurance approval how long will it take before I am booked for surgery?

*"Questions for Your Surgeon" provided by OAC Board member Julie Janeway and Little Victories Press