Frequently Asked Questions
How do you lose weight from this surgery?
The surgery reduces the amount of food you can eat at one sitting. Because the pouch is much smaller, you eat less food and feel satisfied more quickly.. Your appetite is also reduced. Because you will be eating less, you will lose weight.
What types of surgery are there?
Here are the three most popular surgical procedures.
Gastric Bypass (Also called Roux-en Y or RNY):
This operation reduces the size of the stomach and its capacity by creating a pouch at the top of the stomach. This pouch is connected directly to the small intestine, bypassing the lower stomach and the first portion of the intestinal tract. Besides restricting the volume of the stomach and the capacity to hold food, this procedure also reduces the absorption of calories. Having the food enter the lower part of the intestine sooner also may allow you to feel satisfied sooner. Weight loss is generally greater with this procedure than with the vertical banded gastroplasty, but it also carries more risk of nutritional deficiencies.
The Duodenal Switch:
The DS procedure reduces the stomach along the greater curvature, effectively restricting its capacity while maintaining the its normal functionality. Unlike the BPD and the RNY procedures, which employ a gastric “pouch” and bypass the pyloric valve, the DS keeps the pyloric valve intact -- a main benefit of which is the elimination of dumping syndrome, marginal ulcers, stoma closures and blockages. Unlike the BPD and the RNY, the DS keeps a portion of the duodenum in the the food tract of the small intestine, enabling more-normal absorption of many nutrients, including calcium, iron and vitamin B12.
Vertical Banded Gastroplasty (VBG)
This procedure also creates a small pouch in the stomach with a restricted outlet that is sometimes reinforced with a ring. The outlet from the pouch is about the size of a dime, which delays the passage of food and reinforces the feeling of fullness. An advantage of this procedure is that it preserves the continuity of the entire digestive tract and lessens the risks of nutrient deficiencies. The Fobi Pouch Surgery comes under this heading.
Who qualifies for weight loss surgery?
Candidates for surgery are usually at least 100 pounds over their ideal body weight. Another measure of obesity is the body mass index (BMI) The body mass index is your height in kilograms divided by the square of your height in meters. There are several web sites that have body mass calculators. Generally a body mass of 40 or higher qualifies for surgery, or over 35 with certain health problems called co-morbidities. You must also have tried to lose weight in the past by more conventional methods.
What kind of health problems are considered co-morbidities?
Some of the more common health problems that are considered are , diabetes, sleep apnea, degenerative arthritis, cardiovascular or pulmonary disorders, or a family history of these problems.
What are the benefits of weight loss surgery?
Most patients lose weight rapidly for 18 to 24 months after surgery. Some patients may then regain some of their lost weight, although few will regain it all. Surgery also improves most obesity related health problems, such as diabetes.
What are the risks of surgery?
Weight loss surgery is considered major surgery and has the same risks as any surgical procedure. Some of the more specific risks are abdominal hernias that require further surgery, blood clots, and wound infections, breakdown of the staple line and stretched stomach pouches. Rapid weight loss increases the risk of gallstones. This can be prevented by taking bile salts for six months after surgery. Nutritional deficiencies may occur, but can be avoided if vitamin and mineral supplements are taken.
Will I have to exercise?
Exercise is very important after weight loss surgery. It aids in losing weight faster and helps skin and muscles tighten up after the weight loss.
Is the surgery covered by insurance?
This depends on your individual insurance company and your specific situation. Most insurance companies will cover it if is determined to be medically necessary.
What is the difference between open and lap surgery?
The only difference is the size of the incision. Traditional or open surgery is one where there is an abdominal incision from 8-12 inches long. Lap surgery is done by making five or six small incisions about 1/4 to ˝ inch each. A laparoscope is inserted into the incision and is connected to a video camera and shows on a monitor. The entire operation is performed inside the abdomen after gas has been used to expand the abdomen.
What kind of medical tests will I have to take before surgery?
This will vary from doctor to doctor. Some insurance companies also require specific tests. These may include an upper GI, endoscopy, gall bladder ultrasound, blood tests, and x-rays. Sometimes a psychiatric evaluation is done. This is to ensure that patients understand what this surgery will or won't do for them, and they will be able to commit to the major lifestyle change.
What is a diet history?
Some doctors and insurance companies require patients to complete a detailed diet history. This is because surgery is a drastic choice and should be used only when traditional methods have not worked. A diet history is a list of other weight loss methods that you have tried. There are supervised methods, such as Weight Watchers, Diet Workshop and Opti-fast, as well as methods tried on your own such as Slim Fast, calorie counting, low fat, etc. It will also help to have doctors records that show unsuccessful weight loss attempts.
Can I ever lose too much weight?
With the possible exception of the rare patient who develops obstruction of the stomach outlet, it is unlikely that you will ever lose too much weight. On the other hand, snacking and high calorie liquids can put on weight readily.
Will my skin sag?
Because of the large amount of fat between the skin and the true body, the skin will surely sag as fat is removed by the slow gradual burning of energy in everyday life. The skin of younger bypass patients revcovers more rapidly than others.
What happens to the unused portion of the stomach?
It remains in place and it's ability to function remains intact. The muscles may lose some of their contractile power but each cell is still there and capable of functioning in the unlikely event that it should be called upon.
Can the stomach be hooked up again?
It IS possible, but doing so may result in regaining some of all of the lost weight.
What is DUMPING?
Dumping is the word that describes the fact that liquids and sweets very rapidly empty out of the stomach into the jejunum through the small pouch. Sweets have a characteristic called "hyperosmolality" which means that it has a high concentration of particles in solution. One of the functions of a normal stomach is to act as a reservoir where food will be held until the concentration of particles is diluted to that of other body fluids. When highly concentrated particles are "dumped" from the small pouch into the digestion/absorption part of the gastrointestinal tract, the jejunum reacts by sending off chemical signals to stop the intake of such materials on such a rapid basis. These chemical signals cause nausea, dizziness and faintness - an awful feeling. The chemical signals are relatively harmless but they should not be repeated in order to avoid these unpleasant symptoms. This might be a bad thing if one continued to crave sweets, but most sweets lovers will come to loathe sweets after this sumptom occurs a few times. The avoidance of sweets under these circumstances is called an "aversion reaction". The avoidance of sweets by the patient who has a gastric bypass procedure probably accounts for a significant part of the weight loss results.
Is there a chance to regain weight?
Some patients may come to feel frustrated and discouraged after weight levels off but is yet too high, or when slow weight regain occurs. This cannot go uncorrected. While responsibility to continue making progress and to avoid regression remains with the patient, help is available. It is important to constantly realize that the pouch is there only as a tool and must be used properly.
Can you become deficient in some vitamins after this surgery from lack of absorption??
You need to take vitamins and mineral suppliments the rest of your life. This is known and understood prior to surgery.
Can you become protein deficient?
One of the most important issues for the bariatric patient is eating a diet adequate in protein. Protein builds and maintains body tissues, and is necessary for metabolic functions. You MUST consume good sources of protein to avoid protein nutrition related complications. Good protein sources are considered "complete" as they contain all the essential amino acids. Complete proteins are primarily of animal origin (e.g. egg, fish, poultry, milk, cheese, cottage cheese, and meat) while grains and vegtables proteins are "incomplete".
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