| Dan's Surgical Weight Loss Information Menu |
| News | Listen | BMI | Benefits | Operations | About Me | FAQ | Contact Me | Order | Home | Site Map |
|
|
| FAQ |
How soon will I start to lose weight? You will start losing weight immediately after surgery but you may not notice any loss until the 2nd week.Weight loss after the band is more gradual and constant, approximately 2-3 lbs per week. The weight loss after RYSB or BPD/DS is initially rapid, with a slowing about 9 months after surgery. At the 3 week follow-up visit, we typically see a 15-20 pound weight loss. This depends on how much the starting weight was. The heavier the starting weight, the more weight that is lost. The lap band provides a constant restriction, however you have more control of your weightloss. If you resort to taking in soft sweets such as chocolate, ice cream or drinks with high calorie liquids, you will regain the weight. With the gastric bypass, weight loss continues for 2 years and then plateaus. Depending on the size of the stomach pouch and the type of food eaten, some patients can experience a 20 to 30 pound weight regain after 2 years. That is why it is very important that you use the stomach pouch as a tool, and follow the instructions given to you by the nutritionist on how and what to eat. The BPD/DS similarly provides continuous weight loss for 2 years with a subsequent plateau, but weight regain is very rare. Patients as far out as 18 years have stayed at the same weight as they were 2 years after the surgery. The BPD/DS limits how many calories are absorbed. Is it possible for me to get too thin? It is unusual for a person to become too thin after bariatric surgery. These operations still allow you to ingest and absorb a sufficient amount of calories (about 1000-1500) so that you do not become too thin. With time, you will be able to eat more than you were able to immediately after surgery. With the band, once you reach your target weight you will not need further adjustments . What are the risks of surgery? The decision to undergo surgery for weight loss is a serious one. Before making this decision, you must understand both the risks and benefits of any weight-loss surgical procedure. The risks of surgery are not insignificant and must be weighed against the benefits you will receive when free from obesity and its related problems. It is important you understand that the risks of surgery are low and that the majority of patients have no complications. The risks increaes the longer the operation is the heavier the individual is and the more complicated the surgery is. In general the gastric banding has the lowest and least severe complication rate and the BPD/DS has the highest most serious complication rate. Lung Problems Atelectasis Pulmonary
Embolism During and after surgery, you will have sequential compression devices on your legs which act like blood pressure cuffs that massage your legs and prevent blood clots from forming. The best prevention is ambulating soon after surgery. If help is necessary, we will provide a physical therapist. High risk patients who may have blood clots in the past, will receive a blood thinner called heparin. Bleeding All surgeries have a risk of bleeding. This is because blood vessels are cut during surgery. Before they are cut, the blood vessels are tied, stapled or are "sealed" shut with special heat-based devices. Although typically there is little bleeding during laparoscopic surgery, sometimes, a blood vessel may begin to bleed several hours after the surgery is finished. This can result in hemorrhage, either internally, or at the skin level. Bleeding usually stops by itself, however sometimes another operation may be necessary to find and stop the bleeding. Part of the surgery is performed near an organ called the spleen. The spleen contributes to the immune system and fights certain bacteria. It is a fragile organ that can bleed easily if injured. Bleeding can usually be successfully stopped in an injured spleen, however rarely, the spleen must be removed. A person can live normally without a spleen, but will have to receive a vaccine after the surgery. Some patients will need a blood thinner to prevent the formation of blood clots. This blood thinner can interfere with normal blood clotting and may increase the risk of bleeding during and after surgery. We give the blood thinner, heparin, only to those patients who have a higher risk of blood clots. If bleeding occurs, the patient is closely monitored and the heparin may have to be stopped. Leakage of Bowel Contents Leakage of bowel contents from an anastomosis is the most serious complication of gastic bypass and BPD/DS. This does not apply to the Lap Band. The new connection made between the stomach and the intestine, or between the intestine with another piece of intestine, is called an anastomosis. Anytime there is an anastomosis, there is a risk of leakage of stomach and intestinal contents. This can cause infection and even death. We try to identify any leakages before they are a problem. We obtain a radiologic study prior to your discharge to assess the anastomosis. Leakage at the anastomosis can cause a very high heart rate, pain in the abdomen or back, or fever. Depending on the size of the leak, this problem can be treated either non-surgically with intravenous antibiotics or with surgical repair. Blockage of the Stomach Remnant After the new stomach pouch is made in the Roux-en-Y gastric bypass, the rest of the stomach is detached and left alone. It is still alive with blood vessels and drains any fluid it makes through the intestine, but it shrinks in size. If there is a blockage of this detached stomach remnant, then the back-up of fluid can cause a leakage of bowel contents. This problem is very rare, but sometimes is difficult to diagnose because it does not cause vomiting. Instead, it may cause persistent hiccups or left shoulder pain, at which time you should call your surgeon. You would then need to have a CT scan of your abdomen, and if the stomach is seen to be blown-up, a small needle is used to deflate the stomach like a balloon, using local anesthesia. This does not apply to the Lap Band. Narrowing of the Stomach Pouch Outlet The connection between the new stomach pouch and the intestine is created with a stapling technique. With all healing, there is scar formation similar to a scab. Sometimes this scar can tighten around the anastomosis and cause it to narrow to a point where food cannot pass through. This typically occurs 4-6 weeks after surgery. If this occurs with the gastric band then this may mean that the band is too tight and fluid needs to be removed druing your office visit. This problem is treated with endoscopy and stretching of the narrowed area by a gastroenterologist.
Wound Infection With any surgery, the wound is exposed during an operation and can become infected. In overweight patients with more fat in the abdominal walls, the infection can be deeper than usual. A minor infection is treated with oral antibiotics. A serious deeper infection may require opening the wound and packing it with gauze, in addition to antibiotics. Band Slippage The band is placed at the top of the stomach and held in place by sewing the stomach around it. In rare instances, the band can slip and cause constant regurgitation and heartburn. This isdiagnosed with a barium swallow study. If this happens, the band would likely need to be repositioned with another operation, laparoscopically. We try to prevent slippage from occuring by placing you on a specific diet the 1st four weeks after surgery (Week 1-2: liquids, Week 3-4: shakes and purees) Band Erosion There is a rare chance that the band can erode into the stomach. his does not cause pain, but may result in inadequate weight loss. This is diagnosed by endoscopy and would require surgical repair laparoscopically. For this reason, aspirin and ibuprofen should be avoided. What are the potential long-term complications of weight-loss surgery? The Roux-en-Y gastric bypass (Rygb)and the biliopancreatic Diversion with duodenal switch (BPD/DS) both carry a very small possibility for nutritional problems which can be avoided. Therefore it is very important that you take your vitamin and mineral supplements everyday and have your laboratory tests checked as instructed. The gastric band carries no nutritional risk, but we recommend a daily multivitamin. Vitamin Deficiency The decreased amount of food intake after surgery results in decreased absorption of vitamins and nutrients. In addition, certain areas of the stomach and intestine that absorb specific vitamins are not in contact with food. Other parts of the intestine can compensate but only if greater amounts of the vitamins are taken in. This specifically concerns Vitamin B12. Therefore a multivitamin plus a B12 vitamin must be taken each day. The BPD/DS causes poor absorption of fat. Certain vitamins are absorbed only in the presence of fat, and therefore can be poorly absorbed after this operation. These include Vitamins A, D, E and K. A daily vitamin called ADEKS contains all these vitamins but that can be absorbed with water. Protein Deficiency With the decreased amount of food intake, the amount of protein intake is also smaller. It is important to make sure that you eat enough protein so that your body does not begin to break down your muscles. The nutritionist will outline the best foods and supplements to take in order to maintain sufficient protein intake. Mineral Deficiency Calcium and iron, especially in women, can be a problem and therefore must be taken everyday. Specifically, about 1500 to 2000 mg of calcium per day must be taken to prevent osteoporosis, especially after BPD/DS. Foods high in calcium will be outlined by the nutritionist. Menstruating women must take iron to prevent anemia. What
are the side-effects of surgical weight loss? What happens to the rest of my stomach after gastric bypass surgery? In the Roux-en-Y gastric bypass, the rest of the stomach is disconnected from the new stomach pouch and left intact. It still has a blood supply and drains any small amount of fluid through the small intestine, or duodenum. Because it is not used, it shrinks in size and stays dormant. What do I do if I want to get pregnant? Although there have been women who successfully carried pregnancies to term as early as 6 months after surgery, their babies were overall lower in weight and some women had miscarriages. Because we do not fully understand the implications of weight loss surgery on successful pregnancy, we suggest that you wait for at least 18 months after surgery to have a child. And even after that, you must make sure that your obstetrician is aware of your weight loss surgery and that you and your baby should be followed closely. If you have the gastric band, all that needs to be done si have some or all of the fluid removed to allow you to take in enough nutrition during your pregnancy. After delivery, the band can be tightened accordingly. What will happen to the excess skin after I lose weight? After a large amount of weight loss, you may find yourself with excess skin in places you never knew existed. Some people find the excess skin a nuisance or cosmetically unappealing, others do not. Weight loss after surgery continues for about 18-24 months. After that, your body is equilibrated and ready for additional surgery for excess skin removal. This is typically performed by a plastic surgeon experienced in this field. The plastic surgeon will evaluate you and decide with you what areas need "tightening" up. Unfortunately, this is cosmetic surgery and not covered by insurance. However, there are many plastic surgeons who are flexible and may be able to work out a payment schedule with you. When will I be able to return to work or to exercise? Using a laparoscopic technique for bariatric surgery has the advantage of allowing you to return to daily activities much faster than if you had the standard open incision. Healing of smaller incisions is faster with less pain, and has a lower risk for the development of hernias. Therefore, we encourage you to exercise as soon as you feel ready, and this can be as early as one week. Some people have returned to work on the 4th day after surgery, however, most patients find that they need 1 or 2 weeks before going back to work. You may feel tired during the first week, but you will feel more energetic as you lose weight. Does insurance cover surgery for weight loss? Most insurance policies do cover surgery for weight loss, however most require a letter of medical necessity which states that it is not for cosmetic purposes. The surgeon’s office will provide such a detailed letter to the company which will usually result in a satisfactory pre-certification. Some insurance companies may not accept this and may refuse coverage. It is up to you, the patient, to contact the insurance carrier and be relentless in your appeal. Legal assistance can be obtained to appeal the refusal. For more information, see Obesity Law and Advocacy Center. How do
ask a question which is not answered on this website?
|
| Dan's Surgical Weight Loss Information Menu |
| News | Listen | BMI | Benefits | Operations | About Me | FAQ | Contact Me | Order | Home | Site Map |
|
|
