For A New Beginning
But what it does really is not only alters the size of your stomach, which reduces how much you can eat, but it changes the hormones and the body's metabolism, which helps the body maintain a healthy weight.
The most common of those is called a Single Anastomosis Duodenal Ileostomy - which is medical talk for a single anastomosis or single connection version of the duodenal switch.
That's a minimally invasive or less invasive surgical approach where we make four or five small incisions and use long, thin instruments and a narrow, long camera to look into the abdominal cavity without making a large incision and to do different manipulations without making large incisions.
So, the sleeve gastrectomy portion is often misunderstood because people have heard about other types of sleeve operations that involve, you know, putting material in, over or folding things over within the body to create sort of a sleeve. But, the sleeve gastrectomy is really conceptually pretty simple. What we're doing with that is cutting and dividing and sealing closed the stomach right up the middle in a longitudinal direction - so going from the bottom to the top of the stomach, and it turns the remaining portion of the stomach into the shape of a jacket sleeve. So it has this long, narrow curved shape.
The other portion of the stomach, about two-thirds to three-quarters of the volume of the stomach, is then removed from the body completely. That then has the effect of changing the body's biology that tends to drive this disease of obesity to become healthier.
It helps people to lose weight, yes, but also to improve some of the medical problems that come along with obesity, such as high cholesterol, high blood pressure, and has a positive effect on diabetes as well.
Laparoscopic means that the surgery is done in a minimally invasive approach, meaning that we use several small incisions, usually 4 or 5 small incisions, to re-align the flow of food through the gastrointestinal tract.
Gastric bypass implies that we are bypassing a large portion of the stomach. We cut the top portion of the stomach away from the rest of the stomach, then we sew a part of the middle of the intestine to the top portion of the stomach. So after surgery, when someone drinks or eats their food, it does enter the top of the stomach but then it goes straight into the middle of the intestine, therefore, bypassing the stomach and the very top portion of the intestinal tract.
What that leads to is several different hormonal and other biologic function changes in the body that make people less likely to eat, or want to eat, or have the drive or desire to eat, and to limit cravings for foods that are high in sugars or carbohydrates, things that we know are not advantageous for weight loss. It seems to also have effects to directly change how the body handles calories, and so may directly have effect for weight loss.
Some of the older ideas about how bypass surgery works, including malabsorption and restriction which is, you know, you have a smaller stomach so you can't eat as much at one time, are really not the main thrust of how these surgeries work.
As we've learned more about the biology surrounding bariatric surgery, they do play minor roles, but the main change, the main way that we encourage weight loss after surgery is by changing the body's basic physiologic functions.
It oftentimes takes them years and years before they're able to come and see us. And when seeing them, I ask them their expectations. How much weight are they trying to lose? What are their main goals that they're trying to achieve? What are some of the resolutions of medical comorbidities that they're looking at?
Then, I present them with a couple of the surgical options. I also touch base about non-surgical options and see which one would serve them best.
When deciding on the type of surgical procedure, I make sure that I go through all the options with my patients and align their goals with the goals of the procedure and see whether we can achieve them in a reasonable and reliable fashion.
For example, not every surgical procedure would be a good procedure for certain patients. So, certain medical conditions may be prohibitive. The most common procedures include Sleeve Gastrectomy and Roux-en-Y Gastric Bypass.
Sleeve Gastrectomy is better served for patients who have a lot of medical problems versus Roux-en-Y Gastric Bypass may be better served for patients who have bad diabetes or bad reflux.
Overall, it's a stepwise process and we have to take into consideration patient preferences, their medical history, as well as the realistic outcomes of the surgical procedure.
The different surgeries that we do for obesity have slightly different effects on some of these
other medical problems that come along with obesity. Whereas, gastric bypass is particularly good for patients with diabetes or severe gastroesophageal reflux or heartburn, it may not be the right answer for patients who don't have those problems as part of their complex of diseases that come along with obesity.
So, we try to match up the type of surgery with the medical problems that a certain patient has.
There are many considerations as to who qualifies for bariatric surgery. The main ones are generated by your body mass index, which is a ratio of your height to your weight. A body mass index above 40 would qualify someone for surgery.
Someone may qualify if they have a BMI of 35 to 40 if they also have weight-related comorbidities. This includes diabetes, high blood pressure on multiple occasions, heart disease, obstructive sleep apnea, and liver disease.
In medicine in general, we look at things based on the research results that we have. Unfortunately, research results done by studying a large group of people who either take the same medicine or have the same surgery only gives us averages.
So, I can't tell any patient exactly how much weight they're going to lose, but I can give them a range of the average amount of weight that similar people have lost when they've undergone the surgery in the past.
Luckily, in bariatric surgery, we have many, many research studies over the last many years, over several decades, that have followed people out in the long term, so we have pretty good data to give us these really robust averages.
On average, people will lose around a third of their total body weight. For many people, that's over 100 pounds. But, once we are able to talk with a patient, get their weight and their height, we can give much more accurate estimates as to the average amount of weight loss someone in their shape can expect to lose after surgery.
The vast majority of people are doing well enough within that timeframe to be able to go home. Now, that's not to say it's not surgery, right? Because it is, it still has some pain. A lot of folks do have some nausea, but those things usually are very treatable with the medications we give people standardly after these operations and tend to do much better after a couple of days of recovery.
Most patients are then really working on learning their new diet. We do have folks on a modified liquid diet for the first couple weeks after surgery, but almost everybody's ready to get back to work within a couple weeks of surgery.
For example, there is a constellation of symptoms that go hand in hand with being obese, or having extra weight, and those are called metabolic syndromes. They represent a constellation of symptoms under that umbrella.
They can include hypertension or high blood pressure, high cholesterol, as well as diabetes. Some of the other more common comorbid or additional medical problems that we often see include obstructive sleep apnea, fatty liver, in addition to many others.
Also, since bariatric surgery is considered an elective surgery in most states still, many insurance companies require that qualifying evaluation.
I can tell you about the method I use and it includes a comprehensive interview with the patient, preferably in person, via Zoom if needed.
It also includes the administration of various assessment tools such as the Beck’s Depression Inventory, Diet Readiness Test, and other assessments as well.
A typical psychological evaluation takes between one and a half to three hours.