| Overview | Malabsorbtive
Procedures | Restrictive
not for everyone. It is a serious step reserved only for those patients
with severe or morbid obesity. We follow the National Institutes
of Health Guidelines and have minimal weight requirements based
on ones height. BMI calculator.
Only after a thorough consultation and only if we are satisfied
that you are aware of the implications and alternatives of this
type of surgery will we offer you the procedure. In addition, there
are many surgeons who practice closer to your home. We encourage
you to be as close to your surgeon as possible, but we recognize
that not all programs provide the services and procedures as yet.
We can make special arrangements depending on your individual circumstances.
There are many procedures available for weight loss. Most can be
categorized as restrictive (vertical-banded gastroplasty, roux-en-y
gastric bypass, laparoscopic roux-en-y-gastric bypass) or malabsorbtive
(biliopancreatic diversion, distal roux-en-y gastric bypass, jejuno-ileal
bypass). We do not perform the malabsorbtive procedures as we have
not found convincing evidence that they provide a more consistent
weight loss or improved quality of life. We have converted many
of these procedures to the Roux-en-Y Gastric Bypass because of severe
metabolic complications and malnutrition.
There are many other procedures that are touted as "unique".
We are only presenting common procedures with known tract records
and definable statistics. We advise you to use common sense in your
educational process. If it sounds too good to be true, it generally
Common to all
malabsorbtive procedures is the apparent shortening of the intestine
in contact with food. Although seemingly logical at first, making
the system less efficient in its absorption of nutrients requires
continued overindulgance by the patient for survival. The "eat
to live" configuration can be quite harmful if adequate volumes
of food were not available or if you were to contract a simple case
of the "flu". Because of the shortened intestinal tract,
hospitalization may be required and therefore travel to certain
countries that do not have the medical facilities here in the United
States should be discouraged.
protein, vitamin and mineral deficiencies mandate continued supplements
and occasional intravenous therapy.
Roux-en-Y Gastric Bypass
is often confused with the Roux-en-Y Gastric Bypass. It is however,
much closer to the biliopancreatic diversion. This operation attempts
to combine a gastric restrictive and malabsorbtive procedure. A
small gastric pouch is formed and over 50% of the small intestine
is bypassed. This lends itself to a higher degree of protein-calorie
malabsorbtion and marginal ulcer formation than the biliopancreatic
diversion. Fortunately, in this case, the stomach pouch will continue
to increase in size as long as the patient is encouraged to overeat.
is of historic importance. This prototypical malabsorbtive procedure
was performed from 1963 to 1980. The amount of small intestine in
contact with food was severely shortened. Although this procedure
was quite simple to perform, the metabolic complications were devestating.
Protein-calorie malabsorbtion, diarrhea, vitamin and mineral deficiencies
were common. In addition, kidney failure has been seen in patients
ten years out from surgery. It is because of this failed procedure
that many physicians and insurance companies look down on all bariatric
was described in Italy in 1973 and is still being performed in a
few centers. This operation consists of removing part of the stomach,
leaving a 200-250 cc pouch and shortening the small intestinal food
conduit to 250 cm. There is a 50 cm common channel in which bile
and pancreatic digestive juices mix prior to entering the colon.
Weight loss occurs as a result of "dumping" most of the
calories and nutrients into the colon where they are not absorbed.
There is need for precise control of types of food ingested and
an emphasis on protein load. Most patients require life-long nutritional
supplements which can be quite expensive. Blood tests are required
every few months. Weight loss has not been shown to be superior
to the restrictive operations. The social aspects of intestinal
gas, diarrhea and odor can be devestating. Most insurance companies
will not authorize this type of procedure because of the high complication
rates and metabolic problems
procedures take advantage of your inherent efficiency by limiting
the amount of food you can eat at any one time. Diarrhea is uncommon
and there are no travel restrictions. Most foods are tolerated quite
well and individuals are asked to supplement their diet with a only
single multi-vitamin per day.
has paralleled the surgical and medical literature. In most cases,
obesity related diseases such as diabetes, hypertension and GERD
are either vastly improved or cured. Not only is the need for medical
care lessened, patients find they save money on meals.
has been available for almost 20 years. Designed to allow ingestion
of almost any type of food, but limiting in the amount, this operation
is conducive to healthy eating habits. In constrast to malabsorbtive
procedures, the Roux-en-Y Gastric Bypass does not promote
diarrhea, gas problems or malnutrition.
Gastric Bypass is usually performed through an incision 3-4 inches
in the upper part of the abdomen. It takes about 90 minutes and
hospital stay varies between two and four days. Diet and follow-up
is identical to the Laparoscopic Roux-en-Y Gastric Bypass.
The gallbladder is not removed unless there are stones or problems
with its function.
of a small stomach pouch, patients eat less and get "full"
faster. The type of food will determine the quantity at which this
occurs, but most patients will be able to eat a half sandwich by
the end of a year as a complete meal. Most patients will find an
aversion to "sweets" and "greasy" foods. Many
patients have asked if we have removed their "chocolate gland".
most of the stomach and only about 12 inches of small intestine.
Therefore most nutrients are absorbed naturally.
The pouch is
created in such a way that it will not increase in size as was common
to other procedures. We expect our patients to eat a variety of
foods such as: steak, fish, poultry, vegetables, fruits, pasta,
and milk products. Many patients are lactose intolerant but are
able to eat yogurt, cheese and cottage cheese for the benefits of
calcium. Carbonated drinks and alcoholic beverages are allowed,
but do not contain nutrients and are therefore discouraged.
With a balanced
diet, nutritional supplements are usually not necessary. However,
it is difficult to eat a balanced diet even prior to surgery so
we advise taking a multivitamin once a day in addition to choosing
the proper foods.
by most as the "gastric stapling" procedure. This procedure
creates a small pouch along the inner curve of the stomach and controls
the size of the opening of the pouch with a plastic band. This is
the most "physiologic" of the procedures, in that no intestine
is bypassed. However, weight loss has not been as predictable as
with the Roux-en-Y Gastric Bypass. Weight gain has been because
of breakdown of the staple line or other factors. Problems with
the band can only be solved with further surgery. Although many
surgeons still have acceptable results with this operation, even
laparoscopically, we feel that Roux-en-Y Gastric Bypass is still
a superior alternative for most individuals.
Roux-en-Y Gastric Bypass
Roux-en-Y Gastric Bypass
of the particular way in which we perform the procedure, we
have not experienced the complications reported by other programs.
The Laparoscopic Roux-en-Y Gastric Bypass is identical to the
standard Roux-en-Y Gastric Bypass except that the stomach pouch
is separated from the main stomach. This is because of the instrumentation
available that will fit through a ½ inch incision. This has
not lead to an increased incidence of intestinal leaks.
procedure was two years in planning and development. Although
the laparoscopic approach has been described since 1994, we
were concerned with the complications associated with that initial
procedure. In order to maintain the safety demonstrated with
our "open" procedure, Roux-en-Y Gastric Bypass, we
preserved all aspects that have made this procedure safe. This
forced us to develop the necessary technical skills to accomplish
operation is performed under general anesthesia. Access is accomplished
through five 10 to 12mm incisions. The operation can be performed
routinely in 90 minutes or less, depending on the patient. The
operation can be performed regardless if you have had a previous
operation (in most cases) and has been performed in patients
up to 500 lbs. Only patients who have had previous bariatric
or gastric surgery are excluded from this approach.
Patients usually stay one to two nights in the
hospital after the
surgery is performed.
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