Valley Surgical Bariatric

Surgery is 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 one’s 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 is.

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.

Iron, calcium, protein, vitamin and mineral deficiencies mandate continued supplements and occasional intravenous therapy.

This operation 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.

This operation 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 procedures.

This operation 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

Restrictive 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.

Our experience 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.

This operation 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.

The Roux-en-Y 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.

By creation 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".

Food bypasses 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.

Described 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.

Essential Steps

	Before the Operation The Stomach Before the Laparoscopic Roux-en-Y Gastric Bypass Operation
	Step 1 A small pouch (20cc) is created in a very specific way so it will not continue to expand over time as was common with earlier less successful operations.
	Step 2 The small intestine is cut very close to the bottom of the stomach and attached to the pouch. This provides the outflow for food. A very small amount of intestine is bypassed (less than a foot) so that malabsorption of nutrients is minimalized.
	Step 3 Fluid from the remaining stomach and digestive juices from the pancreas and liver mix with food further down the intestine. Absorption of vital nutrients is maintained.
	After The Operation No intestine or stomach is removed. Because the pouch is small, you will get a feeling of fullness with less volume of food. Because very little intestine is bypassed, diarrhea and other unpleasant side-effects are avoided.

Laparoscopic Roux-en-Y Gastric Bypass

Because 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.

Our 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 this goal.

The 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.