Bariatric surgery is not a one-size-fits-all solution. This is why it is so important to gather information and learn more about the various surgical procedures available before making a decision. Bariatric surgery induce weight loss by restricting food intake or interrupting digestive processes.
Before undergoing any bariatric procedure it’s important to fully understand the advantages and disadvantages associated with each procedure. Attend a local seminar by our surgeons to find out more. Bariatric surgery involves making changes to the stomach and/or small intestine. There are two types of surgical procedures used to promote weight loss:
Restrictive Surgery
During these procedures the stomach is made smaller. A section of your stomach is removed or closed which limits the amount of food it can hold and causes you to feel full. Laparoscopic gastric banding surgery (e.g. LAP Band ® or Realize Band ®) is the most common restrictive surgery method. This is where a band divides your stomach and causes it to become smaller. Gastric banding can either be adjustable or non-adjustable. The other common form of restrictive surgery is a sleeve gastrectomy or gastric sleeve surgery. This is where a skinny tube and staples are applied to create a new longer skinny stomach. The primary restrictive methods of weight loss surgery are:
- Vertical Banded Gastroplasty
- Laparoscopic Adjustable Gastric Banding (LAP-BAND ® and REALIZE Band ®)
- Gastric Sleeve
Malabsorptive Surgery
Most of digestion and absorption takes place in the small intestine. Surgery to this area shortens the length of the small intestine and/or changes where it connects to the stomach, limiting the amount of food that is completely digested or absorbed (causing malabsorption). These surgeries are now performed along with restrictive surgery. There are several variations of malabsorptive surgery, such as Roux-en-Y, Biliopancreatic Diversion, Fobi Pouch and Biliopancreatic Diversion with Duodenal Switch. Roux-en-Y gastric bypass is the most commonly performed bariatric procedure. It works by combining both restrictive and malabsorptive elements. The primary malabsorptive methods of weight loss surgery are:
- Biliopancreatic Diversion
- Biliopancreatic Diversion with Duodenal Switch
- Roux-en-Y Gastric Bypass
Through food intake restriction, malabsorption, or a combination of both, you can lose weight since less food either goes into your stomach or stays in your small intestine long enough to be digested and absorbed.
Bariatric Surgery and Type 2 Diabetes
While most people undergo bariatric surgery to treat morbid obesity, there are a number of underlying conditions that improve after bariatric surgery. Most bariatric patients see improvements in high cholesterol, gastroesophageal reflux disease, asthma, heart disease, sleep apnea, and even Type 2 diabetes.
Diabetes is traditionally viewed as a chronic, incurable disease and delay of end-organ complications is usually the major treatment goal; however, evidence shows that patients who undergo bariatric surgery see improvement or even complete remission of their Type 2 diabetes.
Studies of Bariatric Surgery and Type 2 Diabetes
- After bariatric surgery, 77% of patients see their type 2 diabetes completely resolved. In these patients, diabetes completely disappeared or treatment (medicines, insulin) was no longer needed. In studies measuring for “resolution or improvement,” the number rose to 86% of patients (source).
- Bariatric surgery for type 2 diabetes delivers rapid results. For some patients, diabetes disappeared almost immediately—as soon as a few days after surgery. Others saw blood sugar levels begin to fall soon after surgery, becoming completely normal within a year.
- Patients who undergo bariatric surgery for Type 2 diabetes see a 92% reduction in deaths from diabetes-related causes.
Note that different types of bariatric procedures had different degrees of impact. Gastric bypass surgery resolved type 2 diabetes in 84% of patients, whereas gastric band procedures resolved diabetes in 73% of patients.
How to Choose the Right Bariatric Procedure for You
Deciding which procedure is best for you requires information and insight. All three types of bariatric procedures can help with weight loss and may help with type 2 diabetes.
Pacific Bariatric offers a number of seminars that you can attend to get answers to all of your questions about bariatric surgery for type 2 diabetes.
Type 2 Diabetes Management
Any amount of weight loss after surgery will help with your type 2 diabetes management. For some patients, their diabetes completely resolves after losing weight from bariatric surgery.
Although any weight loss will improve type 2 diabetes, you should follow your doctor’s recommendations to get the full effect from surgery. This includes closely following your post-surgery diet and your post-surgery exercise plan.
PRE-SURGERY FAQs
1. Can I skip the lecture? If I’ve already researched the gastric bypass surgery, why do I need to go?
You are required to attend a lecture no matter how educated you are about the surgery. Lectures are a starting point for a programmatic approach to your care. In addition, the information presented at the lecture will assist you in completing the written exam. The lecture is given in three parts. The first session is usually presented by a patient/patients or one of our staff that have had the surgery. The second session is the medical information presented by one of the surgeons. General insurance questions may also be covered. All three sections give the audience an opportunity to ask questions which pertain to each. Of course, questions from other individuals may help make you more informed. We want our potential patients to be as educated as possible so they can be certain gastric bypass surgery is right for them.
2. Can I have the laparoscopic procedure? What are the criteria?
The laparoscopic procedure is the approach our surgeons focus upon. There are exceptions where it may not be feasible to perform the surgery in this manner, but your surgeon will advise you if this is the case.
3. How long does the surgery take?
The surgery takes approximately 1 to 2 hours for the average patient. Sometimes it takes longer with larger patients. It takes an additional 30 minutes if you are having your gallbladder removed, or having the surgery laparoscopically.
4. How many days am I in the hospital?
Most gastric bypass patients are in the hospital from three to four days. It is all contingent upon your individual medical condition.
5. When can I return to work?
Usually gastric bypass patients return to work within two weeks. This should be discussed with your surgeon though. In addition, there is a lifting restriction of 15 lbs. or more for 4 to 6 weeks.
6. Is it safe to get pregnant after this surgery?
After the gastric bypass procedure we request that you wait at least one year following your surgery before attempting pregnancy. Our main concern is for the nutritional well being of the fetus. You must take extra precautions throughout the first year.
7. What causes hair loss with this program, and what could help minimize hair loss?
As one of the more common gastric bypass side effects, about 80 percent of our patients will experience temporary hair loss. The trauma and anesthesia from any surgery, a lack of protein, toxins in the body from the rapid weight loss, and stress are all contributing factors in causing temporary hair loss. Coloring or perming the hair in addition can cause more damage to your already fragile hair condition. The temporary hair loss usually starts about 3 to 4 months after surgery and continues on for 3 to 6 months. To help keep hair loss at a minimum, there are several things you can do. For this and some other gastric bypass side effects, double up on your vitamins (one in the morning and one at night), make sure you are getting enough protein, and drink lots of water. Water helps dilute the toxins from the rapid weight loss.
8. How can I prepare myself for surgery?
The best way to prepare is to read your protocol, review your paperwork, begin your protein supplement, take your vitamins, and start your exercise program. We also encourage you to attend our support groups as you can learn from our post-op patients. Be sure to share your preparatory work with your surgeon as well.
9. What is the success rate?
Across the nation, the success rate for a Roux-en-Y divided gastric bypass is approximately 85 percent. Our program is slightly higher than that and is dependent upon the patient. Remember, this is just a “tool”, not a guarantee of success.
POST-SURGERY FAQs
1. What can I eat?
From the first five days to a week after gastric bypass, only clear liquids and protein drinks are allowed. After the first visit your diet will be modified at the discretion of your surgeon.
2. Can I advance my diet before seeing the doctor?
No. Usually the bariatric surgeon will see the patient within five to seven days after the surgery and at that time, if everything is going well and the doctor’s examination is satisfactory, the patient will then progress to a Level 4 diet.
3. What can I take for gas?
A variety of simethicone-related products are available for gas such as Gas-X, Mylicon-80, etc. Gas and gas pains are most often related to swallowed air that is taken in by mouth accumulating in the colon or the bowel forming gas bubbles. At times this needs to be relieved with an enema, hot tub baths, or other means. Should the gas pain not respond to such measures, the patient should see a physician or contact your bariatric surgeon.
4. Why am I burping so much?
Again, burping represents the expulsion of gas that is swallowed by the mouth. In the early period after surgery, the anastomosis of the small upper stomach to the intestine is quite small and will remain so.
5. When can I swim?
Ordinarily, the incisions heal quite satisfactorily within a period of seven days and swimming can be allowed thereafter. It is advisable that for the first several days to a week after the patient gets back in the pool that water aerobics be undertaken in the shallow end of the pool rather than swimming in the deep end, due to the possibility of cramps.
6. What can I take for nausea?
Some nausea in the early aftermath of weight loss surgery, for the first two to three weeks, is very common. The use of peppermint extract is helpful. On occasion, one-half teaspoon of soda bicarbonate in a half glass of lukewarm water will relieve the nausea; sometimes antacids of Mylanta II are helpful. The use of ginger (made into a tea) is very helpful when a patient is nauseated. If nausea is excessive or persistent for a significant amount of time after weight loss surgery, please contact your physician.
7. How do I use peppermint extract?
Place two or three drops of peppermint extract on crushed ice along with two or three ounces of water and sipped very slowly. This is very tolerable.
8. How long do I take Prevacid ® / Prilosec /Aciphex / Nexium / Protonix?
As a rule, Prevacid ®, as well as similar products should be taken after the surgery for a period of thirty to forty-five days.
9. Can I have crackers?
The critical thing here is that crackers, cookies or such snacks must not be taken between meals (i.e., as a snack or fourth meal) at any time after gastric bypass surgery. They are, especially crackers, one of the causes of failure of the gastric bypass to maintain weight reduction.
10. When can I drive?
Ordinarily, the incision is very well healed and the patient is well on the way to recovery within two weeks after gastric bypass surgery and at that time driving is permitted. The patient must use reasonable caution and good judgment and should not drive after taking medications, when in a state of pain or reduced alertness, or when other problems occur. Always check with your surgeon after gastric bypass surgery for confirmation.
11. What can I take for a cold?
After Roux en Y gastric bypass, any of the usual cold medications may be taken, with the exception of those that contain nonsteroidal anti-inflammatory drugs (e.g., Advil Cold and Sinus ™, Motrin Cold and Sinus ®, etc.), alcohol, or aspirin. More specifically, the following drugs cannot be taken after gastric bypass:
- Aspirin
- Any form of nonsteroidal anti-inflammatory drugs with the exceptions mentioned above in Answer 3 (gas products).
- Alcohol
12. How long will I feel weak and tired?
After gastric bypass surgery, and for the first three to six months following the surgery, there is very rapid breakdown of the toxic metabolic products of fat in the body. These materials reach the body’s circulation in the form of uric acid, urea and various ketones and acetones. While this rapid phase of weight loss is occurring and these materials are circulating in the blood, before the kidneys can excrete them, there is an associated group of common observations that patients have:
- A feeling of fatigue and weakness
- Temporary hair loss
- A metallic odor of the breath
- Change in the odor or feel of the skin
These changes are temporary and will begin to fade after the most rapid phase (the first six months) of weight loss is over.
13. Why am I losing so much hair?
This is one of the most common gastric bypass side effects. The best explanation is mentioned above. The hair follicles throughout the body are sensitive to circulating levels of acidic components such as uric acid, ketones and acetones, and urea nitrogen. Consuming large amounts of water advised in the protocol, vitamins, and the combination of intensive exercise can reduce many gastric bypass complications, especially this one. If symptoms persist, increase the protein shake to twice a day and contact your doctor.
14. Why have I stopped losing weight?
In the first six months after the surgery, approximately two thirds of all the excess weight will be lost provided that the patient observes the following:
- No snacking between meals
- Exercise at least one hour four days a week
- Take protein supplements, at least 30 grams daily
- Take vitamins + B12
Even during the three to six month period, and particularly after the first six month period, the patient will observe periods of two to four weeks or more where there is “a plateau effect.” This is common, to be expected, and as long as the above four principles of dietary and lifestyle change are observed, should not be worrisome.