Frequently Asked Questions About Weight Loss Surgery
Answered by Dr. Dan Jones, Chief of Minimally Invasive Surgery and Director of the Bariatric Surgery Program at Beth Israel Deaconess Medical Center
Q. What are the options for weight loss surgery?
A. There are three FDA-approved options - gastric bypass, laparoscopic gastric bypass
and laparoscopic adjustable gastric band (LAGB).
Gastric bypass involves separating the stomach into a small pouch. This partitioning delays the mixing of food and digestive juices from the lower stomach. You feel full with small meals. This procedure is done both open -one large incision-- and now laparoscopically, with smaller incisions and the use of a tiny camera to help guide the surgeon to the proper areas of the stomach. Studies have shown the laparoscopic version yields a quicker recovery time for the patient.
The adjustable band procedure places a ring around the top of the stomach, squeezing down on it to create a small pouch. It takes only small amounts of food to feel hungry, therefore you eat less. The band is also adjustable through a port placed outside the body, allowing the physician to decrease the size of the stomach over time without re-operation, creating a greater opportunity for weight loss. Studies have shown that because the band procedure requires no cutting or stapling of the stomach, there are fewer peri-operative complications and a quicker recovery than traditional gastric bypass surgery.
Q. If the laparoscopic band is a less risky procedure, why would anyone choose gastric bypass?
A. On average, people lose more weight, quicker, with the gastric bypass procedure.
However, because it involves the rerouting of the intestine, patients need to be particularly careful about avoiding sweets and fatty foods as the body no longer is able to process these foods. As part of your initial visit, your medical team will help you decide which procedure may be best for you to consider.
Q. How much weight will I lose?
A. It ultimately depends on the individual patient. Weight loss is a matter of how many
calories you take in versus how much exercise you do. The band and bypass are "tools" that make achieving success a little easier.
With bypass, most patients will lose 50-70 percent of their excess weight. That means if you're 100 pounds overweight, you might lose 50-70 pounds with proper diet and lifestyle modifications. Patients who have the band procedure lose between 35 and 70 percent of their excess weight. But note: like with any weight loss plan, if you "cheat" by, say, drinking high calorie liquids (like milkshakes), you could conceivably GAIN weight.
Q. How will my diet change?
A. Your post-surgery diet may vary depending on which type of surgery you choose. It's important to follow whatever dietary guidelines your weight loss program nutritionists have outlined for you.
Overall, you will need to eat small portions that are low in sugar. You will need to
chew your food thoroughly and eat very slowly, waiting a couple of minutes in-between bites. You will also need to avoid alcohol, carbonated drinks, and foods high in fat.
Q. What if I eat too much?
A. Because the size of your stomach is now much smaller, only so much food and liquid will fit. If you eat too much, it comes right back up. This is why patients must be ready to make a major change in the way they eat.
Q. Are these procedures reversible? What if I find I just can't adjust to eating this way?
A. While weight loss surgery is reversible as a last resort, these are serious procedures that carry some real risk and must be thought of as permanent.
Before any patient is approved for surgery, they must be ready to make a commitment to this new way of eating and exercise. In our program at Beth Israel Deaconess Medical Center, all patients are encouraged to work with a nutritionist, exercise physiologist, psychologist, and social worker in addition to a surgeon to ensure they are ready mentally as well as physically for this change.
Q. What are the major complications of the procedures?
A. All of these procedures carry risks including bleeding, infection, potential problems with the heart or lungs, and the risks of general anesthesia. The chance of these complications is small, but they can be life-threatening. For gastric bypass, the risks also include leaks, infection, stomal obstruction, small bowel obstruction, and malnutrition.
For banding, risks include band slippage/stomach herniation, band erosion, and injury to adjacent organs. The national mortality rate from either of these procedures is between .2 - 1%. In addition, if you experience problems, the band may need to be revised or removed.
Q. When will I be able to go back to work?
A. With laparoscopic bypass or band procedures, most patients return to work within 2-3
weeks, depending on the type of work you do. Recovery with traditional gastric bypass may be longer.
Q. How much does the procedure cost and will my insurance cover it?
A. The procedure costs between $25,000 and $30,000. Most insurance plans do cover most of the cost for those patients who are appropriate candidates for the procedure. Patients should check with their insurer to find out more.
Q. What should I consider when selecting a weight loss surgeon/surgery program?
A. At Beth Israel Deaconess Medical Center, we believe all weight loss surgery programs should be accredited by the American College of Surgeons.
In 2004, a panel convened by the State Department of Public Health recommended
that all doctors who perform weight loss surgery receive ongoing training. They also reported that complications are most likely to be minimized when the surgery is performed by high-volume surgeons (those doing 50-100 cases per year) operating in properly equipped, high volume weight loss centers with integrated and multidisciplinary treatment. Last year BIDMC performed over 300 bariatric procedures.
In addition to asking your surgeon how many procedures he or she has performed, we also emphasize the importance of finding the right fit. You need to feel comfortable with your weight loss team in order to be successful.
*Complication rates from The Executive Report of the Betsy Lehman expert panel on weight loss surgery, Commonwealth of Massachusetts, 2004.
Above content provided by Beth Israel Deaconess Medical Center
For advice about your medical care, consult your doctor
Posted March 2009