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Frequently Asked Questions about Weight Loss Surgery

Dr. Dan Jones, Chief of Minimally Invasive Surgery and Director of the Bariatric Program at BIDMC

Answered by Dr. Dan Jones, Chief of Minimally Invasive Surgery and Director of the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center in Boston.

Q. What are the options for weight loss surgery?

A. The most popular options are gastric bypass, laparoscopic gastric bypass and laparoscopic adjustable gastric band. There is also another surgical procedure known as the gastric sleeve. This procedure is a relatively new option, and four Massachusetts insurance plans (CIGNA, Harvard Pilgrim, Tufts and United Health Care) now cover it.

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 usually feel full with small meals. This procedure is done both open - one large incision - and now laparoscopically, with several smaller incisions and the use of a laparoscope "tiny camera." Studies have shown the laparoscopic version yields a quicker recovery time for the patient compared to open incision surgery.

The adjustable gastric band procedure places a "belt" around the top of the stomach, squeezing down on it to create a small pouch. Small amounts of food fill the stomach to help you eat less. The band is also adjustable through a port placed under the skin, allowing the physician to tighten or loosen the belt 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.

The gastric sleeve is similar in some ways to the gastric bypass. Like the gastric bypass, this surgery divides the stomach and creates a new, smaller stomach pouch that holds less food. During this procedure, three quarters of the stomach is removed, leaving the remainder of the stomach in a tube or sleeve shape. The procedure can be also be done laparoscopically.

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. Because you bypass the first part of the GI tract, B12, iron, calcium and folate levels must be supplemented to avoid serious sequela. As part of your initial visit, the Bariatric team will review each procedure, your individual history and needs; the team will also explain the risks and benefits of each procedure to help you decide which surgery is the best option for your individual lifestyle.

Q. How much weight will I lose?

A. It ultimately depends on the individual patient. Weight loss is a matter of your metabolism, 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 gastric bypass, most patients will lose 70 to 80 percent of their excess weight. That means if you're 100 pounds overweight, you might lose 70 to 80 pounds with proper diet and lifestyle modifications. Patients who have the band procedure lose between 50 to 60 percent of their excess weight. But note: like with any weight loss plan, if you "cheat" by, say, drinking high calorie liquids, 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 comfortably. If you eat too much or too fast, it may come 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 work with a bariatrician, dietitian, nurse and social worker in addition to a surgeon to ensure you are ready medically and mentally for a lifestyle change. We also have exercise physiologists who can help you become more physically fit.

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 quite small, but they can be life threatening. For gastric bypass, the risks also include leakage of fluid from the stomach or intestine through the sutures which results in abdominal infection (0.7 to 5.1 percent)*, stomal obstruction (8 to 19 percent), small bowel obstruction (0.2 to 4.5 percent), and malnutrition (under 1 percent). For banding, risks include band slippage/stomach herniation (2 to 3 percent), band erosion (1 percent) and injury to adjacent organs (0.5 percent), but over one's lifetime the band may need to be revised or removed. The national mortality rate from either of these procedures is between 0.2 to 1 percent. BIDMC posts outcomes on our website ( click here to view).

Q. When will I be able to go back to work?

A. With laparoscopic bypass or band procedures, most patients return to work within two to three weeks, depending on the type of work you do. Recovery with traditional gastric bypass is typically 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 or all 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 or the American Society of Metabolic and Bariatric Surgery.

In 2004, a panel convened by the State Department of Public Health 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.

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 September 2011

Contact Information

Weight Loss Surgery Center
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 3rd Floor
330 Brookline Avenue
Boston, MA 02215
617-667-5100

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