In most cases, patients who are accepted for surgery fall within the National Institute of Health guidelines, adopted at a national conference in 1992, using a formula that takes into account both a patient’s height and weight. This is called the Body Mass Index (BMI). Patients with a Body Mass Index from 30-34.9 with obesity related diseases can be considered for Lap-Band® surgery. Patients with a BMI over 35 are considered surgical candidates if they have health problems aggravated by their weight. Patients with BMIs over 40 are considered surgical candidates even if they have no weight-aggravated health problems. A BMI calculator and BMI tables are available on our website.
Patients who are over 400 pounds may consider gastric sleeve (sleeve gastrectomy) surgery or may be better served by one of the operations we do not perform, such as biliopancreatic diversion or duodenal switch. We would generally refer those patients to an appropriate center.
How does the gastric bypass help a patient lose weight?
The weight loss effect of gastric bypass comes from a combination of (1) a much smaller stomach capacity, resulting in feeling full much sooner; (2) less hunger sensation for most patients; and (3) slightly quicker passage of food through the small bowel, resulting in less time for absorption.
How does the gastric band help a patient lose weight?
Once a band is properly adjusted, a patient will generally have a sense of fullness after only a small amount of food. This sense of fullness helps one stick to a good low-calorie nutrition program.
How much weight will be lost?
The exact amount of weight which a patient will lose after any type of weight control surgery cannot be exactly predicted. As with any weight control plan, final outcome depends on many factors, such as activity, food choices, motivation, age, etc. However, the experience with our form of gastric bypass in the past several years is that most patients lose well over half of their excess fat in the first 12-18 months after surgery. Most patients with a gastric band will lose that weight in approximately 2- 2 ½ years. Patients who participate in a good exercise program after surgical recovery often lose 75% or more of their extra fat. While there is the potential for minor weight gains, major weight re-gain is unlikely, provided that the patient does their part to follow good eating patterns and remain active.
Other than eating less, what foods will I have to give up?
We have found that all patients are different in food tolerance after surgery, so no exact statements can be made. In general, however, patients should avoid foods high in fat or sweets. High-quality protein should be eaten first, and water or thin liquids should be avoided about 30 minutes prior to meals so that the pouch has room to hold the needed nutrition. High-calorie thick liquids such as smoothies or shakes can get past the new pouch and potentially defeat the surgery. In addition, patient who have had gastric bypass may develop “dumping syndrome,” which is a sensation of indigestion soon after eating this sort of food, often accompanied by cramping, lightheadedness, and sometimes diarrhea. Whole milk, ice cream, and cream-based soups also often trigger these symptoms and may need to be severely limited or eliminated from the diet by many patients after gastric bypass.
Is pregnancy safe after gastric bypass?
We advise against becoming pregnant in the first two years after gastric bypass since the body is still adjusting to the new digestive arrangement. After the first year, pregnancy probably carries no greater risks to mother or unborn child than for a mother of similar age who has not had gastric bypass. However, there are relatively few studies on this point in medical literature. Any gastric bypass patient who decides to try to become pregnant, or who finds herself unexpectedly pregnant, should promptly register for prenatal care, and should make her obstetrician aware of her gastric bypass surgery. All gastric bypass patients, for whom future pregnancy is planned or possible, should be very faithful to keeping up their vitamin and mineral supplements, including vitamin B12, to minimize the risk of fetal development problems which can sometimes result from inadequate trace elements in the mother.
We prefer that women wait at least a year before becoming pregnant to allow maximum weight loss to occur. The patient should promptly begin prenatal care with an obstetrician, with whom we will coordinate to potentially loosen the band to allow a more normal food intake. The patient will then need to continue healthy nutrition and activity to avoid excess weight gain during the pregnancy.
Is it true I will lose my hair after weight-loss surgery?
It is not uncommon for patients to experience a phase of some increased brittleness or thinning of their hair in the early months after gastric bypass. The causes for this are not fully understood, but may reflect a general response of the body to the many changes in nutritional balance which occur as the body burns off the extra fat stores as weight is lost. Other factors include loss of lean muscle mass and protein stores. Doing resistance training (weight-lifting exercise) during the pre-operative phase may help this. During the immediate post-operative phase we will encourage you to pursue moderate cardio exercise and avoid strenuous resistance training until your rate of ongoing weight loss slows down. In our experience, hair thinning, if it occurs, is usually temporary, happens during the first few months after surgery, and is rarely severe.
Where will the incisions be made? How much of a scar will there be?
The incisions will be made in the upper abdomen, from the umbilicus (navel) upwards, and under both rib cages. All incisions are about one inch in length. It should be noted that occasionally, for safety reasons, the laparoscopic operation must be converted to the traditional, “open,” operation. This is unusual and done only out of necessity to ensure the safety of the patient and the technical quality of the operation. It is not considered a complication. If this is the case, the patient would have a larger vertical incision in the abdomen and need an extra 1-2 days in the hospital for pain control.
Will Plastic Surgery be needed for loose skin after I lose weight?
Some patients develop excessively loose skin on various parts of the body as major weight loss occurs. Many factors determine whether this loose skin can be toned back to satisfactory shape by exercise or whether plastic surgery may be necessary to help. In general, younger patients, and those with less extreme obesity before surgery, are more likely to be able to regain a satisfactory figure without plastic surgery. If plastic surgery is needed, the area which can usually be helped the most is the skin of the abdominal region by a tightening, or so-called “tummy tuck”. In a few patients, breast lift or breast reduction, skin tightening of the upper arms, and skin tightening of the upper thighs may be considered.
Will gastric bypass help my medical problems?
A number of serious and life-threatening medical conditions result from excessive weight gain and can be successfully prevented and/or treated by weight-reduction surgery. Adult-onset diabetes, obstructive sleep apnea, acid reflux, high blood pressure, joint disease, and others, can be drastically improved or cured by weight loss surgery. Gastric bypass is especially effective for diabetes and reflux. Other conditions that this surgery can help correct are stress urinary incontinence, infertility, and heart disease.
What short-term and long-term complications can result from gastric bypass?
The risk of short-term complications from this operation is about 12% (1 out of 8 ) and includes internal bleeding, infection, wound problems, pneumonia, and hernia formation. Potentially life-threatening complications such as respiratory failure, pulmonary embolus (blood clots in the lung), and leakage from internal intestinal connections occur in approximately 2-5% of patients. Occasionally open operation or re-operation is needed to address these complications. Long-term complications (less than 10% of patients) include stricture (partial blockage) of internal intestinal connections causing vomiting, ulcer formation causing bleeding, internal hernia formation, inadequate weight loss or recurrent weight gain, and malnutrition. It is always possible to develop unforeseeable complications.
Short-term complications include injury to the stomach, esophagus, and other nearby organs. Longer-term problems may include band slippage or erosion into the stomach (1-3%), port complication such as infection, leak or malposition (5-8%), and stomal swelling.
Are there other weight control operations besides gastric bypass, gastric band and gastric sleeve?
There are different weight-control operations which are done in different centers around the world. Other operations for weight control are “biliopancreatic bypass,” “duodenal switch,” and “distal bypass.” These three operations all involve a greater degree of rearrangement of the small intestine and create a greater degree of malabsorption of food. For some extremely large patients, especially over 400 pounds, these may be more reliable for significant weight loss. We will usually refer a patient who needs these operations to one of the appropriate centers. We continue to stay abreast of scientific advancement by participating in surgical meetings and conferences.