Online Weight Loss Surgery Information Class

Online Weight Loss Surgery Information Class


(synthesizer tones) – Welcome to the Online Weight Loss Surgery Information class. My name is Dr. Rod McKinlay
and I am the medical director of bariatric surgery here
at St. Mark’s Hospital. We’re going to start our
discussion by talking about weight control in the year 2017. We’ve understood a lot
through the years over the research that has been
done on obesity and the medical problems related
to obesity that has a lot more to do with the
metabolism inside of someone’s body as opposed to
simply diet and exercise, although we believe
those are very important points about good weight control. Today we’re gonna be talking
more about surgery and how that helps to alter metabolism to
promote better weight control, not just in the short-term,
but in the long-term, as well. We understand that there many
components to weight control. We’ve already mentioned diet and exercise. We certainly encourage a healthy diet and an active lifestyle. But as we look deeper into the body’s mechanisms for maintaining
a healthy weight, we find that it has a
lot to do with how your body processes carbohydrates, proteins, and fats and converts them into energy. So the surgeries that
we’ll be discussing today range in their metabolic
power from the lap band, which frankly, does not have a lot of metabolic influence on the
body, to the duodenal switch, which is a very powerful
metabolic surgery. The most common surgeries
that are done today include the sleeve gastrectomy
and the gastric bypass. We will be discussing those. To give a more broad introduction, not only is metabolism
involved with weight control, but our environment is a big part of it, as is one’s genetic
blueprint, if you will. We all come with a
different genetic profile, and oftentimes weight control has a lot to do with our genes. Well, what do genes code for? They code for the hormones
inside of the body, which are in charge of metabolism. Metabolism has so much to do with how hungry we are before we eat, how full we are after we eat, and how efficiently our body converts carbohydrates and fats into energy. As we look at operations
like the sleeve gastrectomy, the gastric bypass, the duodenal switch, all of these operations
reduce the volume of the stomach so that they will
only a certain amount of food into the body, thus
reducing caloric intake. But more importantly, they
actually reduce hunger. And they create a more efficient energy metabolism inside of the body. And as that is done, then one
is able to lose weight and actually enjoy the process
because their metabolism is speeding up to help them
along with their weight loss. We’ll also be talking
about some of the pros and cons of each of these surgeries. As with any surgery, there are risks associated
with the operation. So we want to talk about that and allow you to become
more familiar with how much weight you might lose and
how your weight-related problems like diabetes,
high blood pressure, can be overcome on a long-term basis. – Obesity is a disease. It is not a, just a condition, it’s not a behavioral
disorder, it is a disease. And we know that because
of all the different problems that we call comorbidities. Comorbidities are conditions
that are either directly caused by obesity or significantly
aggravated by obesity. And we’re talking about
medical comorbidities, there are over 65 medical
conditions that are considered weight-related comorbidities. For example, type 2 diabetes
really leads the list. High blood pressure, heart
disease, sleep apnea, joint problems, reflux, cancer. Many people don’t realize that obesity’s a huge risk factor for cancer. That the 14 most common
cancers that we treat in our society are increased in
obese patients over non-obese patients anywhere from double to 15 times. There are other comorbidities
that are not medical, though. Things like clothing selection, being able to be seated in restaurants, at theaters, on airplanes, sanitation. These are restrictions due
to your physical state. You can’t go out to any
store and buy clothes, and when you do, there’s
a limited selection often. Increased cost. It’s true that, for instance,
when it comes to a job, that you’re less likely to get the job if you’re morbidly obese. If you get the job, you’re
less likely to be promoted. When it comes to professional schools, medical school, dental school, law school, studies show that any school
that you have to either show a photograph or
have a interview with, is you are less likely to be accepted even though you may be fully qualified. Even within the medical profession. Many doctors have biases
against obese patients. Many nurses. It’s very difficult to take care of a morbidly obese patient. Now, the real problem is the cause. The controversy, everything
in obesity is controversial, even though we have plenty
of science to support it, why is it so controversial? And it’s because of the
misunderstanding of the cause. We’re told that the cause of obesity is a behavioral abnormality. That you simply eat too much
and exercise too little. Another issue with obesity
is the treatments of obesity. We’re told that medical
therapy is the gold standard by which the treatment of
obesity should be undertaken, and I have no problem with people attempting medical therapy. The average person on
that regimen will lose about 10% of their excess body weight, which is about 10 pounds at six months. But at one year, many of ’em
have already regained it. Studies would show as soon as they go off the medication the weight
tends to come back. So not very satisfactory. Diet and exercise, we all
should try diet and exercise and become a lifetime goal, but again, studies do not, are not very
promising in that regard. But it’s worth trying. How about behavioral modification? I personally like journaling. But again, journaling has admittedly not been shown to really help, at least I look at what I’m doing wrong and try to work on it. How do I know that this doesn’t work? ‘Cause that’s what you’ll hear. In 1991 the Centers of Disease Control did a what they call a meta analysis, and what you do in a meta
analysis is you collect all the research data on
a subject and compile that data and see if you can
come up with conclusions. And the conclusion they
came up with is that less than 5% of patients
could lose 10% or more of their excess body
weight, and that’s again, if you’re a hundred pounds overweight, that’s equivalent of losing 10 pounds, and keep it off for two years or longer. Now that’s pretty dismal. The Centers of Disease
Control actually comes up with obesity data
about every two years. Last time they published,
her data was three years ago, and they found that only
about 2% of patients with significant weight problems
were able to control them and get them under control
with medical weight loss. So it, unfortunately, is, the
results are pretty dismal. We just are not, we just
don’t have the medical tools to attack ’em and that’s
why surgical weight loss is the most effective
way of dealing with this. Morbid obesity is a chronic
illness that is difficult to treat with medical therapy
and exercise therapy alone. Again, they found that
surgery, in that case they were talking primary
gastric bypass surgery, was the best long-term treatment. In fact, in that same
document they come out to point out that it was the
only reliable long-term treatment that they found at that time. (slow synthesizer music) – So candidates for
bariatric surgery are people who have significant weight to lose. In 1991 the National Institute of Health submitted guidelines based
on all of the evidence there was about bariatric surgery, and those guidelines said
that anybody with a body mass index of 40 or greater is
a candidate for surgery. And anyone with a body mass index of 35 or greater who also carries one of the comorbidities that we’ve
been talking about, such as hypertension, high
cholesterol, sleep apnea, diabetes, or significant
degenerative joint disease, any of those comorbidities will also qualify someone for surgery. You know, it’s also important
to note that there are certain psychiatric illnesses
that if poorly controlled could also be problematic after surgery. As we’ve stated, surgery
is a stepping point in a life-long process of change. It requires ongoing use of
medications and multivitamins. And sometimes when people
have psychiatric issues, they stop completely taking medications, they stop following up with doctors, and that could be potentially problematic. So that is a requirement, as well. That if people do have psychiatric issues, such as depression or bipolar disease, that they’re well-controlled
with their medications. You know, another issue
is alcohol or drug abuse. We have found that people
after having gastric bypass surgery are more
prone to alcoholism. We don’t entirely know why that is. It may be a change in the way people metabolize certain drugs or alcohol. But we’ve also, as a result,
adjusted who we consider candidates for surgery and say
that nobody with ongoing or current issues with alcohol
or drug abuse is a candidate. The third issue is we
really try to get a sense of people that are committed
to a lifelong change. Bariatric surgery is a tool. It’s a tool that’s going to
help you lose a lot of weight. And it’s a tool that’s gonna help you keep that weight off long-term. But diet and exercise and
lifestyle, in general, are still gonna be a very
key component in your ability to keep the weight off an
maintain a healthy lifestyle. And so, people that are committed to that are also the best candidates. Bariatric surgery, over
the past several years, has really, really become
known as a treatment for diabetes, far more
than it was in the past. In fact, it was almost
an accidental discovery. We were doing these surgeries
to help people lose weight, but what we found is
that people with diabetes started having resolution
of their diabetes to the point they don’t
need to take medications at all within weeks of having surgery. Far before they had
significant weight loss that would account for the
improvement in their diabetes. As time goes on, there’s more and more research being done in this area. In fact, there are even
ongoing research studies going on looking at doing
surgery specifically for diabetes rather than weight loss. And in some of those studies,
people with a BMI down between 30 and 35 who are
not normally candidates for surgery are being evaluated
with very good success. What we find with the
three procedures that have some metabolic effect, namely the sleeve, the gastric bypass, and
the duodenal switch, is that patients that
undergo the gastric sleeve, between 70 to 80% of those
patients within several months experience remission,
and if not remission, very significant improvement
in their diabetes to the point that, like I said, most people are able to stop
taking medications completely. With the Roux-en-Y gastric bypass, we’re seeing that about 85% of people are able to stop taking
medications completely. With the duodenal switch, those numbers are between 90
and 98% complete remission. Now, it’s important to be noted
here that as time goes on, five, 10, 15 years down the road, in a small percentage of patients we are seeing some recurrence of their diabetes. Sometimes that correlates
with some weight regain. Other times not. That is something that we treat
appropriately if it recurs, but for most of the people
who have these procedures, it does not recur that way. (slow synthesizer music) – Here at St. Mark’s Hospital we have a variety of surgical options. We offer the lap band or the gastric band, the sleeve gastrectomy,
the gastric bypass, and the biliopancreatic
diversion with duodenal switch, which we oftentimes will abbreviate or shorten to just duodenal switch. So those are four different operations. The three most common surgeries we do are the sleeve, the bypass,
and the duodenal switch. And they range in aggressiveness, if you will, or degree of invasiveness. All of them involve some
surgery on the stomach and two of the three, the
bypass and the duodenal switch, also involve some work on
the small intestine, as well. (slow synthesizer music) I’ll start off by talking about the lesser invasive ones and then proceed. We’ll start by talking about
the lap band or gastric band. Now this was a very popular option. It became FDA approved in the year 2001, and probably reached a peak of popularity about somewhere between 2004 and 2010. At that time, we were
putting some lap bands in, and basically, the way
the surgery works is it is a ring, a plastic
ring, medical grade plastic, that goes around the
top part of the stomach and it acts as a brake on the food. It’s a portion control
device, if you will. The band is adjustable. It’s connected, the little ring that goes around the top part of
the stomach is connected by some tubing that goes to a port, which sits underneath the skin of the abdomen and is sewn onto the muscle. And we can use that port to adjust the tightness of the band. It’s been very helpful for a
lot of people to lose weight. One thing we know about the band, though, and the reason it has
diminished in popularity over the last three to four years, is that it doesn’t affect
the body hormones as much in terms of appetite
suppression or control. It typically works more
by a pressure phenomenon. If someone is eating and they
have a small amount of food, that band will put some
pressure there where they’ll feel some feedback where they will feel full and not want to eat further. The other potential issue with
the band could be heartburn, not necessarily immediately
after the surgery, but maybe two or three
years later when food may have a tougher time going through, and we might have to loosen the band. For several reasons
it’s become a little bit less popular but we do still offer it. It has been a helpful adjunct in terms of getting more weight off for people. Regarding weight loss with the lap band, we typically see about 40
to 50% excess weight loss, which means that if you’re
a hundred pounds overweight, you’d lose about 40 to
50 pounds, on average. Some patients are gonna
lose more than that, and some probably a little bit less. It will depend on coming back for regular follow-up visits to make sure that your band is appropriately tightened. There are some risks with
the lap band, as well. Heartburn is one. Nausea or vomiting could be other risks, especially if you’re not taking time to chew your food thoroughly. And an additional risk, which is really quite rare with the band, would be an erosion where the band could actually erode into the stomach, which would require its removal. (slow synthesizer music) Another surgery that works
only on on the stomach like the band is the sleeve gastrectomy. This surgery has become more
popular in recent years. It now rivals gastric bypass as one of the more common weight loss surgeries in the country and in our practice. With the sleeve gastrectomy, we create a small tube out of the stomach. The stomach is normally
shaped like a sphere and by using a stapling device we are actually removing about 3/4 of the stomach, fashioning it into a tube or a cylinder. This way, there’s a
little bit more pressure, a little bit more
resistance into the stomach so that when you’re eating
you feel full more quickly. It also actually impacts
the hormones of the body with regard to appetite
and fullness so that you’re feeling less hungry
even before you eat, and more full after you
eat a small amount of food. The weight loss results
with the sleeve are, generally speaking, higher
than with the lap band. They would average between 50
and 70% excess weight loss. Like the band, it does
have some complications. All the weight loss procedures do. One of the potential
complications with the sleeve would be heartburn and there would be a very small risk of a staple line leak. That would be about one to
2%, so a very rare occurrence, but if it does occur,
that would be significant and would have to be dealt with either surgically or through drains. Someone would be a good
candidate for sleeve who wants to lose a
significant amount of weight and who also may have had
lower abdominal surgery or surgery on other parts of their abdomen like the small intestine or the colon or if they’ve had a hernia repair on the lower abdomen which was more significant. Because the sleeve will then avoid any of that scar tissue by focusing mainly on the upper part of the abdomen. It’s just on the stomach. Sometimes we also think
of it as a good procedure for someone who may be more medically ill. That the other two surgeries
that are more aggressive, the bypass and the duodenal switch, might be a little bit too much for them, and the sleeve is very
helpful in that situation. The sleeve gastrectomy appeals to a lot of people because it is more simple than the gastric bypass and
the duodenal switch. It also does not affect
the small intestine, and therefore there are very few, if any, absorption problems with
the sleeve gastrectomy. This would be very helpful if
someone already has difficulty with iron absorption or
a vitamin deficiency. Of course, we’re going
to recommend that for all of these surgeries that you take your vitamins carefully and
completely after the surgery. The sleeve, though, really is focused exclusively on the stomach. We don’t see any problems
with bowel obstruction or any kinking or twisting of the
small intestine because we are simply not operating
on that part of the body. It also tends to appeal
to people who are looking for the surgery that will have the lowest surgical complication
risk but still get them at least 50% excess body weight loss. (slow synthesizer music) – The Roux-en-Y gastric bypass
is a procedure that was, kinda came about as a
combination of several things. Dr. Roux started doing this
procedure a century ago to treat patients where he had to take out a significant segment of their stomach and find a way to reconnect things. Then in the 1950s and ’60s when we were doing a lot of surgery for ulcer disease, we found that a Roux-en-Y was much better than some of the
alternatives because of the long-term lack of side effects. But as a, kind of a, an
accidental discovery, we also found that
patients that were having this surgery done to treat their ulcers, if they were significantly overweight, lost a significant amount of weight. And that’s what drew the attention of the bariatric community. The first Roux-en-Y gastric
bypass that was done for weight loss was in the mid-1960s. Since then, it’s been done all over the country because of its great success. We transitioned to doing this surgery laparoscopically in the early ’90s, and ever since then it’s
been done in that manner. It’s worth noting that
once we transitioned from doing open surgery to laparoscopic surgery the risk of having complications
or repeat surgeries, et cetera, significantly decreased. At this point, most people
who undergo a Roux-en-Y gastric bypass can expect a weight loss of between 60 and 80% of
their excess body weight by about five years out from surgery. Now, by year 25, that number
is still between 50 and 60%, so this is an extremely
durable procedure, as well. In fact, because it’s
been around for so long it’s really become the
gold standard by which we measure success for all
other bariatric procedures. Both the procedures that
we’re currently doing and new variations or
experimental surgeries that we’re in the process
of trying to develop. So if these other surgeries don’t have the safety profile and the
efficacy of a gastric bypass, a lot of times they won’t go any further. Now, a Roux-en-Y is performed when we go and we divide the stomach, making a small two to four ounce pouch. Then we pull part of the
jejunum, the small intestine, up and connect it to that pouch. Where we took the
intestine from down below and then we reconnect
and it makes a Y shape, hence the name Roux-en-Y. But the point is that food
then travels down and in this image you can see
that there’s a red arrow. Food travels down along that
track with the red arrow and only once it meets
the connecting portion of intestine signified by the green arrow, where those arrows join
we call the portion of the intestine beyond
that the common channel, and that’s where the
majority of food breakdown, digestion, and absorption occurs. Once upon a time we thought
that there was a significant amount of malabsorption
related to a gastric bypass, but we find that with ongoing studies, that’s really not the case. In fact, the main benefit of a gastric bypass is it’s
change on metabolism. And that’s important to describe. The duodenum, that C-shaped segment of intestine just beyond the stomach, is the hormone center for your entire digestive and metabolic process. It responds, meaning that
the signals to release certain hormones is actually
food passing through the lumen touching the
inside surface of it. So when we divert food past the duodenum, it really blunts a lot of
those metabolic responses and therefore, changes
the way we metabolize food in a really favorable fashion. It decreases our cravings. Decreases our hunger. It does not allow our body
to slow down our burn rate, so our metabolic rate, as we lose weight, which is where we see
the long-term benefit of the gastric bypass on weight loss. (slow synthesizer music) – So another potential
downside or side effect of the Roux-en-Y gastric bypass is
what we call dumping syndrome. Now, because our gastric pouch is quite small and there’s no valve between that gastric pouch and our small intestine, food is able to pass into our intestine sometimes very quickly. When people, after they’ve
had a gastric bypass, eat things that are high in carbohydrate or sometimes just very
rich foods in general, it can cause this syndrome
where people for maybe 1/2 an hour, sometimes up to
an hour, will feel not right. It’s not often a painful experience, although they feel some
kind of low level nausea, a lot of abdominal discomfort, sometimes some diaphoresis
or sweaty sensations. Oftentimes it ends with a
diarrhea bowel movement. And so that can be really
unpleasant for a lot of people, and it’s not, definitely not something that we intend to have happen. Now, a lot of people come back to us and say that there’s a silver lining. The fact that this
usually occurs if people eat foods that they shouldn’t be eating, it actually keeps them honest and helps them avoid those things long-term, and therefore, may be something that contributes to their success in some way. But again, not something that
we intend to have happen, and something that everyone
needs to be aware of before they choose to undergo
this type of procedure. Beyond that, should some other
problem arise in the future, whether any number of
things, such as cancer, or problems in the intestine related or not related to gastric bypass, and we had to go back
and undo the surgery, it is possible, but it is
quite difficult and it takes a significant surgery to go
and reverse this surgery. You know, after people
have a gastric bypass, generally speaking, we
keep them in the hospital overnight and I would
say 80 to 85% of people are able to go home the next day. There are a few people
that for whatever reason we end up keeping in the
hospital one more day, but the majority go home the very next. There are some surgical complications, or postoperative complications that we do see and people need to be aware of. One of them is the possibility
of an anastomotic leak. Now, an anastomosis is simply
anywhere we connect intestine. In the gastric bypass,
we’ve got a connection between the stomach pouch
and the small intestine, and we have a second
connection where we connect the small intestine back
to itself down lower. An anastomotic leak can occur
if where we’ve connected the intestine the tissue just
doesn’t heal quite right. If we find the leak early in that manner most of the time it just means one, maybe two extra days in the hospital. However, people are right back on track. If leaks are discovered several days to a week after surgery, sometimes it does involve a potentially longer hospitalization and more involved treatment such as drains, et cetera. Another potential
complication is a stricture. Where we connect the intestine the body deposits scar tissue. Now, scar tissue over
time tends to contract. That’s what brings the edges of a wound together after we’ve
been cut, for example. Unfortunately, if we
have a tubular structure and that scar tissue contracts over time, it can sometimes narrow that opening. Fortunately, that only happens between three and 5% of the time. And if it does, people
can sometimes notice that, when they swallow, food
just tends to stick. It doesn’t pass through as easily. And in severe cases, it
doesn’t pass through at all and people have to bring it back up. So we advise all of our
patients that if they start experiencing symptoms like
that to come back to us. One of the other potential complications is what we call a bowel obstruction. You can kind of think of this
as a kink or a twist in your intestine that just doesn’t
let food pass through. That can occur anywhere
between one to 2% of the time within the first year to two years. It usually is a result of scar tissue at the time of surgery. So, again, sometimes scar tissue on the inside of the abdomen can have untoward effects that are completely unforeseeable, and this is one of those. Other times these
obstructions occur because of what we call an internal hernia. Again, something that we do
our best to minimize the risk of but can still sometimes
occur in that one to 2% range. Whenever you talk about a surgery, it’s important to comment on the potential risk of mortality. Every surgery in the United States that’s done regularly has a mortality rate. For gastric bypass, that’s
about 0.2% nationwide. Usually when that happens
it’s as a result of other complications such as
a blood clot that forms and goes to your lungs or a significant infection that could
develop after surgery, and really not directly
related to the surgery itself. But again, one of the
reasons that we just insist that people follow up
with us closely is to find any sign or symptom that may indicate something’s wrong so that
we can intervene long before we get to the point
that it’s life threatening. (slow synthesizer music) – But the most powerful
operation is the duodenal switch. What we do is we amputate,
we start by amputating the greater curvature of the stomach, turning the stomach into a tube. That’s that vertical gastrectomy that’s also called a vertical sleeve gastrectomy. That has several different effects. First of all, we realize that that in it alone has metabolic effect. Not only does it reduce
your stomach so eat less, but more importantly,
it alters metabolism. The stomach is more complicated. There’s different types of
cells in the upper part, the fundus, and then
the body of the stomach, or in the antrum, which
is the distal part. And when those cells
either come in contact with food or don’t come
in contact with food, it affects metabolism. And so, when you take them
out of the circulation, then we go down below the stomach onto the duodenum about an inch. The duodenum is the first
portion of the small intestine, and we divide that. And then we go down to
the colon and measure the bowel, develop what
we call a Roux-en-Y limb, which brings a part of the bowel up to, that we can bring up
to the stomach to sew. And we measure that from
the colon backwards. So that the food comes down from one side, the digestive enzymes
come down from another. Again, the mix at where
you’ve sewn the bowel back together and then the digestion, most of that absorption
occurs in that common channel, which is the most distal portion. In the duodenal switch that
common channel is short. It’s only about three feet long. Now, for 35 years we thought about this operation in terms of behavior and said it works because the stomach is made small. But that doesn’t really work
because everybody can eat more with time and that doesn’t
correlate with weight gain. So we said, well, we’re bypassing 90% of the intestinal tract so therefore, there’s substantial malabsorption, you’re not absorbing as many nutrients. In theory, you’re only absorbing 10% of your nutrients, right? Well the answer is wrong. The bowel has tremendous
absorptive capacity. It also has tremendous adaptive capacity. With time, the bowel adapts
so it becomes more absorptive. And so, what we find is that you absorb carbohydrates fairly normally. Protein absorption is decreased maybe 10%, but in some patients probably not at all. Fat absorption is decreased
anywhere between 30 to 80%. And again, we said, well,
that works ’cause, again, not absorbing fat will
give you less calories. Fat’s not really a big problem
when it comes to obesity. When you look at the metabolism
of fat deposition and obesity it’s really related
to carbohydrates, not fats. But what it does do is
if you have undigested fat that gets into the large intestine, that can cause gas and diarrhea. So for those patients who have DS, that’s a good incentive for
them to avoid high-fat foods. So again, it’s very, very powerful. We see that patients
on average lose greater than 80% of their excess body weight. On average, less than 10% are regaining their weight at 10 years. Very powerful weight loss. Very, a durable operation. And again, to demonstrate
its metabolic effect, we see that over 95%, anywhere
from 95, in our experience, 98% of our type 2 diabetics
go into remission, meaning that the disease goes away. That’s compared to a
gastric bypass which is about 80 to 85%, which is excellent, versus a sleeve, which is about 70%. Most of them go into remission within the first two or three days after surgery. Definitely within the first two weeks. So very, very powerful
metabolic operation. Downside, increased complications, okay? It is more complex and therefore, there are more risks
such as leaks to occur. Nutritionally you have to pay
attention a little bit more. Not a lot, but a little bit more because you can get into some
nutritional problems. (slow synthesizer music) – Whenever we undertake a
surgery there are inherent risks. With any major abdominal surgery, this could include having
your gallbladder taken out, getting your appendix removed, really any surgery where we’re going into your abdominal cavity, there is a risk of developing what we call a pulmonary embolus. Now what that is, is it’s
a blood clot that usually forms in your legs and can
break free and go to your lungs. That happens anywhere
between zero and 3% of major abdominal procedures done
in the United States. Fortunately, only a very small
number of those are fatal, and that’s, unfortunately, about .5%. So one in 500 of people
that get pulmonary emboli, it can be fatal. Usually what we see,
though, is if we notice before it has broken
free and go to the lungs, people can develop swelling in one leg or pain in their calf, and that alerts us that
there may be a blood clot. Which if we identify we can treat before it ever causes problems with the lung. Unfortunately, sometimes we
don’t know about the blood clot until it has broken free
and traveled to the lungs. What that does is it blocks blood flow to a portion of the lungs, so even though you’re
breathing oxygen just fine, the oxygen can’t get
into your bloodstream. What we find is people
start to breathe rapidly. Their heart rate goes up a little bit. And again, that can
alert us that something’s not right and we can look for, do some tests to identify
a pulmonary embolism. If we do identify either
a blood clot in the legs or a blood clot that’s
gone to someone’s lung, we treat that with
anticoagulant medications that people need to
take for several months. Generally, at that point they can stop taking them and go back to normal. But it is something that we
watch very carefully for. Again, for comparison,
we see the same rate of pulmonary embolism and
blood clot in gallbladder surgery or any other abdominal surgery. Interestingly, the rates of
blood clots and pulmonary embolism are significantly
lower in this type of surgery than they are for
orthopedic procedures. Another thing that,
again, is a risk factor in general for surgery is
the risk of bleeding. At the time of surgery
we assure that there’s no bleeding prior to
finishing the procedure, but in some cases, after surgery, if people’s blood pressure gets high or, in some cases we never
identify really a reason why, people can have bleeding. Sometimes that requires
us to go back to the operating room and kind of wash things out and find that bleeding vessel and seal it. Other times it could simply require a blood transfusion and that’s all. But it is something that
we watch for very carefully and it does happen from time to time. Furthermore, as we’ve spoken of earlier, leaks where we make connections
of the intestine can occur. Fortunately, it’s very low likelihood. Bowel obstructions and internal hernias can occur between one and 3% of the time. After we’ve modified the
way our body ingests food and processes it we also see some vitamin, some changes in the way
our body absorbs vitamins. In cases like dealing with iron, B12, and calcium, we notice
that there’s a decreased ability to absorb those
things, and that’s, again, the reason that we administer
multivitamins daily. The surgeries that we
perform currently all have some significant change in metabolism. Some metabolic affect. And surgeries that have
the greatest metabolic effect tend to be the
most effective at helping people lose weight, keep it off, and also resolve some of the comorbidities they may experience. Whereas the procedures with the least metabolic activity still
do all of those things, but maybe not quite as effectively. And I like to put these
surgeries on a spectrum. On one end is the duodenal switch, which is the most powerful
metabolic procedure that we have. We’re seeing people losing
between 70 and 90% of their excess body weight and
keeping it off for five years. We’re seeing 90 to 95%
resolution of diabetes. In the middle of the spectrum
is the gastric bypass. And again, patients can
generally expect to lose between 60 and 80% of
their excess body weight and keep it off for five years. We’re seeing between 75 to 85% of patients with diabetes having complete resolution within several weeks of surgery. And on the low end is the gastric sleeve. People are seeing between 50 and 60% excess body weight loss at five years, and between 70 and 80%
resolution of diabetes. (slow syntehsizer music) – So when we think about
these surgeries as a tool, like anything else,
there’s two parts to it. One is actually having
the surgery and making sure it’s done well,
effectively, and safely, and that’s where we obviously
are here to help with that. The second part is the partnership of you making the right decisions. Deciding to eat the right kinds of foods. The ones that are rich in
nutrition, high in protein. Obviously we’re gonna
want to avoid foods that are high in carbohydrates,
sugars, and fats. Keeping that portion size down. Drinking lots of water,
not liquid calories. So there’s a real
partnership that goes there. Having a well-done surgery along with good compliance afterwards. And when we see those two
things going together, really amazing results can happen. – We’re here to give you information. Information that you can use to make an informed decision about
what’s best for you. We’re not here to talk
anybody into anything. We want you to continue
to do your homework. Talk to people who’ve had these surgeries. Talk to people who have done well. Talk to people who have had problems. But I counsel you to
talk to the individuals. The choice is yours whether weight loss surgery is for you or not. If you tell me that it’s not, that’s fine. If surgery is for you, it’s up to you to determine which procedure that you want. We’re not gonna tell you,
we’re gonna help you make that decision by answering your questions. Now there are a number
of obstacles to surgery. So many times I hear from
patients, well, you know, everybody tells me this
is the easy way out. This is not the easy way out. Unfortunately, it’s the only way out for many of our patients. So we want you to really
talk to your family, talk to people, and understand,
let’s help them understand. Insurance can be an
issue, we understand that. But bariatric surgery is a
very unique area in medicine. It is one of the only areas of medicine that is actually cost effective. We actually save the
healthcare system money. Other obstacles is just
the fear of surgery, and as I’ve said in
other portions of this, the risk is there, but
the risk compared to other operations is not as high. We’ve tended to inflate the risk and the fear that goes along with it. On the other side, we tend
to diminish or tend to underestimate what the
damage of obesity has done. Obesity is now one of the
world’s largest problems. And yet, we tend to treat it as nothing more than a personal body image issue rather than a real health issue, when it is really a major health issue. So you need to look at
yourself and what you really, what problems you really have and what you’re really trying to accomplish. And what risks you’re really willing to take in order to get this done. And then, take a consideration of which operation is best for you. – You may be thinking, what do I do next after viewing this online seminar. In this case, you’re gonna
want to take the online post-test to make sure
that you’ve captured the information that we
have talked about here. And then, you’ll proceed
to submit your application so that you can come in for a consultation so that we can talk
more in detail with you about your health, your
medical conditions, which surgery is right for you, and to make sure that you’re a good candidate for weight loss surgery. (slow synthesizer music)

1 Comment

  1. My enthusiasm to take “Yamzοkο Weebly” (Google it) weight loss plan is at all time high. I didn`t alter my eating habits and also did not increase my exercise level. In merely a short time of Four weeks, I already lost 6 pounds. Making use of this process, I did observe that I ate less and also filled up faster. .

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