1. What is Bariatric Surgery? 

Bariatric weight loss surgery offers several options to reduce the food capacity of the stomach or to modify parts of the digestive system to decrease calorie absorption.

The term "bariatric" is derived from the Greek word "baros" which means weight and which survives in English words such as "barometer."  Bariatric surgical procedures are performed via a conventional long incision or, more recently, via laparoscopy which uses a thin, lighted telescope connected to a TV camera. The laparoscopic approach allows for smaller incisions, less scarring, less discomfort and faster recovery. 

Types of Bariatric Procedures:

Restrictive (limits food intake)
Fobi Pouch, Adjustable Lap Banding, VG

Malabsorptive (reduces calorie absorption)
Bilio-Pancreatic Diversion - Europe

Hybrid (combination of moderate restrictive and moderate malabsorption)
Duodenal Switch Procedure

Revision and reversal depend on the surgical procedure that was performed and on the experience of the surgical team. The LapDS and the LapBand, as well as other procedures, can be reversed and revised. 

3. Who is a candidate for weight loss surgery?

To qualify for bariatric surgery a person must have:

• Body Mass Index (BMI) (link to II.A.3) of at least 40 (equivalent to 100 pounds or more overweight)
• OR  BMI of at least 35 with a co-morbidity or disabling condition
• OR  have had a prior failed bariatric procedure

Factors that are also considered include:

• Smoking: Must be a non-smoker prior to surgery and remain a non-smoker after surgery
• Age: No absolute limits, however most candidates are between 18 and 65
• Substance abuse: Must be free of drug or alcohol abuse
• Emotional: Free of any major unstable emotional disorder

There are significant dietary restrictions after the Roux-en Y Gastric Bypass.
However, one of the biggest advantages of the Duodenal Switch procedure is "normal eating." Within about one year, a diet high in protein is well tolerated in near normal amounts. Patients should stay away from sweets (including fruit and fruit juices) during the initial weight-loss period of 12-18 months. Some people experience lactose intolerance and since lactose is a dairy sugar we recommend that patients stay away from dairy for at least six months.

5.  What diseases and conditions tend to develop as a result of obesity?

Obesity and its co-existing diseases (link to II.A.4) (co-morbidities) result in many conditions patients often do not recognize they have such as: Diabetes, high blood pressure, cardiac disease, sleep-apnea, asthma, gastro-esaphageal reflux (heartburn), infertility, degenerative disease of weight-bearing joints, deep vein thrombosis and pulmonary embolism, hypoventilation, dyslipidemia (high lipids), urinary stress incontinence and depression, to name just a few.

6. How can weight loss surgery make a difference in an obese person's life?
 
With considerable excess weight loss, most co-existing diseases go away and dramatic changes in overall health occur. For example, many diabetic patients come off insulin in the hospital before going home. Patients experience a feeling of "empowerment," with  increased self-esteem and increased confidence as a result of losing weight. 

7. How can I find other people who have undergone weight-loss surgery?

The first thing you can do is attend a monthly support group meeting (http://www.paclap.com/SupportGroups/supportgroups.html)  hosted by Dr. Rabkin at St. Mary's. You can log on to DS_PacificLaparoscopy@yahoogroups.com for our post-op email community and call (415) 668-3200 to register for the Pacific Laparoscopy newsletter mailing list.

Also visit: www.duodenalswitch.com

8. How can I learn more about obesity and weight-loss surgery?

Attend an educational, support group meeting hosted by Dr. Rabkin at St. Mary's Medical Center.

You may also visit the following websites:

• Pacific Laparoscopy:  www.paclap.com
• American Obesity Society:   www.obesity.org/education/advisor.shtml
• JAMA patient page on Bariatric Surgery:  www.ama-assn.org/public/journals/patient/archive/jpg121102.htm
• Medline plus:  www.nlm.nih.gov/medlineplus/weightlosssurgery.htm
• National Institute of Diabetes & Digestive & Kidney Diseases: www.niddk.nih.gov
• ObesityHelp.com:  www.obesityhelp.com

Some insurance companies authorize weight-loss surgery if you are a qualified candidate. An alternative self-pay package is obtainable by calling Pacific Laparoscopy at (415) 668-3200.  Many patients have proceeded with self-pay, but continue to fight their insurance companies denial and have had the denials overturned.

10. How much weight can I expect to lose and how quickly will I lose it?

Laparoscopic Duodenal Switch patients show on the average 91% excess weight loss at two years after surgery. Two ten-year studies have shown the Duodenal Switch procedure to have anywhere between 75% and 85% excess weight loss. 

11. What are the risks of weight loss surgery?

According to national statistics, any morbidly obese patient has a 1/200 chance of dying from "any" type of anesthesia. Acute complications from the Duodenal Switch procedure  can include, bleeding, pneumonia, collapsed lung, infection, abscess, pulmonary embolism (blood clots), deep vein thrombosis and leaks.  Long-term complications could be vitamin insufficiency if not taking vitamins, anemia if not taking enough Iron and osteoporosis if not taking adequate Calcium. 

A three-day stay is routine for most patients. You'll stay in a beautiful private room and family members or loved ones are encouraged to spend the night with you. And you can shower in the hospital.

• Day 1:  You'll start on clear liquid diet.
• Day 2:  You'll advance to soft pureed foods.
• Day 3:  You'll go home to a diet of soft, high protein, pushing fluids, low sugar, low-to moderate fat content foods.

13. What is a typical recovery experience like?

By the second month, patients typically eat regular food. They should always eat protein first and pay strict attention to fluid intake to avoid dehydration.  Exercise is considered part of "pre-op" readiness and is continually evaluated to make sure body fat and not lean body mass is being lost.  Depending on what type of work they do, most patients return to work four to six weeks after surgery. Heavy lifting can resume gradually after six weeks in most instances.