Plastic Surgeons in Beverly Hills - Los Angeles - Plastic Surgery

About Weight Loss Surgery

1. Choosing Surgery
2. How Effective Is Surgery?
3. How Surgery Reduces Weight
4. Options for Treatment
5. Preparation for Surgery
6. Risks and Complications of Bariatric Surgery
7. Weight Loss Surgery Procedures
8. Weight Loss Surgery Options
9. The Hospital Stay

Choosing Surgery

Weight loss surgery is major surgery. Although most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer.

That is why you should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. They may, as part of routine evaluation for weight loss surgery, require that you consult with a dietician/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success.

It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. There can be unexpected outcomes in even the simplest procedures. What can be said, however, is that weight loss surgery will only succeed when the patient makes a lifelong commitment. Some of the challenges facing a person after weight loss surgery can be unexpected. Lifestyle changes can strain relationships within families and between married couples. To help patients achieve their goals and deal with the changes surgery and weight loss can bring, most bariatric surgeons offer follow-up care that includes support groups, dieticians and other forms of continuing education.

Ultimately, the decision to have the procedure is entirely up to you. After having heard all the information, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.

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How Effective Is Surgery?

The actual weight a patient will lose after the procedure is dependent on several factors. These include:

1. Patient's age
2. Weight before surgery
3. Overall condition of patient's health
4. Surgical procedure
5. Ability to exercise
6. Commitment to maintaining dietary guidelines and other follow-up care
7. Motivation of patient and cooperation of their family, friends and associates

In general, weight loss surgery success is defined as achieving loss of 50% or more of excess body weight and maintaining that level for at least five years. Clinical data will vary for each of the different procedures mentioned on this site. Results may also vary by surgeon. Ask your doctor for the clinical data stating their results of the procedure they are recommending.

Clinical studies show that, following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Patients may lose 30 to 50% of their excess weight in the first six months and 77% of excess weight as early as 12 months after surgery. Another study showed that patients can maintain a 50-60% loss of excess weight 10-14 years after surgery. Patients with higher initial BMIs tend to lose more total weight. Patients with lower initial BMIs will lose a greater percentage of their excess weight and will more likely come closer to their ideal body weight. Patients with Type 2 Diabetes tend to show less overall excess weight loss than patients without Type 2 Diabetes. The surgery has been found to be effective in improving and controlling many obesity-related health conditions. A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved. For example, many patients with Type 2 Diabetes, while showing less overall excess weight loss, have demonstrated excellent resolution of their diabetic condition, to the point of having little or no need for continuing medication.

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How Surgery Reduces Weight

Surgeons first began to recognize the potential for surgical weight loss while performing operations that required the removal of large segments of a patient's stomach and intestine. After the surgery, doctors noticed that in many cases patients were unable to maintain their pre-surgical weight. With further study, surgeons were able to recommend similar modifications that could be safely used to produce weight loss in morbidly obese patients. Over the last decade these procedures have been continually refined in order to improve results and minimize risks. Today's bariatric surgeons have access to a substantial body of clinical data to help them determine which surgeries should be used and why.

Today, the American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change.

Restrictive Procedures

The theory is simple. When you feel full, you are more likely to have reduced feelings of hunger and will no longer feel deprived. The result is that you are likely to eat less. Restrictive weight loss surgery works by reducing the amount of food consumed at one time. It does not, however, interfere with the normal absorption (digestion) of food. In a restrictive procedure, the surgeon creates a smaller upper stomach pouch. The pouch, with a capacity of approximately 1/2 to 1 oz. (15 to 30 ml), connects to the rest of the stomach through an outlet known as a "stoma." In a cooperative and compliant patient, the reduced stomach capacity, along with behavioral changes, can result in consistently lower caloric intake and consistent weight loss.

During recovery, patients must adhere to the strict specific dietary guidelines and restrictions their surgeon prescribes. While these guidelines may vary from one surgeon to the next, it is important for each patient to follow the surgeon's guidelines. When the time comes to resume eating "regular" food, the patient must learn to adapt to a new way of eating. At each meal, they are restricted to consuming approximately 1/2 to a full cup of food before feeling uncomfortably full. Patients who see the best results from a restrictive procedure are those who learn to eat slowly, eat less, and avoid drinking too many fluids, particularly carbonated beverages. If the patient fails to follow these guidelines, they can stretch the stomach pouch and/or the stoma outlet and defeat the purpose of the surgery. The effectiveness of a restrictive procedure is reduced by constant snacking or by drinking high-calorie, high-fat liquids. Failure to achieve the expected level of weight loss is usually the result of a patient failing to comply with the recommended dietary and behavior modifications, such as increased exercise and regular support group attendance.

Malabsorptive Procedures that Alter Digestion

It can be said that some of the restrictive approaches discussed above have not always achieved the excess weight loss surgeons and patients anticipated. For this reason, procedures that alter digestion, known as malabsorptive procedures, were developed to work in conjunction with restrictive approaches. Some of these techniques involve a bypass of the small intestine, thus limiting the absorption of calories. On balance, malabsorptive or malabsorptive/restrictive procedures have resulted in an overall increase in the loss of excess weight. The risk of complications and side effects generally increases with the lengthening of the small intestine bypass. You and your surgeon must determine the risks and benefits over your lifetime with the type of weight loss surgery you choose.

Basically, weight loss operations fall into three categories:

1. Restrictive procedures make the stomach smaller to limit the amount of food intake.
2. Malabsorptive techniques reduce the amount of intestine that comes in contact with food so that the body absorbs fewer calories.
3. Combination operations take advantage of both restriction and malabsorption.

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Options for Treatment

For anyone who has considered a weight loss program, there is certainly no shortage of choices. In fact, to qualify for insurance coverage of weight loss surgery, many insurers require patients to have a history of medically supervised weight loss efforts.

Most non-surgical weight loss programs are based on some combination of diet/behavior modification and regular exercise. Unfortunately, even the most effective interventions have proven to be effective for only a small percentage of patients. It is estimated that less than 5% of individuals who participate in non-surgical weight loss programs will lose a significant amount of weight and maintain that loss for a long period of time.

According to the National Institutes of Health, more than 90% of all people in these programs regain their weight within one year. Sustained weight loss for patients who are morbidly obese is even harder to achieve. Serious health risks have been identified for people who move from diet to diet, subjecting their bodies to a severe and continuing cycle of weight loss and gain known as "yo-yo dieting."

The fact remains that morbid obesity is a complex, multifactorial chronic disease.

For many patients, the risk of death from not having the surgery is greater than the risks from the possible complications of having the procedure.

That is the key reason that in 2000, approximately 40,000 weight loss surgical procedures were performed and why the American Society for Bariatric Surgery estimates that 50,000 weight loss surgical procedures will be performed in 2001. Patients who have had the procedure and are benefiting from its results report improvements in their quality of life, social interactions, psychological well-being, employment opportunities and economic condition.

In clinical studies, candidates for the procedure who had multiple obesity-related health conditions questioned whether they could safely have the surgery. These studies show that selection of surgical candidates is based on very strict criteria and surgery is an option for the majority of patients.

1. Weight Loss Surgery

   Weight loss surgery is major surgery. Its growing use to treat morbid obesity is the result of three factors:

   1. Our current knowledge of the significant health risks of morbid obesity
   2. The relatively low risk and complications of the procedures versus not having the surgery
   3. The ineffectiveness of current non-surgical approaches to produce sustained weight loss

   Surgery should be viewed first and foremost as a method for alleviating debilitating, chronic disease. In most cases, the minimum qualification for consideration as a candidate for the procedure is 100 lbs. above ideal body weight or those with a Body Mass Index of 40 or greater. Occasionally a procedure will be considered for someone with a BMI of 35 or higher if the patient's physician determines that obesity-related health conditions have resulted in a medical need for weight reduction and, in the doctor's opinion, surgery appears to be the only way to accomplish the targeted weight loss. In many cases, patients are required to show proof that their attempts at dietary weight loss have been ineffective before surgery will be approved. More important, however, is the commitment on the part of the patient to required, long-term follow-up care. Most surgeons require patients to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of their lives after having weight loss surgery.

2. Diet and Behavior Modification

   There are literally hundreds of diets available. Moving from diet to diet in a cycle of weight gain and loss - yo-yo dieting - that stresses the heart, kidneys and other organs can also be a health risk.

   Doctors who prescribe and supervise diets for their patients usually create a customized program with the goal of greatly restricting calorie intake while maintaining nutrition.

   These diets fall into two basic categories:

   1. Low Calorie Diets (LCDs) are individually planned so that the patient takes in 500 to 1,000 fewer calories a day than he or she burns.
   2. Very Low Calorie Diets (VLCDs) typically limit caloric intake to 400 to 800 a day and feature high-protein, low-fat liquids.

   Many patients on Very Low Calorie Diets lose significant amounts of weight. However, after returning to a normal diet, most regain the lost weight in under a year. Ninety percent of people participating in all diet programs will regain the weight they've lost within two years.

   Behavior modification uses therapy to help patients change their eating and exercise habits. Like low-calorie diets, behavior modification, in most patients, results in short-term success that tends to diminish after the first year.

   If diet and behavior modifications have failed you and surgery is your next option, it is important to understand that diet and behavior modification will be instrumental to sustained weight loss after your surgery. The surgery itself is only a tool to get your body started losing weight - complying with diet and behavior modifications required by most surgeons would determine your ultimate success.

3. Exercise

   Starting an exercise program can be especially intimidating for someone suffering from morbid obesity. Your health condition may make any level of physical exertion next to impossible. The benefits of exercise are clear, however. And there are ways to get started.

   A National Institutes of Health survey of 13 studies concludes that physical activity:

   1. results in modest weight loss in overweight and obese individuals
   2. increases cardiovascular fitness, even when there is no weight loss
   3. can help maintain weight loss

   New theories focusing on the body's set point (the weight range in which your body is programmed to weigh and will fight to maintain that weight) highlight the importance of exercise. When you reduce the number of calories you take in, the body simply reacts by slowing metabolism to burn fewer calories. Daily physical activity can help speed up your metabolism, effectively bringing your set point down to a lower natural weight. So when following a diet to attempt to lose weight, exercise increases your chances of long-term success.

   Examples to get you started:

   1. Park at the far end of parking lots and walk
   2. Take the stairs instead of the elevator
   3. Cut down on television
   4. Swim or participate in low-impact water aerobics
   5. Ride an exercise bike

   Overall, walking is one of the best forms of exercise. Start out slowly and build up. Your doctor, or people in a support group, can offer encouragement and advice. Incorporating exercise into your daily activities will improve your overall health and is important for any long-term weight management program, including weight loss surgery. Diet and exercise play a key role in successful weight loss after surgery.

4. Over-the-Counter & Prescription Drug

   New over-the-counter and prescription weight loss medications have been introduced. Some people have found them effective in helping to curb their appetite. The results of most studies show that patients on drug therapy lose around 10 percent of their excess weight and that the weight loss plateaus after six to eight months. As patients stop taking the medication, weight gain usually occurs.

   Weight loss drugs can have serious side effects. Still, medications are an important step in the morbid obesity treatment process. Before insurance companies will reimburse/pay for weight loss surgery, you must follow a well-documented treatment path.

   "Since many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose, the vast amount of money spent on diet clubs, special foods and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted." (New England Journal of Medicine)

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Preparation for Surgery

Weight loss surgery is like other major surgeries. The best preparation is to understand the risks and potential benefits and to closely follow your doctor's instructions.

To mentally prepare yourself:

1. Understand the surgical process and what to expect afterwards.
2. Talk to people who have had weight loss surgery.
3. Write a letter to yourself and your surgeon explaining your reasons for having the surgery and outlining your plans to maintain your weight loss after surgery.
4. Start a journal about your experience. Record how you feel now, the obstacles you encounter, the things you hope to be able to do after surgery.
5. Get a letter of support from your family. It helps to know you have people behind you, waiting to help.

To physically prepare yourself, strictly follow your doctor's guidelines. These usually include, but are not limited to:

1. Restricting yourself to a clear liquid diet 12-24 hours before surgery.
2. Stop smoking for at least a month before surgery.
3. Be certain to follow your surgeon's instructions regarding any medications you may be taking to control other health conditions.
4. Arrive on time, with supplies from home for a three- to four-day hospital stay. If you use special equipment for sleep apnea, you should bring your machine to the hospital.

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Risks and Complications of Bariatric Surgery

Surgery should not be considered until you and your doctor have evaluated all other options. As with all surgeries, there are risks associated with this procedure. If complications occur during the operation, your doctor may choose to perform open surgery. Your doctor must determine if you are an appropriate surgical candidate.

Indication

Weight loss surgery is typically reserved for those individuals 100 pounds or more overweight (Body Mass Index [BMI] of 40 or higher) who have not responded to other less invasive therapies such as diet, exercise, medications, etc.

In certain circumstances, less morbidly obese patients (with BMIs between 35 and 40) may be considered for surgery (patients with high-risk co-morbid conditions and obesity-induced physical problems that are interfering with quality of life).

Important Considerations

Surgery should not be considered until you and your doctor have evaluated all other options. The proper approach to weight-loss surgery requires discussion and careful consideration of the following with your doctor:

1. These procedures are in no way to be considered as cosmetic surgery.
2. The surgery does not involve the removal of adipose tissue (fat) by suction or excision.
3. A decision to elect surgical treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure.
4. These weight loss surgical procedures (approved in the United States) are not reversible.
5. The success of weight loss surgery is dependent upon long-term lifestyle changes in diet and exercise.
6. Problems may arise after surgery that may require reoperations.
7. Success of surgical treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.

Complications and Risks

As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures that should be discussed with your doctor. Possible risks include, but are not limited to:

1. Bleeding*
2. Complications due to anesthesia and medications
3. Deep vein thrombosis
4. Dehiscence
5. Infections
6. Leaks from staple line breakdown
7. Marginal ulcers
8. Pulmonary problems
9. Spleen injury*
10. Stenosis

*Removal of the spleen is necessary in about 0.3% of patients to control operative bleeding.

If surgery is performed laparoscopically and complications occur during the operation, your doctor may choose to perform open surgery.

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Weight Loss Surgery Procedures

Which Is Right for You?

The most important step in weight loss surgery is getting all of the information you need about the various surgical options. Ultimately your surgeon and other physicians are your best resource for information about the procedure they will recommend to you. When you ask a question, make sure you understand the answer. Do not hesitate to ask for a clearer explanation given in simpler language. The decision to have a weight loss surgical procedure may take several visits to their office and consultation with more than one doctor. Ask your doctor for names of other patients who have had similar procedures and who are willing to discuss their experiences, good and bad, with you.

You may choose to research weight loss surgery on your own via the Internet or through your local library. As with any search for medical information, be sure that your sources are responsible recognized experts in the field you are investigating. An excellent resource for weight loss surgery is the American Society for Bariatric Surgery.

Although the results of weight loss surgery can be drastic, there are potential risks and complications. Before making your decision, you should be well informed. These steps are necessary if you are to give what is called "informed consent" for the procedure. Informed consent is a legal term meaning that a patient agrees that they have received and understood enough information about a procedure's benefits and risks to allow them to make a decision that is right for them. Your surgeon will require you to sign a consent form before performing your procedure. Before you sign a consent form, you should have a solid understanding of what is about to take place. You should know what you would need to do to live well after the operation. And you should be aware of the signs or symptoms of complications to look for which may occur after your surgery.

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Weight Loss Surgery Options

The American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:

1. Restrictive procedures that decrease food intake.
2. Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.

Gastric Restrictive Procedure - Vertical Banded Gastroplasty

Vertical Banded Gastroplasty (VBG) is a purely restrictive procedure. In this procedure the upper stomach near the esophagus is stapled vertically for about 2-1/2 inches (6 cm) to create a smaller stomach pouch. The outlet from the pouch is restricted by a band or ring that slows the emptying of the food and thus creates the feeling of fullness.

Advantages

1. The primary advantage of this restrictive procedure is that a reduced amount of well-chewed food enters and passes through the digestive tract in the usual order. That allows the nutrients and vitamins (as well as the calories) to be fully absorbed into the body.
2. After 10 years, studies show that patients can maintain 50% of targeted excess weight loss.

Risks

1. Postoperatively, stapling of the stomach carries with it the risk of staple-line disruption that can result in leakage and/or serious infection. This may require prolonged hospitalization with antibiotic treatment and/or additional operations.
2. Staple-line disruption may also, in the long-term, lead to weight gain. For these reasons, some surgeons divide the staple-line wall of the pouch from the rest of the stomach to reduce the risk of long-term staple-line disruption.
3. The band or ring applied may lead to complications of obstruction or perforation, requiring surgical intervention.
4. Characteristically, these procedures, while creating a sense of fullness, do not provide the necessary feeling of satisfaction that one has had "enough" to eat.
5. Because restrictive procedures rely solely on a small stomach pouch to reduce food intake, there is the risk of the pouch stretching or of the restricting band or ring at the pouch outlet breaking or migrating, thus allowing patients to eat too much.
6. Around 40% of patients undergoing these procedures have lost less than half their excess body weight.
7. As is the case with all weight loss surgeries, readmission to a hospital may be required for fluid replacement or nutritional support if there is excessive vomiting and adequate food intake cannot be maintained.

Malabsorptive Procedures - Biliopancreatic Diversion

While these operations also reduce the size of the stomach, the stomach pouch created is much larger than with other procedures. The goal is to restrict the amount of food consumed and alter the normal digestive process, but to a much greater degree. The anatomy of the small intestine is changed to divert the bile and pancreatic juices so they meet the ingested food closer to the middle or the end of the small intestine.With the three approaches discussed below, absorption of nutrients and calories is also reduced, but to a much greater degree than with previously discussed procedures. Each of the three differs in how and when the digestive juices (i.e., bile) come into contact with the food.

Since food bypasses the duodenum, all the risk considerations discussed in the gastric bypass section regarding the malabsorption of some minerals and vitamins also apply to these techniques, only to a greater degree.

Biliopancreatic Diversion (BPD)

BPD removes approximately 3/4 of the stomach to produce both restriction of food intake and reduction of acid output. Leaving enough upper stomach is important to maintain proper nutrition. The small intestine is then divided with one end attached to the stomach pouch to create what is called an "alimentary limb." All the food moves through this segment, however, not much is absorbed. The bile and pancreatic juices move through the "biliopancreatic limb," which is connected to the side of the intestine close to the end. This supplies digestive juices in the section of the intestine now called the "common limb." The surgeon is able to vary the length of the common limb to regulate the amount of absorption of protein, fat and fat-soluble vitamins.

Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E)

RYGBP-E is an alternative means of achieving malabsorption by creating a stapled or divided small gastric pouch, leaving the remainder of stomach in place. A long limb of the small intestine is attached to the stomach to divert the bile and pancreatic juices. This procedure carries with it fewer operative risks by avoiding removal of the lower 3/4 of the stomach. Gastric pouch size and the length of the bypassed intestine determine the risks for ulcers, malnutrition and other effects.

Biliopancreatic Diversion with "Duodenal Switch"

This procedure is a variation of BPD in which stomach removal is restricted to the outer margin, leaving a sleeve of stomach with the pylorus and the beginning of the duodenum at its end. The duodenum, the first portion of the small intestine, is divided so that pancreatic and bile drainage is bypassed. The near end of the "alimentary limb" is then attached to the beginning of the duodenum, while the "common limb" is created in the same way as described above.

Advantages

1. These operations often result in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure.
2. These procedures can produce the greatest excess weight loss because they provide the highest levels of malabsorption.
3. In one study of 125 patients, excess weight loss of 74% at one year, 78% at two years, 81% at three years, 84% at four years, and 91% at five years was achieved.
4. Long-term maintenance of excess body weight loss can be successful if the patient adapts and adheres to a straightforward dietary, supplement, exercise and behavioral regimen.

Risks

1. For all malabsorption procedures there is a period of intestinal adaptation when bowel movements can be very liquid and frequent. This condition may lessen over time, but may be a permanent lifelong occurrence.
2. Abdominal bloating and malodorous stool or gas may occur.
3. Close lifelong monitoring for protein malnutrition, anemia and bone disease is recommended. As well, lifelong vitamin supplementing is required. It has been generally observed that if eating and vitamin supplement instructions are not rigorously followed, at least 25% of patients will develop problems that require treatment.
4. Changes to the intestinal structure can result in the increased risk of gallstone formation and the need for removal of the gallbladder.
5. Re-routing of bile, pancreatic and other digestive juices beyond the stomach can cause intestinal irritation and ulcers.

Combined Restrictive & Malabsorptive Procedure - Gastric Bypass Roux-en-Y

In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Advantages

1. The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
2. One year after surgery, weight loss can average 77% of excess body weight. Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
3. A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.

Risks

1. Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
2. Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
3. A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
4. A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
5. In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
6. The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

Laparoscopic or Minimally Invasive Surgery

For the last decade, laparoscopic procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still "experimental." In fact, laparoscopy has become the predominant technique in some areas of surgery and has been used for weight loss surgery for several years. Although few bariatric surgeons perform laparoscopic weight loss surgeries, more are offering patients this less invasive surgical option whenever possible.

When a laparoscopic operation is performed, a small video camera is inserted into the abdomen. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them better visualization and access to key anatomical structures.

The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. A recent study shows that patients having had laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and lung function and higher overall oxygen levels. Other realized benefits with laparoscopy have been fewer wound complications such as infection or hernia, and patients returning more quickly to pre-surgical levels of activity.

Laparoscopic procedures for weight loss surgery employ the same principles as their "open" counterparts and produce similar excess weight loss. Not all patients are candidates for this approach, just as all bariatric surgeons are not trained in the advanced techniques required to perform this less invasive method. The American Society for Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.

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The Hospital Stay

Most patients stay in the hospital approximately five to eight days after an open procedure and two to five days after a laparoscopic procedure. You will be discharged when you are able to:

1. Take enough liquids and nutrients by mouth to prevent dehydration
2. Have no fever
3. Have adequate pain control with medication

Depending on which procedure is performed, one or two small tubes may be placed around the stomach pouch and the bypassed stomach to drain body fluids after the surgery. These are usually removed in three to ten days. To help prevent blood clots, anti-embolism stockings or other compression devices will be placed on your legs, and your surgeon will require you to attempt to stand up and move around as soon as possible, usually within the first 24 hours.

Depending on your medical condition, there is the possibility of being placed in the intensive care unit to closely monitor your heart and lungs. Depending on the hospital, patients who use Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BiPAP) for sleep apnea may be asked to bring their machines with them for use immediately after the operation.

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