What Is Bariatric Surgery? * Spotlight My Health

Many of you know that I recently had bariatric surgery, and many have asked me, “What is bariatric surgery?” So, I will try and answer that to the best of my ability. Subjects I’ll cover in this post are:

**What is bariatric surgery?

**Two types of bariatric surgery-what they are and how they differ.

**Ways the surgeries are performed.

**Possible side effects.

**Diet before and after surgery.

**What criteria needs to be met to have the surgery?

**My progress.

WHAT IS BARIATRIC SURGERY?

Sometimes the usual diet and exercise routines we all try don’t seem to work for some of us who try to lose weight to be healthier. Those of us that don’t manage to lose the weight through diet and exercise may turn to bariatric surgery, which is what I did.

Bariatric surgery is a proven way to help fight obesity by shifting the body’s set-point (metobolic thermostat). This usually results in long-term weight loss.

This type of surgery is usually done by three different methods. Lap band surgery, gastric sleeve or gastric bypass; all fall into different categories which are: restrictive, malabsorptive and a combination of both.

For this article, I will be concentrating on gastric sleeve and gastric bypass as they are the most popular weight loss surgeries, at this point in time.

First, let’s discuss the categories that these surgeries fall into.

**Restrictive

Just as the word suggest, these types of procedure “restricts” how much the stomach can hold, therefore reducing the amounts of calories taken in.

Since the stomach has been made smaller, the recipient automatically eats less. The restrictive methods include gastric banding (lap band), vertical sleeve gastrectomy (gastric sleeve) and gastric balloon.

**Malabsorptive

This procedure reroutes or removes part of the stomach and/or digestive system as a way to absorb less calories. This method causes more weight loss than restrictive.

**Combination

A combination procedure uses both restrictive and malabsorption methods for high amounts of extreme weight loss. The bariatric procedures that fall into this category include duodenal switch and gastric bypass.

Gastric Sleeve Bariatric Surgery

During this surgery, your surgeon removes a major part of your stomach leaving a tube-like pouch. The pouch will be about the size of a banana which is about 15% of the stomach’s original size. This will make you feel fuller, much quicker.

Because so much of your stomach is taken away, you also will not feel hungry much of the time. That is because the place where our hunger hormones are produced has been taken away. Therefore, your cravings for food are diminished because the section of your stomach that produces the hunger hormone “Ghrelin” is no longer there.

When you no longer have this hormone available it results in an increase of the body’s metabolic rate and its fat burning capabilities along with a decrease of appetite.

A gastric sleeve procedure leaves the digestive tract intact, therefore, normal absorption of all foods takes place.

Gastric Bypass Bariatric Surgery

The “Roux-en-Y gastric bypass (RYGB) is considered the “gold standard” for weight loss surgery by the National Institute of Health.

This surgery actually involves two parts (1) dividing the stomach into a smaller upper pouch and a larger lower part. The upper pouch becomes your functional stomach. (2) Disconnecting the small intestine and connecting it to the smaller stomach pouch.

This allows food to bypass the lower part of the stomach, the duodenum (the first segment of the small intestine). Next, your surgeon will attach this pouch directly to part of the small intestine called the Roux limb. Doing this procedure reduces the amount of fat and calories you absorb from your food, but it also reduces the amount of vitamins and minerals that get absorbed from your food.

This causes parts of your stomach and small intestine to be bypassed, making it possible for the food to go directly from the smaller pouch to the small intestine.

Gastric bypass will also give you a quick feeling of fullness after eating very small amounts of food. The result reduces hunger and cravings and gives much less time for absorbing calories and that results in less nutritional, mineral and vitamin absorption.

This is what makes this procedure a combination of “restrictive” and “malabsorptive”.

Differences Between Gastric Bypass and Gastric Sleeve

I’m going to be writing about these two procedures. Per my doctor, not many lap band surgeries are done these days as they did not work the way they were expected to. I can attest to that.

I had lap band surgery a good number of years ago and did lose weight. Not near as much as I had hoped, but I did feel better than before the surgery.

Unfortunately, I began to have trouble with my stomach and had to have the band removed. And guess what? The weight I had lost came back along with the feelings of being unhealthy I had before the the surgery.

Apparently, this is what has happened over and over again with many lap band recipients.

Several years went by before I decided to look into bariatic surgery again and I chose the “sleeve” surgery rather than the “bypass”. Both surgeries are irreversible. Here are the differences.

Gastric Bypass

*Stomach is made egg sized.

*Can lose about 80% of excess weight in a year and a half.

* Probable chance of nutritional, vitamin and mineral deficiencies.

*Need to have a BMI over 40 to 49.99.

*Four-to-six-week recovery time.

*Potential for more complications.

*More difficult and more expensive.

*More significant weight loss.

Gastric Sleeve

*Stomach will be about the size of a banana.

*Can lose about 70-80% of weight within a year and a half.

*Doesn’t usually cause any type of nutritional deficiencies.

*Takes four to six weeks recovery time.

*Need a BMI over 35.

*Safer, less complicated, and less invasive surgery.

*Lose weight faster.

knees feeling better after bariatric surgery

THREE WAYS YOUR BARIATRIC SURGERY MAY BE PERFORMED

Traditional Surgery

This is the type of surgery that most of us are used to. This method uses longer incisions to give the surgeon a better view of the open surgical area. Your surgeon may have reasons for why he/she prefers you get this type of procedure.

Laproscopic Surgery

This is a minimally invasive surgery that has advantages such as minimal pain, blood loss, scarring and much smaller incisions. This surgery is usually shorter than the traditional surgery and has replaced traditional surgery.

Laproscopic weight loss surgery uses small, ½ inch incisions for the surgical instruments to be inserted into. Also inserted in one of these small incisions is a telescope which gives the surgeon a view on a video camera. This gives your surgeon an enhanced visual field for the surgery.

Robotic Assisted Surgery

Some clinics offer robotic surgery using the da Vinci Surgical Robot System. It’s cutting-edge technology, that allows your surgeon, through small incisions, to view the operative area on a monitor with high-resolution images that are relayed through a high-definition 3-D camera.

Your surgeon is then able to do the surgery from the controls of the robot using the small robotic instruments that precisely carry out the surgeon’s movements. This results in a less invasive surgery and aides in a shorter recovery time than traditional open surgery.

In both 2nd and 3rd types of surgeries there are several benefits such as small incisions, more precise surgery, faster healing, less scarring, less blood loss during the surgery and reduced postoperative pain.

All these benefits for these two surgeries are great, but you also need to realize that it takes a surgeon that has obtained extensive specialty training. Be sure that if you choose the 2nd or 3rd ways to have surgery, that your surgeon is qualified to do them and has experience performing these surgeries using these two techniques.

Surgery Times and Recovery

For the 2nd and 3rd types of surgeries, the patient would get general anesthesia. And of the two, gastric bypass is definitely the more invasive and radical, taking about 2-3 hours. On the other hand, gastric sleeve only takes 1-2 hours of surgery time. The hospital stay for both surgeries is only a 1 or 2 day stay.

SIDE EFFECTS FOR THESE SURGERIES

Gastric Bypass

**This surgery can cause a condition called “dumping syndrome.” This happens when food enters the first part of your small intestine faster than normal. It can be caused by the limited functionality of the smaller stomach. So, the food is dumped much faster into the small intestine.

As a result, there could be vomiting, nausea or painful abdominal cramps after the last meal eaten.

**Gastric bypass surgery can cause nutritional deficiency by limiting the amount of calories absorbed into the body. This can lead to other ailments like osteoporosis or anemia. That is why, with this surgery, meals should be of high nutritional value along with adding supplements such as vitamins and minerals.

**Another side effect after gastric bypass surgery is constipation. Granular fiber (metamucil) should be avoided as it could lead to a bowel obstruction.

**When substantial weight is lost quickly with this surgery, it could lead to gallstones. This can happen when substances in the body such as cholesterol harden and form small masses in the gallbladder.

Gastric Sleeve

Gastric sleeve surgery is a safer procedure and has less side effects than gastric bypass. But it still could cause a few side effects.

**You could become vitamin deficient since your food intake is so much less. A whole diet needs to be followed while also taking supplements to get the required vitamins and minerals.

**Leakage along the staple lines of surgery. This could be the result of poor wound healing.

**This surgery could also cause gallstones due to the rapid weight loss.

Possible Side Effects for Both Surgeries

*infection

*blood clots

*bleeding

*adverse reaction to the anesthesia

YOUR DIET BEFORE/AFTER BARIATRIC SURGERY

It’s very important to follow proper dietary suggestions after either one of these surgeries. Doing so lowers the chances of getting some of the aforementioned side effects, such as vomiting and constipation.

Following the doctor’s diet given to you after surgery will also help you to learn better eating habits. Truthfully, the word “diet” gives the impression of temporarily changing the way one eats. When weight loss surgery is decided upon, your diet must become a permanent change in the things eaten and drank.

Diet Before and After Surgery

Bariatric surgery is a significant tool to help in your weight loss journey, but in the end, it is still your responsibility to change the way you eat and what you eat.

Without learning how to do that and then putting what you’ve learned into practice, you may not see the weight loss results you are looking for.

Consuming fewer calories is still the name of the game and that is why most surgeons will have you see a nutritionist or dietitian.

Doing so will help you start learning how to eat differently, way before the surgery happens.

Months Before Surgery

Your eating should be restricted to these four food groups and in this order. That means, eat your protein first, then the veggies and so on. It’s more important to consume the protein and veggies before the other two groups. Nothing but these four groups should be eaten.

*protein-rich foods (fish, meats, soy-based products)

*veggies

*fruits

*small amounts of high-fiber starches (whole wheat wraps or bread)

However, a few weeks before surgery and for 4-6 weeks after surgery, your diet will be very restrictive.

Pre-surgery

Two weeks before surgery, your diet will change again-drastically. I had to do a partial to full meal replacement diet. This not only promotes a bit more weight loss, but it gets your body more ready for after your surgery. It also leads to your liver shrinking just a bit so that it is easier for your surgeon to get to your stomach for the surgery.

Other advantages and reasons for this eating change is to help stablize co-morbid conditions before surgery. A few important benefits of this are:

*improves protein levels for better healing

*easier recovery

*decrease of intra abdominal fat mass

*improves fatty liver

*improved respiratory function

Also, during these two weeks, you may be asked to stop taking any medication containing, aspirin and/or ibuprofen so that the chances of excessive bleeding during surgery are reduced.

Post Surgery

You will again be asked to see a nutritionist/dietitian either right before surgery or right after to get detailed, written instructions on how to eat in the weeks after your surgery.

Your diet, after surgery, really does have to be restrictive. Remember, your stomach has just been through a war and the rest of your body didn’t like it much either. Your body and stomach need time to heal rather than pushing food through your system.

I know it seems harsh and I’ll admit it wasn’t easy—some of the time. But, I’m telling you that first week, at least, you may not feel like eating much of anything, anyway.

So, take it easy on yourself and follow the plan, knowing that there are very good reasons for it.

Stage 1 Diet

You can’t eat after surgery until you have a UGI test done to check things out. After that, for a day or two, you get to have a clear liquid diet consisting of things like broth, sugar free jello and decaffeinated tea.

Stage 2 Diet

Around day two, you’ll get to start on a full nutrient-enriched liquid diet. This is the diet that you will stay on until your first postoperative doctor’s visit. About two weeks from surgery.

Stage 3 Diet

Here you will move onto a pureed food diet mainly of protein and produce. This stage lasts four to six weeks.

Stage 4 Diet

Now you get to move onto solid foods that are low in added sugars, low in fat, but high in protein and increased fiber. Restriction is still the name of the game, but after nothing but liquids or pureed food for the four-six weeks, this stage seems like you have died and gone to heaven.

Here are the general rules of this stage:

*three small meals per day with two protein shakes

Solids should only be 4T of solids or 4oz. by weight, of food per meal.

*always measure every meal

*natural foods rather than pre-packaged

*again, eat the protein first and avoid white carbs

*avoid carbonated and/or caffeinated beverages

*this is a biggie—DRINK 64ozs. of water daily

*get up and MOVE

QUALIFICATION CRITERIA FOR BARIATRIC SURGERY

There are many qualifications that have to be met by someone contemplating weight loss surgery, from your doctor, surgeon and insurance.

General Doctor

Your general doctor is the place to start your conversation and possibly direct you to a surgeon. Also, right before your surgery, your surgeon may need something in writing from your general doctor stating that you are healthy enough to go through surgery.

Surgeon

There will be many qualifications to meet before your surgeon will OK surgery. Here are a few, but each surgeon may have more or less on their list for you to check off.

*Over 18 years of age

*Body Mass Index over 40

*BMI of 35-40 with co-morbid conditions of Type II diabetes, high blodd pressure, sleep apnea, high cholesterol, acid reflux, degenerative joint disease.

*Willingness to make a commitment to permanent lifestyle changes.

Insurance Company

After your discussion with your general doctor, your insurance company should be the next call you make as they will most likely have their own checklist before they will approve your surgery.

Luckily for me, my insurance company’s list fit my surgeon’s, except for one thing. I had to agree to some type of diet plan with an organization that could keep track of my progress or lack thereof. I’ve also heard of those that have had to do this for a year.

So, know that this process is not a quick or easy one. You truly have to be dedicated to get through every item on any checklist that you are given.

Making the decision for weight loss surgery is a very big step towards making your life healthier and happier. It will provide a dramatic change with obesity related ailments, your quality of life and your mobility.

As I’ve said before, one of the things I look forward to is being able to bend over to tie my shoes and actually breath at the same time…lol.

But you still will need to look at the side effects from the surgery, risks of the surgery and deciding if you can make it through and abide by the dietary changes you will have to make.

Most information for this post was obtained from DHMR Clinics.

MY RESULTS

Truthfully, I’m still having a bit of a bad time with the vomiting. I can come into my house at the end of the day and whatever hubby is cooking can sometimes make me gag. So does brushing my teeth. I spend a lot of time with an upset stomach and running to the bathroom to hurl. It hasn’t been easy or pleasant.

According to my doctor, this type of surgery can play havoc with your hormones. I have to agree with him, as I feel just like I did through two pregnancies. I was sick the whole time because my body apparently doesn’t like messing with my hormones. The minute I was no longer pregnant, I was fine.

But, I do believe I’m seeing the light at the end of the tunnel. Thank goodness. I’m not always feeling so upset and ready to run to the bathroom. And I can sometimes eat or take my medications without feeling too badly.

The good news is that I’m down 30 lbs in two months. Not bad, huh! I’ve also noticed that my knees feel better going up and down the stairs, which is a biggie for me. Before this surgery, I hated having to go up a set of stairs; my knees just didn’t like it. I’ll take any step forward at this stage of the game. I’ve got a long way to go, so I look forward to more good things happening!

FINAL THOUGHTS

This process is long and not for the faint of heart. You need some stamina and determination to get through it. Each type of bariatric surgery has its good and bad points. You would have to weigh the options and determine what you want to get out of any surgery to decide if this is a good path for you.

All things considered, for me right now its been a good decision.

If you have any questions, just ask in the comments below and I’ll be glad to help as much as I can.

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