LewisGale Physicians General and Bariatric Surgery

You must have a minimum BMI of 40, or at least 35 with medical comorbidities associated with obesity, such as diabetes, hypertension, obstructive sleep apnea, osteoarthritis, and high cholesterol. You must be committed to a lifestyle change to include dietary changes, increased activity, and long-term follow-up with your bariatric surgical team.

Standardized operations include Gastric Banding, Roux-en-Y Gastric Bypass, and Vertical Sleeve Gastrectomy. All these surgeries are performed laparoscopically to minimize pain, hospital stay, cost, and patient recovery time. Sometimes it is also necessary to convert one surgery to another or revise a surgery to treat a complication. These are customized to meet each individual patient’s unique needs.

The best operation for you is the one that you have chosen based on your knowledge of the risks, benefits, and alternatives. It is our job to educate and advise and to help you chose the one that will benefit you the most.

The alternatives to surgery are those things that all patients should have diligently tried prior to considering surgery. These include diets, exercise, medications, and holistic programs that include combinations of these. When these prove ineffective at providing lasting weight loss, surgery should be considered. Even though there are risks involved with surgery, the benefits of weight loss far outweigh the risks, especially when you consider the risks of obesity itself, and the personal costs obesity brings in terms of reduction in quality of life.

The process includes trying to lose weight by other means first and, when this is unsuccessful, considering surgery. The first and best next step is to attend an informational workshop where we’ll discuss weight loss surgery in detail, the process, and our program. You’ll then meet with your surgeon for a complete medical and surgical history. Next, you’ll meet with a specially trained bariatric dietitian and qualified psychologist whose jobs are to prepare you for surgery and a lifestyle of success. There will be some medical workup individualized to each patient. When everyone says you are ready, you’ll meet with your surgeon to plan surgery. There is also a necessary insurance pre-approval process. The whole process, from the time you start in the surgeon’s office to the time of surgery, takes an average of six to eight months.

The risks of surgery are many and include death, anesthetic complications, heart attack, stroke, pneumonia, blood clots, infection, bleeding, internal injury, surgical leaks, internal hernias, wound problems, strictures, and weight regain. We do all we can to reduce the risks of these complications, identify them accurately when they occur, and treat them appropriately and in a timely manner for the best outcomes possible. We partner with the patients and other medical practitioners to accomplish this.

The diet after surgery changes over time to fulfill specific goals. Early after surgery you will be on a liquid diet consisting of protein shakes and non-calories liquids for four weeks. We then transition to soft, nutritious foods that don’t contain any sugar. We then move on to solid, high-protein, low-carbohydrate foods. The focus will be on meal-size, meal-consistency, and nutritional content. Eventually patients get to the point where they are eating three small meals per day to get all the nutrition they need to maintain health, well-being, energy levels, and weight loss. You will be eating good food - meals consisting of mostly meat and a little bit of cooked vegetables, and very little else.

Our skin is our largest organ and is amazing in its ability to cover what it is supposed to cover. It grows with us and shrinks with us. Typically, as patients lose weight, the skin shrinks accordingly. The final outcome is affected by factors such as age, starting weight and shape, sex, and exercise. Many patients don’t necessarily like the looseness of the skin in the end, but most patients do not have enough to really bother with it. For those where excess skin really is a problem, skilled plastic surgeons can remove the excess. This is another major surgery with its own set of risks. We strongly recommend waiting at least two years before considering this, as this gives the skin and underlying tissues time to develop to the patient’s new, healthy, natural shape.

Dumping syndrome is what occurs when patients eat foods containing too much sugar and sometimes fat. It occurs because the anatomic changes made with surgery allow rapid transit of undigested food into the small bowel. The small bowel cannot handle high concentrations of undigested sugar and/or fat and will try to get rid of it by all means necessary. This will include vomiting and diarrhea. The bowel will also draw water from the bloodstream causing cramping abdominal pain, fainting, and flushing. In addition, the sugar gets partially absorbed in its undigested form causing spikes in insulin levels. This will cause precipitously low blood sugar levels and all the symptoms associated with low blood sugar. These symptoms last until all the sugar has passed in one direction or the other. There is no treatment besides letting the symptoms pass and avoiding the foods that caused it like candy, cookies, and ice cream -- foods that should be avoided if you are trying to lose weight. This is a behavior modifier, one that forces a patient to avoid the problem foods that shouldn’t be eaten anyway.

Yes, potential long-term complications are mostly nutritional. On the one side is the potential formal nutrition, vitamin and mineral deficiencies, and dehydration. On the other side is the potential for weight regain over time. All of these are avoided by good patient compliance with the diet, the taking of appropriate vitamins and minerals, follow-up with your bariatric surgeon, and nutritional labs when appropriate. All of this should be done in the setting of a multidisciplinary bariatric surgical program.

These surgeries are not fool-proof and require a compliant patient eating and drinking the way they are supposed to. There are essentially three ways a patient can overcome the restrictions of the surgery. First, they can snack their way through, and gain weight by consuming small amounts of high-calorie foods frequently. Second, they can overcome the mechanical restriction by consuming soft or liquid-type foods. Third, they can slowly stretch the stomach back to a size where they can consume enough to begin gaining weight again. All these can be avoided by maintaining proper meal frequency, consistency, size, and content.

The most common cause of low blood surgery after surgery is taking medications that lower blood sugar. These should be used with caution and are typically stopped completely after surgery. The next most common cause is the dumping syndrome, when patients eat something sweet, paradoxically lowering their blood sugar. The treatment is to NOT eat something sweet, as this will continue to cause the opposite effect. Drink a protein shake and wait it out - the problem will resolve itself. The answer is to avoid diabetes medicines and avoid foods that cause the dumping syndrome, thereby avoiding low blood sugars.

This is a very common complaint. The answer is: this is a temporary but necessary part of the surgery process. Switch flavors. Switch brands. Play with temperature. Play with consistency. Take a break and try again in a few hours. But stick with the liquid diet. Eating food too early will make things worse. Dehydration will eventually set in and make it worse. Once this happens, you’ll have to go to the ER for evaluation and IV fluids.