St. John Weight Loss

WHY WEIGHT LOSS SURGERY?

Weight loss surgery has helped millions of people shed excess weight and live healthier lives. It is a common treatment option for people with severe obesity who have been unsuccessful with other weight loss methods. Weight loss surgery works because it also includes education to transform eating habits to maintain an ideal weight and thus live a healthier life.

Bariatric surgery involves education both before and after surgery to ensure that the patient is able to gradually lose weight and remain healthy while doing it. Thus, weight loss surgery is a holistic program that involves a firm, lifelong commitment to certain personal lifestyle changes.

At St. John Weight Loss, our goal is to meet our patients’ needs before, during and after surgery. Our staff understands the challenges involved in overcoming obesity. They are available to support your commitment to change, whether you need one-one-one support or formal support group sessions after surgery. An important part of St. John Weight Loss’ program is our passion for healing the whole person.

SURGICAL WEIGHT LOSS PROCEDURES

St. John offer the latest and safest weight loss surgery options available. Surgical options fall into three categories according to how they promote weight loss: restrictive, malabsorptive and restrictive with some malabsorption.


Restrictive Procedures with Some Malabsorption


Roux-en-Y Gastric Bypass:

Considered the “gold standard” of bariatric surgery and recognized by the National Institutes of Health (NIH) for the treatment of severe obesity. This procedure is performed either laparoscopically or by using the open technique and results in gastric restriction with slow gastric emptying.

With this procedure, the stomach is divided to form a new, smaller pouch for food. The small bowel is re-routed to empty into the new, smaller pouch. As food enters the pouch, it quickly fills and causes the patient to have a sensation of fullness after eating only a small portion of food. The remainder of the stomach is still present, but no longer acts as a reservoir for food.

Roux-en-Y Gastric Bypass is one of the most frequently performed weight loss procedures in the U.S. with patients losing 70-80 percent of their excess weight after five years. Additionally, 96 percent of certain associated health conditions or co-morbidities (sleep apnea, high blood pressure, diabetes and depression) are typically improved or resolved following this surgery.



Side effects of Roux-en-Y Gastric Bypass may include:

 Complications of Roux-en-Y Gastric Bypass may include:

• Leaks


• Bleeding


• Embolus (blood clots)


• Respiratory (pneumonia)


• Hernias (when performed as an open procedure only)


• Bowel obstruction


• Stricture


• Anemia/nutritional deficiencies


• Infection (always higher when the bowel is opened)

Restrictive Procedures

Laparoscopic Adjustable Gastric Banding

Also called the LAP-BAND System, it was first used in Europe in 1993 and was approved by the FDA in June 2001. The procedure, which is usually done laparoscopically using several small incisions, works by limiting the amount of food that a person can consume at one time.

During the operation, surgeons implant an inflatable silicone band into the patient’s abdomen. The band is fastened around the upper stomach creating a new, small pouch and small outlet for food. This new pouch/outlet limits the amount of food intake and slows the process of food emptying into the stomach and intestine. After surgery, the diameter of the stoma outlet between the small upper stomach pouch and the rest of the stomach can be adjusted by adding saline solution to the silicon band. The saline solution can be injected or removed with a needle via a port that is implanted under the skin and connected to the band by tubing.

Since there is no cutting, stapling or stomach re-routing involved with the LAP-BAND procedure, it is considered the safest and least traumatic type of weight loss surgery. The laparoscopic approach to the surgery also offers the advantages of reducedis also reverseable and once it is removed, the stomach generally returns to its original form.

The LAP-BAND System is the only adjustable weight loss surgery. Adjustments to the diameter of the band can be made with the addition or removal of saline solution for a customized weight-loss rate. Your individual needs can change as you lose weight. For example, pregnant patients can expand their band to accommodate a growing fetus, while patients who aren’t experiencing significant weight loss may need to have their bands tightened. Studies show that patients can maintain 30-40% excess weight loss after 3 years with this procedure.

Side effects of the LAP-BAND may include:

• Nausea and vomiting


• Gastroesophageal reflux (regurgitation)

Complications of the LAP-BAND may include:

• Band slippage/pouch dilatation


• Stomal obstruction (stomach-band outlet blockage)


• Esophageal dilatation or dysmotility (poor esophageal function)


• Constipation, diarrhea and dysphasia (difficulty swallowing)


• Leak or twist at the access port


• Band erosion into the stomach


• Port displacement, port site pain


• Re-operation to fix a problem with the band or initial surgery

Malabsorptive Procedures


Biliopancreatic Diversion

A malabsorptive procedure that is performed using an open technique to remove part of the stomach to create a smaller pouch about 4-5 oz (120-150cc) in size. The stomach is connected to the jejunum and a large segment of small intestine is bypassed. The intestine is re-routed so that the food bypasses most of it and decreases the absorption of calories. This procedure can be done in two stages, with sleeve gastrectomy being the first stage, and produces rapid initial weight loss. It is a good option for patients with a BMI >40 and it has a higher total average of weight loss of all operations.

Complications of Biliopancreatic Diversion may include:

• Malabsorption effects: anemia, osteoporosis, severe diarrhea, bloating, heartburn, bowel obstruction, kidney stones, vitamin deficiency more so than gastric bypass


• Gallstones (gallbladder is not stimulated)


• Severe weight loss and malnutrition which requires reversal of procedure


• Leaking from stomach cut edge or small bowel connections


• Small bowel obstruction
  
  

Laparoscopic Sleeve Gastrectomy: This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is stapled and divided vertically, with more than 85 percent of it being removed. This part of the procedure is not reversible. The remaining portion of the stomach is shaped like a very slim banana and measures bewteen 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing its volume.

This is a relatively new procedure that can be used as a standalone procedure for those who have a BMI <35 or as a staged procedure for high-risk patients with a BMI >40. The advantages to this type of proecedure is that there is a low risk of malnutrition and no diarrhea, anemia, dumping syndrome or vitamin loss therefore it is an alternative for patients with anemia, Crohn’s and other conditions that make them too high-risk for intestinal bypass. This procedure often produces slower initial weight loss which may be a disadvantage for some.

Complications of Laparoscopic Sleeve Gastrectomy may include:

• possible leak that may require surgery
•  Bleeding
• Embolus (blood clots)
• Respiratory (pneumonia)
• Infection (always higher when the bowel is opened)
  

HOW WEIGHT LOSS SURGERIES ARE PEFORMED

Open vs. Laparoscopic Surgery

“Open” and “laparoscopic” refer to how the abdominal cavity is entered to perform a specific type of surgery. Each type of weight loss surgery may be performed as either an open or a laparoscopic procedure and some, like Roux-en-Y Gastric Bypass, can be performed either way.

When performing open surgery, surgeons create a single incision to open the abdomen for the operation. For women, the incision is typically 4.5 to 6 inches, and for men, it is 5.5 to 7 inches.

When performing laparoscopic surgery, the surgeon makes a few small incisions (or “ports”) in the abdominal wall for the insertion of long, thin surgical instruments. A narrow camera is also passed through a port so the surgeon can view the operative site on a nearby video monitor. Because this type of surgery is minimally-invasive, procedures performed laparoscopically are typically safer and result in a shorter recovery time, less pain and less risk of infection than open surgical procedures.

Not all surgeries can be performed laparoscopically though. If multiple adhesions are found from previous abdominal operations, the surgeon may need to open the patient up even during a procedure that is normally done laparoscopically.

Risks, Complications and Potential Side Effects of Weight Loss Surgery

Surgery for morbid obesity is considered major surgery and, as with all types of surgery, carries all the risks of surgery, which are more common as weight increases. General risks include: myocardial infarction, congestive heart failure, irregular heartbeat, or stroke, liver or kidney problems. And, although rare, death may occur with any surgery.

As part of the educational process, it is important to describe potential complications to patients and patients are encouraged to ask questions. The statistics associated with complications may change and may vary among different procedures and the consideration of other factors.

Risks and complications during or after surgery may include perforation (a hole) in the stomach or intestine, with a leak and peritonitis or abscess; internal bleeding; wound infection, including opening of the wound; incisional hernia, injury to the spleen or potential removal of the spleen; and bowel obstruction.

Gallbladder disease is also common with morbid obesity and the gallbladder often must be removed if if gallbladder disease is discovered before or during surgery.

Pulmonary complications can include blood clots to your lungs, post-operative pneumonia, collapse of lung tissue, and fluid in the chest or other breathing problems and preventative measures are usually taken to prevent clots from forming during periods of maximum risk.

Wound or skin infections may occur along with urinary tract infection, allergic reactions to medications, excessive vomiting/dehydration, development of loose skin, narrowing or stretching of the surgical connections of the stomach or the intestine, and peptic ulcer disease. Ulcers at the site of the stomach or intestinal surgical connections or in the non-functional large stomach pouch may also occur.

Patients who fail to understand and/or follow the nutritional guidelines, post-gastric bypass, may experience refractory anemia, paralysis, loss of bone and muscle tissue, and/or osteoporosis. Late iron deficiency anemia may occur and is particularly serious in women of childbearing years.

Failure to understand and/or follow the behavioral guidelines after surgery may also cause a patient to experience increased anxiety and stress levels that may affect long-term weight management. Psychological and behavioral reactions to new eating patterns and lifestyle changes, including depression, are not uncommon.

After-effects of Weight Loss Surgery

“Dumping syndrome,” a common side effect for gastric bypass patients, occurs in some patients who experience intolerance to certain types of foods after surgery. The most common foods that cause intolerance are sweets, dairy or fatty/greasy foods. Ingestion of these may cause unpleasant symptoms such as sweating, nausea, and shaking that may last from a few minutes to a few hours. Dumping syndrome can be an undesirable reminder of what NOT to eat. Some patients may experience these same symptoms when from eating too quickly, neglecting to chew foods completely before swallowing or, on rare occasion, during a stressful time.

When considering surgery, it is important to ask questions and fully understand the procedure, the risks and benefits. Your surgeon will accommodate any questions you may have and discuss potential complications with you.

Long-Term Effects of Weight Loss Surgery

Surgery itself will not guarantee long-term weight loss success. It is possible (though difficult) to “defeat” the surgery by ignoring dietary guidelines and consuming high-calorie liquids, snacking, and being inactive. This operation is not a cure—it is a tool that helps you choose a healthy life-style.

According to the leading experts from the National Institute of Health, National Heart Lung and Blood Institute and North American Association for the Study of Obesity, “Surgery is an option for patients with extreme obesity. Weight loss surgery provides medically significant sustained weight loss for more than five years in most patients."

THE CHOICE IS YOURS

Making the decision to have weight loss surgery requires careful consideration. While your image can often be improved, weight loss surgery is major surgery, not a cosmetic procedure. Our goal is to help patients improve their quality of life, live longer, healthier lives and gain confidence and self-esteem. We also offer a medically-supervised weight loss program to help you lose weight and keep it off without surgery.