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Tag Archives: bariatric surgery outcomes

What You Need to Know About the Gastric Sleeve

Posted on November 20, 2019 by

The gastric sleeve, or sleeve gastrectomy, is the new kid on the block so to speak. It’s not a new operation. We used to do the surgeries for other reasons not including weight loss. About 15 years ago a hormone was discovered called ghrelin. It’s a hormone made by part of the stomach that makes you feel hungry. We thought if we took that part of the stomach out, we’ve actually done two things. First we’ve made you a smaller stomach so you can’t eat very much. Secondly, when you take that part of the stomach out, ghrelin levels go way down. Since ghrelin makes you feel hungry, hunger levels go way down in its absence. If you think about it, one of the potential downfalls of every single weight loss plan in the world is hunger. If we can control hunger it’s a lot easier to lose weight and keep the weight off. Sleeve gastrectomy is the fastest growing option out there. It is the most common operation for weight loss right now. Last year about 2/3 of all operations done for weight loss were sleeve gastrectomy in the US. It’s close to 95% of what I do these days because it works so well and we see a quick recovery with very low risk. It keeps your anatomy normal.

In the sleeve gastrectomy, we remove the greater curve of the stomach (stretchy part). If you eat a large meal the stomach fills and stretches way out as you eat. That’s how it can hold so much. When we remove the stretchy part it leaves you with a tubular part (or sleeve). Sometimes when people hear the term sleeve gastrectomy they mistakenly think we’re placing something around the stomach. We’re not placing anything around the stomach. It’s referred to as a sleeve gastrectomy because we’re changing the shape. Like the sleeve on a shirt, it’s tubular shaped. We’re making it into a tubular shape. Nothing is bypassed so there is no malabsorption.  Your anatomy remains normal. Food is going to enter the stomach and empty into the small intestine the same way it did before. The size of the stomach is about the size and shape of a medium banana. The part of the stomach that’s removed is the part that makes the hormone ghrelin. Ghrelin is decreased so hunger decreases. This doesn’t mean that you won’t get hungry. There are still good reasons to get hungry. Your hunger is just much easier to control. This surgery is increasingly popular and the fastest growing option out there. It’s literally close to 95% of what I do nowadays.

The surgery doesn’t take that long. It generally lasts about 45 minutes. 95% of the surgeries we do are outpatient. It’s pretty rare that someone needs to spend the night. Full recovery isn’t as fast as the adjustable bands but it’s a lot faster than gastric bypass. Most people are comfortable driving about 3-4 days after surgery. Generally in 2 weeks people can do most things. In a month you can do anything you want. Recovery tends to be really quick.

What are the risks?  The first 30 days is the same as the other surgeries. It’s just slightly different numbers. In theory the death rate and leak rate should be the same as gastric bypass. But we’re not seeing that. What we’re seeing is about 1:1000 for deaths and less than half a percent for leaks. Wound infections, DVT’s, PE’s and dehydration have fewer risks than gastric bypass because the surgery doesn’t last as long. But it’s not impossible for any of those things. One of the things I really like about this operation is that we’ve gotten rid a lot of the long term risks. You’ve got normal anatomy so once you’re healed, you’re healed. The thing we have to keep in mind is stenosis.   Stenosis means narrowing. Anywhere along the tubular stomach could get scarring and become too narrow. If that happened you would go see a gastroenterologist. They can look in there and take care of it. It would be very rare to need another surgery after the sleeve. In theory stenosis should be about 1%. I’ve done over 1600 of these surgeries. I’ve only seen 1 case of stenosis.

We basically see the same weight loss as we did with the gastric bypass. Average weight loss is 70% of what you were overweight. If you are 100 pounds overweight, your average weight loss will be 70 pounds. If you are 200 pounds overweight, your average weight loss will be 140 pounds. That’s average. Some will lose more and some will lose less. That is very good weight loss. Long-term we see about 10-20% regain most of their weight. With any of these operations you can gain your weight back. Your stomach is a little bigger than with the gastric bypass. So why do we see a similar result?  It’s because ghrelin levels go down. In the other operations, that part of the stomach is still there. We can control the hunger somewhat with appetite suppressants. But they’re not necessarily ideal. With the sleeve gastrectomy ghrelin levels go down and hunger is easier to control.

Overall, for most people considering weight loss surgery, the sleeve gastrectomy is the better option. One of the reasons is we keep the anatomy normal. There’s a lower risk with the procedure, a fairly quick recovery and very good weight loss. We also get rid of any concerns about having anatomic abnormalities or nutritional abnormalities (malabsorption). There’s no mechanical device. Finally, you haven’t burned a bridge. That means if you don’t get out of it what you wanted out of it your anatomy is at least still normal. If your anatomy is still normal you could still have any of the other surgeries done. You could have a band placed on it or converted to a bypass. This is much more difficult after any other the other weight loss surgeries. We haven’t revised these things. We’ve seen really good results with them.

How does CFWLS compare to the national average? Obviously we’re doing this for weight loss to improve medical problems and improve your life.  We’re doing the same thing as everyone else in the world but we’re seeing better weight loss. We have a 15.8% better average weight loss at 2 years. We have good education and weight loss.  We give you a full year afterward. And with that better weight loss we also see better reduction in medical problems:  Diabetes 78.6% vs 62.3%, HTN 62.5% vs 46.9%, lipids 70.7% vs 45.3%, sleep apnea 69.4% vs 56.6%, and GERD 74.3% vs 16.6%.  Some people think weight loss surgery shouldn’t be done on patients with GERD. But we’ve seen it get much better, not worse. Again, it’s not the operation. It’s what you do with the operation. If you do the right things it can fix these medical problems.

Why is the education and support so important? We have Weight Management University for Weight Loss Surgery™.  It’s a 12-month post-op program. It includes all kinds of thing including the following:  pre-op and post-op text books, monthly support group, 12 Weight Management University courses, access to Members Only portal, fitness classes, personal training and more.

View the online surgical webinar and then schedule a call with Cat Williamson to go over any further questions you may have.  You’ll get a copy of my best-selling book, Less Weight…More Life!

What are the best weight loss surgery options available today?

Posted on February 27, 2018 by

Weight loss surgery has certainly evolved…thank goodness!  Don’t get me wrong, it is not without any risk but the procedures available today are much safer and more effective than procedures of the past.

This overview includes the three primary surgical procedures performed within the United States as of the publication of this book along with the advantages, risks and typical results/outcomes for each.  These three procedures are the Sleeve Gastrectomy (also referred to as the Gastric Sleeve), the Laparoscopic Adjustable Gastric Banding (also referred to as LapBand® or Realize Band®) and the Laparoscopic Gastric Bypass. 

Sleeve Gastrectomy:

sleeve GastrectomyThe Sleeve Gastrectomy is a newer laparoscopic weight loss surgical procedure in which a small “sleeve-shaped” stomach is created.  Approximately 75% of the “stretchy” portion of the stomach is removed. This also removes the portion of the stomach that makes the hormone ghrelin. Ghrelin is a hormone which makes you feel hungry. The remaining “sleeve” of the stomach is about the size and shape of a medium banana.   Because anatomy remains normal, this procedure can be considered for people with less weight to lose (50-60 lbs. overweight).

Advantages:

  • The portion of the stomach that produces ghrelin (a hormone that stimulates hunger) is removed.
  • The stomach is reduced in volume, but otherwise tends to function normally.
  • No “Dumping Syndrome” since the pylorus is preserved.
  • No intestine is bypassed so there is little chance of nutritional deficiencies.
  • No implanted device that requires adjusting.
  • Procedure is performed laparoscopically most of the time.
  • Usually done as an outpatient.

This procedure tends to work due to 2 major reasons:

  1. You have a much smaller stomach and will feel full with eating only a small amount.
  2. There is a decrease in the hormone ghrelin so that hunger is much better controlled.

The sleeve gastrectomy was originally developed as the 1st stage of a 2 stage procedure (patients would undergo a conversion of the sleeve gastrectomy to a bypass procedure).  However, it was found to work so well on its own that most patients did not need (or want) to go through with the next stage. This surgery cannot be reversed (i.e. once that part of the stomach is gone…it’s gone).

Risks:

Obesity, age, and other diseases increase your risks from any surgery.  Below are identified risks related to surgery and the sleeve gastrectomy procedure based upon national averages? :

  • Risk of death is 1:500-1,000
  • Leaks (1-2%)
  • Infection (2%)
  • Blood Clot/Pulmonary Embolus (1%)
  • Nausea/vomiting
  • Peptic ulcer disease
  • Formation of gallstones due to rapid weight loss
  • Stricture (1%)

Some of these problems may require further surgical intervention

Typical Results and Outcomes:

Weight loss outcomes are tracked closely at the Center for Weight Loss Success.  We are proud that outcomes here generally out-perform national averages.  The average best weight loss for this procedure is 65-70% of a client’s excess body weight (i.e. if someone is 100 lbs. over their ideal body weight, average weight loss outcomes would be 65-70 lbs.).

A weight loss of only about 40% of excess body weight will often show significant improvement in many other medical problems:

  • Many Type 2 diabetics will get off of their medications
  • Hypertensive clients will have improvement or resolution of their hypertension
  • Sleep apnea almost always improves
  • Cholesterol improvement in most clients
  • Arthritic symptoms improve

Laparoscopic Adjustable Gastric Banding (LapBand® or Realize Band®):

The FDA approved adjustable gastric banding surgery in June, 2001.  However, it was developed in the 1980’s and has been used in Europe since 1993.  In terms of surgical procedures for weight loss, this is the least invasive procedure.

LAP-BANDLaparoscopic adjustable gastric banding involves applying a band around the upper part of the stomach.  As a result, this creates a small gastric pouch at the top of the stomach, with a small opening to the rest of the stomach.  The band is made of an inflatable silastic ring that controls the flow of food from the small pouch to the rest of your digestive system.  With this surgery, there is no cutting or stapling required dividing the stomach.

In addition to the band, a small port is connected by tubing to the inflatable ring around the stomach.

The port is secured just beneath the skin where fluid can be injected or withdrawn to inflate or deflate (adjust) the band.  This results in increasing or decreasing the size of the opening between the upper small gastric pouch and the lower portion of the stomach.  The need for an adjustment is determined by the surgeon based upon weight loss and symptoms related to eating.

Like any tool, it can be used correctly or incorrectly.  Used incorrectly (such as drinking high calorie liquids) you will have relatively poor weight loss or even weight gain.  It is still diet, exercise, and behavior change which produce weight loss.  Thus, following your surgeon’s recommendations is crucial to your overall success.

Advantages:

The advantages cited in the literature are outlined below:

  • Risk of death is approximately 1:1000
  • There is no division or re-routing of intestinal tract
  • Minimal risk of malnutrition
  • The procedure is considered reversible since the Band can be removed with minimally invasive technique if needed

The band is adjustable:

  • Often performed under fluoroscopic guidance
  • May require 4-6 adjustments during the first year (or more)
  • Adjustments need to be checked yearly – forever

The band is effective with the following considerations:

  • Weight loss success is directly related to:
    • close clinical follow-up
    • appropriate adjustments
    • exercise
    • diet and behavior modification

The potential disadvantages of laparoscopic adjustable gastric banding are as follows:

  • Weight loss is typically slower when compared to other weight loss surgeries
  • Adjustments are required throughout your lifetime
  • Problems can develop secondary to the mechanical device (see Risks)

Risks:

Obesity, age, and other diseases increase your risks from any surgery.  Below are identified risks related to surgery and the laparoscopic adjustable gastric banding procedure based upon national averages.

  • Risk of death is 1:1000
  • Infection (<1%)
  • Blood Clot/Pulmonary Embolus (1%)
  • Gastric pouch dilation potentially requiring further surgery (5%)
  • Band slippage or migration often requiring further surgery (5%)
  • Band erosion requiring further surgery for band removal (1%)
  • Access port problem or tubing leak requiring further surgery
  • Nausea/vomiting
  • Peptic ulcer disease
  • Formation of gallstones due to rapid weight loss

Some of these problems may require further surgical intervention

Typical Results and Outcomes:                       

Following are expected results and outcomes based upon national averages:

  • Average weight loss is 45-50% of excess body weight, but with aggressive diet and exercise changes you can lose almost all of your excess weight.
  • A weight loss of only about 40% of excess body weight will often show significant improvement in many other medical problems:
    • Many of Type 2 diabetics will get off of medications
    • Hypertensive clients will have improvement or resolution of their hypertension
    • Sleep apnea almost always improves
    • Cholesterol improvement in most clients
    • Arthritic symptoms improve

 

Laparoscopic Gastric Bypass Surgery

Laparoscopic Roux-en-Y Gastric Bypass was first originated by a group of Bariatric surgeons in California in 1994.  This procedure is considered a combination procedure.  It works by both restricting the amount of food consumed and also by providing some malabsorption.   The surgical outcomes of this procedure seem to indicate that the weight loss results are similar to the traditional “open” procedure as long as the procedures are performed the same way.

The procedure begins by dividing the stomach to create a “pouch” that limits the amount of food that can be eaten.  The pouch is about the size of one’s thumb and can hold about 20cc or 2-3 tablespoons of food.  The larger excluded stomach, known as the gastric remnant, is stapled closed and separated from the pouch.  This portion no longer receives food but has a normal blood supply thereby keeping it healthy.

The second step of the procedure involves taking a portion of the small intestine and creating a “bypass” or “Roux” limb that is connected to the new pouch to provide an outlet for food.  This part of the procedure is what creates a slight malabsorption of nutrients to assist in weight loss.

The malabsorptive portion of the procedure also contributes to weight loss by causing a condition known as “Dumping Syndrome”.  Most sugar consumed is normally absorbed in the first 1-2 feet of small intestine in normal situations.  After the Gastric Bypass procedure sugar passes directly from the pouch into the lower small intestine.  The unabsorbed sugar pulls fluid into the small intestine resulting in distension, increased motility (activity), cramping and a neurologic response that may cause an increase in heart rate, sweating, diarrhea, nausea, and even vomiting.  Most patients will experience this at least once and will learn to avoid foods containing high sugar content, thus improving the chance for long-term weight loss success.

The following is a diagram of the described procedure: gastric bypass

Risks:

  • Possible conversion to an open procedure due to limited access and visibility
  • There may be an increased risk for bowel obstruction in the long term
  • Death (1:500-1,000)
  • Pouch leaks – (1%)
  • Deep venous thrombosis (1-2%)
  • Pulmonary emboli (1%)
  • Abdominal wall hernia (1%)
  • Peptic ulcer disease (3-5%)
  • Stricture (narrowing) at gastric pouch (1-2%)
  • Small bowel obstruction (1-2%)

Typical Results and Outcomes:

The average best weight loss for this procedure is 70% of a person’s excess body weight (i.e. if someone is 100 lbs. over their ideal body weight, average weight loss outcomes would be 70 lbs.).

A weight loss of only about 40% of excess body weight will often show significant improvement in many other medical problems:

  • Many Type 2 diabetics will get off of their medications
  • Hypertensive clients will have improvement or resolution of their hypertension
  • Sleep apnea almost always improves
  • Cholesterol improvement in most clients
  • Arthritic symptoms improve

Determining which procedure is right for you will require an evaluation with your surgeon and discussion about your specific situation.  As you meet with him/her you will want to find out what their opinion is regarding the preferred weight loss procedure based upon your medical history as well as the number of procedures he/she has performed and their individual outcomes.

We invite you to view our Weight Loss Surgery webinar to learn more and decide if weight loss surgery is right for you:  Weight Loss Surgery Webinar

CFWLS-Rhonda-04

Rhonda’s Opinion:  The decision has to be yours but I am REALLY happy with the sleeve gastrectomy!