What is Bariatric Surgery?
Bariatric surgery for morbid obesity, also known as weight-loss surgery, alters the size of the stomach digestive process. There are two types of surgical procedures, restrictive and malabsorptive. The restrictive procedure promotes weight loss by dividing parts of the stomach to make it smaller to decrease the intake of food. The malabsorptive procedure causes some of the food to be poorly digested and incompletely absorbed. Malabsorptive techniques are the most common type of surgical procedure. Combined restrictive and malabsorptive operations involve bypassing most of the stomach and large intestine. One such operation is the Roux-en-Y gastric bypass (RGB).

How does the Roux-en-Y gastric bypass work?
This operation, as illustrated below, is the most common and successful malabsorptive surgery (NIH). First a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine) and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the amount of calories and nutrients the body absorbs. Your surgeon may not place a silastic band in the stomach to prevent stretching of the pouch. The surgical procedure can induce significant weight loss, and in turn, may improve secondary Large intestine illnesses such as glucose intolerance, diabetes, sleep apnea, and hypertension.

The procedure can be performed as "open" incision or laparoscopicly. The laparoscopic operation is a less invasive procedure performed with the aid of a laparoscope. This scope allows visualization of the abdominal organs on a TV monitor while surgical instruments are inserted through small incisions in the abdominal wall. Not all patients are candidates for this surgical technique and your surgeon will discuss the best option for your individual condition.

Who is a candidate for Bariatric Surgery?
The option of surgical treatment is offered to patients who are morbidly obese. A patient should be at least 100 pounds above the estimated ideal body weight with a body mass index (BMI) of 40 or more and ineffective dietary attempts at weight control before considering weight loss surgery. Patients with a BMI of 35 to 40 with obesity-induced physical problems may also be considered. The individual should have a strong desire for substantial weight loss because of secondary illnesses and the desire to improve the quality of their life. They must clearly and realistically understand how their lives may change after the operation. * See Page 13 to find your Body Mass Index (BMI).

How long does the surgery take?
We reserve approximately two to six hours for the surgery. The operating room staff, in preparation for the procedure, takes some of this time. Following surgery, you will be in the post anesthesia care unit (PACU) for a few hours before returning to your room.

What can be expected immediately after surgery?
You will be expected to begin movement immediately after the weight loss surgery procedure and ambulate on the following day. A bar may be placed over your bed to help you pull yourself up. You will receive fluids through an intravenous tube to replace fluids lost during surgery. There also will be a tube (catheter) used to drain urine until the patient is able to use the bathroom. The doctor will prescribe medicine for pain or discomfort.

What are the major risks of surgical treatment?
Your surgeon will explain to you all the risks of this procedure as well as the impact on your future lifestyle.

Some of the more common complications are:
Infection
Leaks or blockage at site where tissue is sewn or stapled together (anastomosis) requiring further procedures to repair.
Breathing problems, such as pneumonia, which may require ventilation or a tracheotomy.
Bleeding at an incision site.
Blood clot in the legs or lungs.
Need for spleen removal.
Recurrent vomiting that requires a procedure to stop the problem.
Incisional hernia
Problems from anesthesia
Death

Prior to your procedure, all your questions will be addressed and satisfactorily answered by Dr. Graber. Call your Dr. Graber's office at 624-4740 to address any questions.
 

Are there nutritional consequences associated with this procedure?
The weight-loss surgery causes ingested food to bypass many of the digestive organs. You are at risk of developing nutritional deficiencies, for example loss of Iron, Thiamine/B12, Vitamin D, Calcium and Folic Acid. The dietitian will work with you to begin some of these changes prior to your surgery. Life long supplements of multivitamins. Iron and Calcium are essential following this procedure. The need for long-term follow up evaluation and counseling is required. Eating habits will change, as described in the Post-Operative Nutrition Program: Diet Progression under Section VI of this packet. You will need to comply with the monitoring schedule proposed by the Bariatric team of specialists.

How long will I be in bed?
On the evening of your surgery, you will dangle your legs over the side of the bed and may be helped out of bed. The staff will help you to move and begin to walk.

How long will I be in the hospital?
Most laparoscopic Bariatric procedure patients are in the hospital for 2-3 days. Most patients undergoing an open procedure are in the hospital for 3-5 days.financing is available through our office.

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While there are several proven non-surgical approaches to treating severe obesity, more experience and research are needed to attain positive long-term success.

For those individuals who cannot lose weight by non-surgical means, or who suffer from serious obesity related problems, gastrointestinal bypass surgery may be the best option. The Roux-en-Y gastric bypass is the preferred bypass procedure throughout the United States. Open Roux-en-Y surgical procedures have been done for many years, however, the laparoscopic method of surgery allows for a shorter hospitalization and recovery period.

It is extremely important for all patients who participate in our Bariatric Surgery Program to demonstrate that they can fully commit and participate in all of the aspects, both before, as well as after the actual surgical procedure in order to attain the best result possible.