Bariatric Surgery is derived from the Greek words “weight” and “treatment”. Bariatric Surgeries are major gastrointestinal operations that seal off most of the stomach to reduce the amount of food one can eat and they rearrange the small intestine to reduce the calories the bodies can absorb. Weight loss operations fall into three categories. The first category is the Restrictive procedures make the stomach smaller to limit the amount of food intake. The second category is the Malabsorptive techniques reduce the amount of intestine that comes in contact with food so that the body absorbs fewer calories and the third category is a combination of the operations that employ both restriction and malabsorption.
There are several different types of Bariatric weight loss surgical procedures, but they are all collectively known as “bariatric surgery”. The surgical procedures fall into two categories which are Restrictive Operations and Gastric Bypass Operations. The two Restrictive Operations are known as Gastric Banding (Lap-Band) and Vertical Banded Gastroplasty. Gastric Bypass Operations include Roux-en-Y Gastric Bypass and DISTAL Gastric Bypass.
The Gastric Banding procedure performed by introducing a Gastric Band device through tiny incisions in the abdomen and it is then placed around the upper piece of the stomach. The resulting pouch dramatically reduces the functional capacity of the stomach. The band has a balloon from inside that is adjustable and can reduce stoma size. This prolongs the periods of fullness. The operation is performed under general anesthesia and lasts between thirty minutes to one hour. The Gastric Banding procedure has many advantages including no cutting of the stomach, no stapling of the stomach, calibrated pouch and stoma size, it can be adjusted to patients needs after surgery with no operation to adjust stoma, laparoscopic removal is possible, it is fully reversible and there is a short hospital stay following the procedure that does not exceed 48 hours.
The Vertical Banded Gastroplasty (VBG) is done by making an incision in the upper abdomen that measures several inches. A circular window is made through the stomach a few inches below the esophagus. A surgical stapler is faded to create a cramped vertical pouch by putting a row of staples from window toward the esophagus. The pouch is carefully measured at the time of the surgery and will hold about one tablespoon of solid food. The next step involves a polypropylene band being placed through the window around the outlet of the pouch and it is secured to itself with stitches. The band controls the size of the outlet and keeps it from stretching. VBG limits the amount of food a patient can eat at one time. It works solely by restricting the amount a patient can eat, unlike the Roux-en-Y Gastric Bypass. The procedure is performed under general anesthesia and requires four or five days in the hospital.
The Roux-en-Y Gastric Bypass is the most current Gastric Bypass Surgery. The stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle of the portion of small intestine, bypassing the rest of the stomach and upper portion of the small intestine. This device requires a four to six day stay in the hospital or two to three days for the laparoscopic procedure. It is possible to return to normal activity three to five weeks after the surgery.
The DISTAL Gastric Bypass is performed by removing a portion of the stomach. The remaining small pouch is directly connected to the last portion of the exiguous intestine. There is a risk of nutritional deficiencies with this procedure. The procedure is intended for patients who are more than 200 pounds overweight. The operation adds malabsorption to restriction of intake. The stomach stapling component is the same as the standard procedure, the difference is the location of the distal connection of the intestine which is reconnected much closer to the colon.
Patients generally have more success with the Gastric Bypass Operations than the Restrictive procedures. The risks are similar for both the Gastric Bypass Operations and the Restrictive procedures, although the risk of nutritional deficiencies for iron, calcium and vitamin B-12 are higher in patients who undergo Gastric Bypass operations. There is also a risk of intestinal leaking. There is a possibility of the Gastric Bypass operations causing “dumping syndrome”. This is when food moves too mercurial through the small intestine. This causes nausea, weakness, sweating, faintness and sometimes diarrhea.
In 2003, 103,000 weight loss operations were performed. Every year that number increases. More and more people are using bariatric surgeries to deal with obesity. Although it seems like a fast draw to lose weight the risks need to be carefully evaluated.
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Filed under Gastric Banding by on Apr 22nd, 2011. 
A lot of people that are morbidly obese elect to have a gastric bypass surgery. But this surgery does not reach without at least a few risks that you should be aware of. I’d like to point some of these out.
One of the dangers is Dumping Syndrome which is where the food doesn’t digest anymore, but just apt on through you, and can cause cramps, diarrhea, and the person to feel very unwell. This is one of the things you should be aware of before having gastric bypass surgery.
There is another danger known as Anastamotic leakage. This can be very unsafe since what happens is if the stomach and bowel are not sealed tightly enough so that there is no leakage, then a leakage will occur. What happens is that the fluid off from the intestines will leak out into the stomach. The person can then develop some serious infections and will probably need hospitalization to earn rid of it. Abcesses can also come up from this problem.
There is also a type of stricture that can manufacture known as anastamotic. This is due to the scar tissue growing back too much, and causing a hole so tiny, that the body will no longer have proper nourishment and starve. If this complication happens between the stomach and the bowel, then a procedure known as gastroendoscopy will need doing where the surgeon will region a balloon where the connecting link is between stomach and bowel to open it so food and nourishment can go through.
Since your stomach is obviously made much smaller, and can now only hold diminutive portions of foods, you may find that you are lacking nutrients. people that have had gastric bypass surgery in the past, have found that they are lacking in vitamin B12, iron, protein, and also the very important calcium needed for bone health. The absorption of these nutrients fails after this surgery many times, and as a result, you become undernourished and other medical conditions can result from lack of these vitamins. And the other drawback is, the essential vitamin D that is so needed by the body may fail to absorb too.
If your lines of staples break after this surgery, you run the risk of stomach ulcers which can bleed if not treated promptly, and gallstones too, which often cause pains.
This is the reason whywhen considering having gastric bypass surgery, you should think carefully and whether the benefits will outweigh the risks. Sometimes it is better to lose weight by trying to reduce food intake, and do it slowly. In gastric bypass surgery, if you don’t follow all of the guidlines for eating properly after having this done, this is most commonly when the complications I mentioned can set in. Weight can also come back a few years if you are not careful enough with your dietary regime.
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Filed under Gastric Banding by on Oct 2nd, 2010.
If you are considering having gastric bypass surgery, I’m definite you want to know how mighty weight you can inquire of to lose and impartial how quickly you will lose it. It’s necessary to understand that each individual is different and will experience different results from the surgery. Some people will lose more than others, and some will lose more quickly than others.
There are a number of factors that influence how much weight we will lose, including our starting weight, our metabolism, how carefully we follow our doctor’s dietary guidelines after surgery, our activity level, whether or not we have any health conditions that can affect weight or metabolism (like diabetes or thyroid problems), certain medications we may be taking, the size of the stomach pouch our surgeon creates, and the amount of small intestine our surgeon bypasses. As you can see, some of these things are things we have some control over, like whether or not we follow our doctor’s dietary guidelines and how active we are. Other things, like whether or not we have thyroids problems and our metabolism, we can’t really control.
Studies have found that the average person loses about 60% of their excess body weight after a gastric bypass. That means if you are 100 pounds overweight, you could seek information from to lose about 60 pounds.
To calculate your excess body weight, first choose your ideal weight. You can obtain charts online that will give you the ideal weight for your height, or you can ask your doctor. Subtract that number from your current weight. That is the amount of weight you have to lose.
To calculate how considerable you might lose with gastric bypass surgery, get a calculator and multiply your excess weight by .6.
However, there are several things you should keep in mind while making your calculations. This is just an average, so that means some people lose significantly more than 60% while other lose significantly less. And there are plenty of things you can do to maximize your weight loss. Remember the factors I listed earlier? You have control over some of those things. You can settle to follow your doctor’s dietary guidelines. You can choose to exercise. If you take medications that affect your weight, ask your doctor if there are any alternative drugs you could try instead (there may or may not be).
Also talk to your surgeon about how big he or she will make your pouch and how that will affect your weight loss. One study found that a smaller pouch size was associated with greater weight loss. Ask your surgeon if he or she will be using a sizing balloon to size your pouch. Some surgeons use them and some don’t, but one study found that using a balloon helps get the pouch the right size and maximizes weight loss.
The same things that affect how much weight you will lose also affect how quickly you will lose. Most people lose most of their weight during the first 12 – 18 months after surgery. Those with the most to lose tend to lose the most quickly. Dr. Dirk Rodriguez of Cincinnati, Ohio, says that patients should expect to lose three to five pounds per week at first, and that weight loss will start to slow down after the first few months. However, some patients lose even more quickly than that at the beginning. You should also be aware that it is common to have a week or two (or longer) here and there when you don’t lose anything. It doesn’t mean you are done losing. Weight loss will start up again. Your body is just adjusting to the loss.
Sources:
Matthew Hoffman, MD. http://www.webmd.com/diet/weight-loss-surgery/what-is-gastric-bypass-surgery. What Is Gastric Bypass Surgery? Science Daily. http://www.sciencedaily.com/releases/2008/09/080915165816.htm. Factors Associated With Poor Weight Loss After Gastric Bypass Surgery Identified.
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Filed under Gastric Banding by on Aug 9th, 2010.
Chronic patients who suffer with different health problems which affect their GI tract and who cannot eat or procure pain when they eat or do not tolerate lots of foods can be malnourished. For those patients the doctors by placing different kinds of feeding tubes save their lives. If it’s not taken care of the malnutrition can make lot of other health problems. Sometimes the patient can die when the body does not get any kind of nutrition it weakens the immune system and they are prone to get all kinds of infections and becomes hard to fight them.
The Science and Medical Technology made so much progress to keep people alive for years without eating too. The doctors either suggest that the nutritional supplements that are available in the super markets like, Breakfast Carnation in different flavor, Pediasure, Boost, etc. If the patient can tolerate that they continue that so that they won’t get any problems with the malnutrition. They check them every week to see whether they are gaining weight or not. But there are some chronic patients, Cancer patients who cannot tolerate any kind of food and they accept pain whenever they eat that’s when the doctor’s decide the placement of J-Tube and the way called Jejunostomy. The J-tube is placed in the upper portion of the small intestines called the Jejunum which is just below the stomach. The tube will be located lower and closer to the center of abdomen.
The main reason of J-tube is to bypass the stomach and directly feed into the small intestines so that it won’t bother the stomach. The patients regain a special Enteral pump through which they are supposed to be fed. Enteral treatment means a formula is given to the patient through the tube feedings. Different brands of formulas like some are not that high in fat, some are high in protein and has little bit fat too and the doctor taking all the facts of the patient into consideration writes the prescription for the right mark. The tube feedings can be short term or long term. When the patient has to go through a major surgery and lost too remarkable weight then the doctors plot the feeding tube and give the patient Enteral tube feedings until the patient gains enough weight and has all the nutritional levels are normally required. The tube feedings take a while to adjust to the bowels and the doctors choose that the patient should derive the nutrition at a certain rate which helps them to tolerate and also helps them to gain weight. The tube site should be taken care of everyday cleaning the area and changing the dressing so that the infections can be avoided. When they do the Jejunostomy they check whether it’s in the right place or not. Whenever I go to Radiology Department of Penn Hospital to get the new J-tube after the procedure they check it to seek whether it is in the right place or not.
As I am a chronic Pancreatitis patient and none of the surgeries could pick away my pain I ended up with J-tube forever. I can eat snacks but I will never be able to eat full meals like everyone. When I got the J-tube it was such a hard thing to gain used to. The body does not like the foreign bodies and it always tried to push it out and whenever the tube moved it hurt so much. No matter how much I took care of the site I ended up with so many infections and had to be treated with anti-biotic. At one time I think I was on antibiotic almost every month or alternate month for a year. They had to give good bacteria to replace it which was lost because of taking too much antibiotic. After having so many infections the pain around the tube became very severe. It wound when I toddle, when I try to sleep on to the side, sit for continuously an hour in a chair working on something the injure became unbelievable. So the radiologists told me that it has become chronic. I was very mad for a while. My life was full of pain and they keep adding new kinds to the already exists. When tube was placed it has a small balloon to block the tube from coming out from the small hole but after few months or rarely a year after the balloon gets ruptured and the tube comes out. We make appointment to replace the tube and the Radiologists at the Interventional Radiology replace it. Sometimes this balloon ruptures and the tube starts to come out that means it’s time to get a new tube. I go to Penn Hospital Radiology Department to get it changed.
I ended up in the hospitals with the infections to secure I.V antibiotic treatments by a injure specialist. Then they figured it out and said because I have Meta Port I can retract the I.V treatment at home when the nurses from Infusion Company will come and show me how to do it. I have suffered like that almost two years. My friend from Nevada said one of her neighbor’s daughter have some chronic problems so she has this J-tube too but she uses an ointment which blocks the infections. So she sent me the name of the ointment and we showed that to the wound specialist which he has not seen before so he called the pharmacist in the hospital and gave the name of the ointment. I have started using the ointment and the infections stopped all of a sudden and now the tube site is very clean and I take marvelous care of it. Of course the afflict around the tube also came down. It is still there but it gets worse when I work for hours sitting or bend too much if I get in the mood of cleaning and carried away without paying attention to the time.
Having J-tube helps me to get the enough nutrition for my body. Last year I had very tough year and lost too much weight even though it bypasses the stomach whenever I get the wound I can’t use the tube feedings at the normal rate. Sometimes I have to stop it until the Pancreatitis attack goes away and then start with the low rate and increase it slowly to my normal rate. As I lost too much weight my G.I doctor suggested that I should get TPN for 12 hours at night time. TPN (Total Parenteral Nutrition) can be given through a central line or Meta Port because it is very thick solution which cannot be tolerated by the usual veins used for the I.V. So the TPN treatment is given through intravenously bypassing eating and digestion. This is temporary treatment for me. The TPN formula has all the nutrition required for the daily supplement of the body. It has lipids, amino acids, salts, glucose and all the important nutrition. We have to add vitamins when preparing the formula to hook up. For the first few days I had to check my sugar levels and if they are normal then I don’t have to do it regularly. If the sugar levels go up they give insulin to the patient. Every week the nurse from the Infusion Company visits and she draws blood from the Meta Port to send it for the labs. They check everything to see the TPN is working or not and if they have to make any changes. If something is low or high the doctor who gets the blood work recount asks the nutrition nurse at the Infusion Company to make some changes. The nurse then takes out the needle; well-organized the area, accesses it with the original one, then puts the dressing and flushes the port. The Port which was accessed needs to be flushed with Seline flush before hooking up TPN formula then when the formula is done it needs to be flushed with both Seline and a Heparin. This keeps the port clean and avoids the infection. There is always a great risk of infection with the ports. The first Meta Port I had for almost more than 5 years without any problems. But when they started TPN in fall four weeks later I had very dreadful infection and luckily caught on time. Sometimes the patient can go into Sepsis shock as the infection spreads very posthaste and can be dangerous. That’s why the patients need to be very careful in taking care of the port.
Every week the nutritionist calls and finds about the weight, and whether am I having any problems with the TPN or is it working without any problems? Usually every week I gather one or two pounds. Some times when I have lot of pain I don’t gain any weight but I don’t lose whatever I gained too. So, that’s a good note and means I am on right track. When TPN starts working I feel more energetic, when I do things I do not fetch tired quickly, the paleness goes away and the skin, face look healthy and I start looking healthy and people start noticing too. I have gained fair few pounds and I have a long way to go.
TPN is mostly musty temporarily unlike the J-tube can be used for long term. TPN is venerable for the Cancer patients, GI tract malfunctioning, diseases that need total Bowel rest, Crohn’s disease, Ulcerative colitis, Bowel destruction, Pediatric GI disorders, short bowel syndrome due to surgery.
There is another kind of tube feeding which is almost like J-tube except that it is G-tube and is placed in the stomach and they are archaic for the long term Enteral nutrition. It’s placed in the abdominal wall surgically. Just like the J-tube the station around the tube should be kept clean and use gauze for the dressing. G-tube is also called a Peg tube.
NGtube is called Naso gastric tube another kind of tube feedings which is inserted through nose and passed down the pharynx through the esophagus and into the stomach. NG tube is worn for the short term. They check it whether it’s in the right place or not before each feeding. Before my second major surgery Whipple when I was in the hospital and the doctors were horrified that I was losing the weight so badly and before they send me to the surgeon again they wanted to try NG tube so that I can get some nutrition daily, slowly gain weight and get some strength before they decide what can be done. I was reluctant about it and after the doctor pursued and explained for a long time then I agreed. My Gastroenterologist tried to insert it through my nostrils but he couldn’t get it where he wanted. I was gay it didn’t work out because if they send me home with that my kids could have been so frightened. Then they decided about the J-tube and sent me to another hospital where the surgeon agreed to do Jejunostomy.
These are the different kinds of tube feedings that are used for the people who cannot eat like the normal people because of some GI problems or some other chronic conditions. When they first talked to me about the J-tube I totally gave up at that time but they did not want to give up on me. As the doctor was explaining I said, ‘why don’t you just kill me? ‘ The doctor could not talk to me and got up and left the room. I know they were trying to save me from dying due to malnutrition. Then next day my Gastroenterologist came and slowly explained everything step by step then I agreed to get it done.
I am very glad now that the doctors did not give up on me and also I’m thankful for all these wonderful medical advances which help people like me to live and see the kids graduate, going to college and enjoy watching them becoming successful and happy in whatever they are doing. I have to thank all the doctors and surgeons who gave this life to me.
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Filed under Gastric Banding by on Jul 30th, 2010.