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Undergoing bariatric surgery to achieve weight loss is a very serious and life changing decision. Anyone thinking about this kind of surgery must talk to his/her physicians and nutritionists early in the thought process to achieve a full understanding of what is involved, including the associated personal responsibilities, the risks and the probability of success. Although bariatric surgery has become a very safe treatment modality, complications can occur.

The following are some of the most frequently asked questions about bariatric surgery:

How does bariatric surgery promote weight loss?

Bariatric surgery makes various changes in the digestive system.

One group of bariatric surgeries promotes weight loss by closing off or removing a part of the stomach so that it holds less food, which means you can only eat very small quantities at a time yet be completely satisfied. Operations that solely reduce stomach size are known as restrictive operations because they restrict the amount of food the stomach can hold. The examples of this type of procedures are Gastric Sleeve and Lap Band (Adjustable Gastric Band).

Another type of weight-loss surgery combines stomach restriction with a partial bypass of the small intestine. Such procedures create a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that previously absorbed more of the calories and the nutrients in food. These surgeries are known as malabsorptive operations. The most frequently performed weight loss procedure of this type is a Gastric Bypass.

Bariatric surgery is also believed to induce changes in certain hormones that can lead to a reduction in the feeling of hunger experienced between meals.

What are the benefits of bariatric surgery?

Bariatric surgery has tremendous benefits and can be truly life changing.

Surgery improves most severe obesity-related conditions. For example, studies have shown that blood sugar levels of over 90 percent of obese patients with diabetes returned to normal after surgery. Surgery has also been shown to reduce hypertension, sleep apnea, arthritis, lower back pain and high cholesterol. In addition to direct health benefits, bariatric surgery also improves quality of life, self-esteem and increases longevity.

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What are the risks of bariatric surgery?

Bariatric surgery has become increasingly safe. In fact, according to some sources, a patient suffering from morbid obesity has a nearly six-fold increase in risk by not having the surgery! However, as in any surgical procedure, complications do occur. Abdominal hernia used to be one the most common complications requiring follow-up surgery, though laparoscopic techniques have reduced this problem.

Less common complications include breakdown of the staple line and stretched stomach.

The healing process can cause narrowing of the stomach and intestine and that could lead to too much weight loss. Like anyone who loses a lot of weight or loses weight quickly, some patients who have weight-loss surgery may develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. Taking supplemental bile salts for the first six months after surgery can help prevent gallstones, but be sure to talk to your doctor first.

Some patients who have bariatric surgery develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. Fortunately, these deficiencies can usually be avoided with sufficient vitamin and mineral intake. Women of childbearing age who have had bariatric surgery should avoid pregnancy until their weight stabilizes because rapid weight loss or nutritional deficiencies could be harmful to a developing fetus. Patients are always encouraged to ask questions about the potential risks of surgery.

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What is a laparoscopy?

In laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. It is usually less painful and allows for a more rapid recovery.

In addition, laparoscopic surgery employs a high definition camera, that allows a surgeon to see significantly better than with a naked eye, making surgery even more precise. Dr. Gritsus performs all of his bariatric surgeries utilizing this technique.

What are the surgical options today?

Dr. Gritsus performs three weight loss procedures: Gastric Bypass, Gastric Sleeve and Adjustable Gastric Band (Lap Band) surgeries. All procedures Dr. Gritsus performs are cleared by the FDA and are covered by insurance (provided that you qualify, and coverage is available).

Gastric Bypass

Gastric Bypass, is the most common and the most successful form of bariatric surgery. It is also one of the oldest. A small stomach pouch is created to restrict food intake. Then 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 part of the jejunum (the second segment of the small intestine). The bypass reduces the quantity of calories and nutrients the body will absorb.

A Gastric Bypass operation can produce greater weight loss than purely restrictive operations such as Gastric Sleeve or Adjustable Gastric Band (Lap Band), and is considered more effective in reversing the serious health problems associated with severe obesity such as diabetes.

However, Gastric Bypass surgery also carries a greater risk for nutritional deficiencies because food bypasses the duodenum and jejunum where most of the iron and calcium are absorbed. Menstruating women may develop anemia because not enough vitamin B-12 and iron are absorbed. Decreased absorption of calcium may also contribute to osteoporosis and metabolic bone disease. Patients are thus required to take nutritional supplements, which will usually prevent these deficiencies. Patients who had Gastric bypass surgery must also take the fat-soluble vitamins A, D, E and K in supplement form. Gastric Bypass surgery may also lead to a condition called "dumping syndrome," in which the stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating and faintness, and in some cases, diarrhea after eating.

Adjustable Gastric Band (Lap Band)

Adjustable gastric banding is a procedure during which a hollow band made of specialized material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the remainder of the stomach. The band is then gradually inflated with a saline solution. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of solution.

This surgery significantly limits food intake without otherwise interfering with the normal digestive process. In these procedures, physicians create a small pouch at the top of the stomach where food enters from the esophagus. The pouch holds about one ounce of food. The lower outlet of the pouch usually has a diameter of only about ¾ inch. This small outlet delays the emptying of food from the pouch and results in a feeling of fullness.

After Adjustable Gastric Band surgery, the patient loses the ability to eat anything but very small amounts of food at any one time. The person will usually be able to slowly consume only ¾ to 1 cup of food without discomfort or nausea. In order to be properly digested under these conditions, all food has to be very well chewed.

Successful results depend on the patient's willingness to adopt a long-term plan of healthy eating and regular physical activity. Some patients who undergo restrictive operations fail to lose the desired weight because they fail to adjust their eating habits.

Common risks of Adjustable Gastric Band include vomiting, caused by the small stomach being overly stretched by too much food or food that has not been sufficiently chewed. Band slippage and saline leakage also could occur.

Gastric Sleeve

Gastric Sleeve is the newest type of bariatric surgery and has been in general use since 2009.

In the Gastric Sleeve procedure, about 80 percent of the stomach is removed, resulting in a significantly decreased stomach capacity. The digestive function of the stomach is unchanged.

Because of these changes, a patient feels satisfied with about a half a cup of food. The feeling of fullness is observed to be the most natural after this procedure.

Gastric Sleeve allows for a great quality of life because it enables patients to have broad food choices. Gastric Sleeve is also believed to be responsible for hormonal changes in the stomach, which reduce feelings of hunger.

Gastric Sleeve surgery offers a good weight loss result, in some instances close to what can be achieved with Gastric Bypass, but without potentially causing nutritional problems. However, the surgery has not been used on patients as long as the Gastric Bypass or Adjustable Gastric Band and therefore, long term weight loss results are still unknown.

What is body mass index (BMI) and why do we use it?

Body mass index (BMI) is a measure of body weight relative to height. BMI can be used to determine if you are at a healthy weight, overweight or obese. To figure out your BMI, use the following calculator:

BMI Calculator

A body mass index (BMI) of 18.5 to 25 refers to a healthy weight, a BMI of 25 to 30 refers to overweight and a BMI of 30 or higher refers to obese. A BMI over 40 is considered a condition of morbid obesity.

BMI is a standardized method of measuring obesity, used by medical professionals and insurance companies. Insurance companies will typically pay for weight loss surgery when the patient’s BMI is higher than 40.

How much does bariatric surgery cost?

Costs of surgery may vary from one hospital facility to another. Medical insurance coverage also varies by state and insurance provider. If you are considering weight-loss surgery, you will need to contact your insurance plan to find out if the procedure is covered.

Wherever you choose to have your procedure, your surgeon's office will need to assist you in obtaining insurance authorization for weight-loss surgery.

For patients without insurance, Dr. Gritsus’ office offers reasonable rates that include the surgeon fee and assistant fee. The hospital costs, anesthesia and other miscellaneous charges will depend on the procedure and facility where the surgery is performed, and are quoted separately.

Please contact our office for an exact quote.

Will I be sick a lot after the operation?

Bariatric surgery limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well, or you are not following your diet rules properly. However, it could also mean that there is a problem with the surgery so you should contact Dr. Gritsus if this problem persists. Vomiting should be avoided as much as possible.

How long will it take to recover after surgery?

Adjustable Gastric Band (Lap Band) is a same day surgery; patients are discharged 2-3 hours after the procedure. Gastric Bypass and Gastric Sleeve will require an overnight stay at the hospital. A return to a normal level of activity will vary from patient to patient. Most commonly, patients can expect to resume their normal physical routine in 1-2 weeks.

How much weight will I lose after the surgery?

Weight loss varies, depending upon the surgical procedure, as well as depending upon many other factors such as age, gender, pre-surgical weight and level of physical activity. It is not unusual to see a 100 lb. weight loss after bariatric surgery.

How do the weight loss results with the Lap Band compare to those with the Gastric Bypass and Gastric Sleeve?

The Gastric Bypass statistically has been shown to result in the greatest weight loss when compared to the Gastric Sleeve and Lap Band. The Gastric Sleeve typically results in slightly less weight loss than the Gastric Bypass. Lap Band surgery has been shown to result in the least amount of weight loss compared to the Gastric Bypass and Gastric Sleeve. These are historic statistical comparisons; individual results vary.

Are frequent office visits required after surgery?

Check-ups are a normal and very important part of the weight loss process. The follow-up schedule varies by procedure. Dr. Gritsus will determine the best follow-up schedule for you. The follow-up is necessary to perform Lap Band adjustments, which typically take place in our office. Lap Band patients should expect to visit Dr. Gritsus’ office once a month for the first six months after the procedure. That's why it is important for most of Dr. Gritsus' patients to be local, NJ residents or are able to commit to the monthly commute. Afterwards, the follow-up schedule is determined individually, but typically patients are advised to come for follow-up appointments at least once a year.

Gastric Bypass and Gastric Sleeve patients are typically seen once a year.

During these visits laboratory tests are ordered and reviewed to screen for vitamin deficiencies, anemia and any signs of poor nutrition.

Does Weight Loss Surgery limit any physical activity?

The surgery does not affect or hamper physical activity including aerobics, stretching and strenuous exercise, but patients are advised to return to physical activity only after they have been cleared by Dr. Gritsus to do so.

How is the Lap Band adjusted?

Adjustments are most often carried out in the office. They are performed with use of X-ray or Ultrasound so the access port can be clearly seen. A fine needle is passed through the skin into the access port to add or subtract saline. This process ordinarily takes only a few minutes. Most patients say it is nearly painless. The X-ray is also used to calibrate the size of opening of the Lap Band for more precise adjustment.

Do I have to be careful with the access port just underneath my skin?

There are no restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed it should not cause discomfort or limit your movements or any physical exercise. The only sensation you may have from the port is when you go in for adjustments. If you feel persistent discomfort in the port area, let us know as soon as possible.

Can the Lap Band be removed?

Although the Lap Band is meant to be removable, it does not have to be removed unless there is a complication, or the patient wishes to discontinue the treatment. In most cases this can be performed laparoscopically. The stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon return to your original weight, or gain even more.

Will I need plastic surgery for the excessive skin when I have lost a lot of weight?

This is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation. Sometimes the skin will mold itself around the new body tissue. You should give the skin the time it needs to adjust before you decide to have another surgery. Excessive skin amount after weight loss depends on age, gender, duration of obesity and where most of the weight is carried.

Is it true that the Lap Band seems "tighter" in the morning?

This is a fairly common feeling, especially for people with bands that are tight or just after an adjustment. During the day, the water content in the body changes and this may cause the band to feel "tighter" some of the time. Some women have also noticed that the Lap Band feels tighter during menstruation. It is recommended to start your day with a protein shake if the band feels tighter.

Will I feel hungry or deprived after bariatric surgery?

Bariatric surgery makes you eat less and feel full in two ways: by reducing the capacity of your stomach and increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that the surgery is a tool to help you change your eating habits.

What will happen if I become ill after I had bariatric surgery?

One of the major advantages of the Lap Band System is that it can be adjusted. If your illness requires you to eat more, the band can be loosened. When you have recovered from your illness, the band can be tightened again. If you become affected by any serious illness after Gastric Bypass and Gastric Sleeve surgery, it is recommended that you contact Dr. Gritsus for expert advice on how your treatment may need modification.

What about pregnancy?

Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. If you need to eat more during your pregnancy, the Lap Band can be loosened. After the pregnancy, the Lap Band can be tightened again, and you can resume losing weight. If you had the Gastric Sleeve or Gastric Bypass, pregnancy is generally safe. It is recommended that you wait to become pregnant approximately one year after you have had bariatric surgery. If you are pregnant or are considering getting pregnant, please contact Dr. Gritsus for an evaluation.

Will I need to take vitamin supplements?

It is very important to take vitamin supplements after bariatric surgery. It is possible that you may not get enough vitamins from the three small meals a day you will be eating after your procedure.

At your regular check-ups, your specialist will evaluate whether you are getting enough vitamin B12, folic acid, and iron. It is easy enough to take vitamins regularly and the benefits are tremendous!

What about other medications?

You should be able to take prescribed medication. You may need to use capsules, break big tablets in half or dissolve them in water so they do not get stuck in the stomach and make you sick. You should always ask the doctor who prescribes the drugs about this issue. Please talk to Dr. Gritsus about your medications so he can advise you whether it is safe to continue taking them after weight loss surgery.

What if I go out to eat?

Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.

What about alcohol?

Alcohol has a high number of calories. It also breaks down vitamins. An occasional glass of wine or other alcoholic beverage is not considered harmful to weight loss. Because of the changes in the anatomy, you may experience stronger effects from alcoholic beverages after having bariatric surgery. If you plan to drink alcohol, please be careful – and never drive if you feel impaired!

Can I eat anything in moderation?

After your stomach has healed, you may eat most foods that don't cause discomfort. However, because you can only eat a little, it is important to include foods full of important vitamins and nutrients such as those recommended in the nutrition section of this website, and as advised by your surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat, or drink liquids full of "empty" calories, such as milkshakes, the effect of the bariatric surgery may be greatly reduced or cancelled.

Will I suffer from constipation?

There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you are eating less fiber. This should not cause you severe problems. If difficulties do arise, let Dr. Gritsus know as soon as possible.

What is the best bariatric surgery type for me?

Making a good selection of the weight loss procedure is critical. Unfortunately, it can be very difficult to predict which surgery would work best for any specific patient. Dr. Gritsus utilizes a holistic approach when assisting patients in selecting the procedure. The process begins with attending an educational seminar, where Dr. Gritsus explains how the surgeries work. Next, patients are encouraged to make a selection based upon their comfort level with each surgery, and their lifestyle. If you are still not sure, that’s OK. Dr. Gritsus can meet with you individually and discuss your options.

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