Learn About Bariatric Surgery
We understand the day-to-day challenges faced by people struggling with the disease of obesity; we are here to help. Our team of experts – a highly-skilled surgeon, physician assistant, coordinator, nurses and dietitian – will guide you through the entire process, from selecting the right option, non-surgical or surgical, to providing you with nutrition and fitness advice as well as lifestyle counseling.
Who is a Candidate for Bariatric Surgery?
Qualifications for bariatric surgery inlcude:
- BMI ≥ 40, or more than 100 pounds overweight.
- BMI ≥ 35 and at least two obesity-related co-morbidities such as
- Type II diabetes
- Sleep apnea and other respiratory problems
- Non-alcoholic fatty liver disease—caused by obesity
- Cholesterol problems
- Gastrointestinal disorders
- Heart problems
The National Institutes of Health (NIH), as well as the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) also recommend that surgery be performed by a board certified surgeon with specialized experience/training in bariatric and metabolic surgery, and at a center that has a multidisciplinary team of experts for follow-up care. This may include a nutritionist, an exercise physiologist or specialist, and a mental health professional. Facilities which meet high standards or quality, like those outlined in MBSAQIP, are preferable choices for patients. St. Charles Medical Center, under Dr. Archer’s direction, has met these standards.
The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery and is the most commonly performed bariatric procedure worldwide.
There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.
The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.
Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
- Produces significant long-term weight loss (60 to 80 percent excess weight loss).
- Restricts the amount of food that can be consumed.
- May lead to conditions that increase energy expenditure.
- Produces favorable changes in gut hormones that reduce appetite and enhance satiety.
- Typical maintenance of > 50% excess weight loss.
- Is technically a more complex operation than the Sleeve Gastrectomy and potentially could result in greater complication rates.
- Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate.
- Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance.
- Complications include leaks, bleeding, damage to other organs and others.
Please discuss complications with the team at BMC.
The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.
This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.
Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.
- Restricts the amount of food the stomach can hold.
- Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of > 50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of > 50%.
- Requires no bypass or re-routing of the food stream (RYGB).
- Involves a relatively short hospital stay of approximately 1-2 days.
- Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety.
- Is a non-reversible procedure.
- Has the potential for long-term vitamin deficiencies.
- Complications include leaks, bleeding, damage to other organs and others.
Please discuss complications with the team at BMC.
Because bariatric surgery is elective, and because it affects your life everyday after surgery and also involves significant risk, we want to get to know you very well before your operation. If you are ready to move ahead, fill out the intake form and turn it in to Kathryn Wilson, our coordinator at BMC. From there she will be in contact. You will also want to attend the information seminar. This is a required first step to introduce you to the program. From there you may have several other visits, including:
- Nutrition counseling
- Psychological evaluation
- Exercise Assessment
- Lab work
- EKG or other heart testing
- Sleep study
- Resting Energy Expenditure
- Body Composition
- Addition visits or evaluations may be necessary depending on medical history and insurance requirements
Many of these consultations can be scheduled in one or two days. Kathryn will make every effort to help coordinate your visit.
Please note that we require at least three months of tobacco abstinence prior to moving forward with surgery. In almost all cases we ask patients to lose 5% of their total body weight prior to surgery. We do this because it is a safety issue.
Prior to surgery we will see you again in the office to have a final review of all testing, review again the risks and benefits, do an exam and answer questions. You will be asked to sign a consent form for surgery. You will also usually have a preoperative visit at St. Charles Medical Center.
On the day of your operation you will meet the anesthesiologist and the operating room team. After your operation, you will have a two hour stay in recovery and then go to your room in the hospital. Often we start patients on liquids within hours of surgery. Prior to discharge from the hospital we will review all your medications with a pharmacist and make any changes. Some patients leave with far fewer medications than they came in with!
One of our goals is to make sure you have a great experience before, during and after surgery. Preventing readmissions is a big part of that. Postoperatively you will want to focus on staying very well hydrated. Water, water, water!
After surgery, once bowel function has returned, you will be on protein drinks for three weeks, along with water. Following that you will be on a puree diet, concentrating on healthy fats and proteins and taking in less carbohydrates and sugar. By six weeks after surgery you will be on a regular diet. We like to say real food for real people. Whole, real foods are best.
We will see you frequently after surgery. We want to know if you have questions or problems. Please stay involved after surgery. The support groups are for you and patients who go to support groups tend to lose more weight.
Dr. Archer does most operations using the surgical robot, called da Vinci.
Instead of the large abdominal incision used in open surgery, da Vinci surgeons make just a few small incisions – similar to traditional laparoscopy. The da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. These features enable your surgeon to operate with enhanced vision, precision, dexterity and control.
As a result of da Vinci technology, da Vinci Surgery offers the following potential benefits:
- Low rate of complications
- Low rate of wound infection
- Short hospital stay
As a result of da Vinci technology, da Vinci Bariatric Surgery offers the following potential benefits compared to traditional laparoscopy:
- Much lower rate of gastrointestinal leaks
- Lower risk of needing follow-up surgery
- Lower risk of converting to open surgery
- Reduced surgeon fatigue (due to the da Vinci Systemergonomics)
State-of-the-art da Vinci uses the latest in surgical and robotics technologies and is beneficial for performing complex surgery. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. da Vinci – taking surgery beyond the limits of the human hand.
Physicians have used the da Vinci System successfully worldwide in approximately 1.5 million various surgical procedures to date. da Vinci is changing the experience of surgery for people around the world.
Risks & Considerations Related to Bariatric Surgery
Potential risks of any bariatric procedure may include:
- Fluid leak in gastrointestinal system
- Abdominal pain
- Intestinal blockage
- Nausea with vomiting
- Snyder BE, Wilson T, Leong BY, Klein C, Wilson EB. Robotic-assisted Roux-en-Y Gastric bypass: minimizing morbidity and mortality. Obes Surg. 2010 Mar;20(3):265-70. Epub 2009 Nov 3.
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- Diamantis T, Alexandrou A, Nikiteas N, Giannopoulos A, Papalambros E. Initial experience with robotic sleeve gastrectomy for morbid obesity. Obes Surg. 2011 Aug;21(8):1172-9.
- Ayloo S, Buchs NC, Addeo P, Bianco FM, Giulianotti PC. Robot-assisted sleeve gastrectomy for super-morbidly obese patients. J Laparoendosc Adv Surg Tech A. 2011 May;21(4):295-9. Epub 2011 Mar 28. 11.
- Fourman MM, Saber AA. Robotic bariatric surgery: a systematic review. Surg Obes Relat Dis. 2012 Jul;8(4):483-8. Epub 2012 Mar 29.
- Tieu K, Allison N, Snyder B, Wilson T, Toder M, Wilson E. Robotic-assisted Roux-en-Y gastric bypass: update from 2 high-volume centers. Surg Obes Relat Dis. 2012 Jan 16. [Epub ahead of print].
- Yu SC, Clapp BL, Lee MJ, Albrecht WC, Scarborough TK, Wilson EB. Robotic assistance provides excellent outcomes during the learning curve for laparoscopic Roux-en-Y gastric bypass: results from 100 robotic-assisted gastric bypasses. Am J Surg. 2006 Dec;192(6):746-9.
Serious complications may occur in any surgery, including da Vinci® Surgery, up to and including death. Examples of serious or life-threatening complications, which may require prolonged and/or unexpected hospitalization and/or reoperation, include but are not limited to, one or more of the following: injury to tissues/organs, bleeding, infection and internal scarring that can cause long-lasting dysfunction/pain. Risks of surgery also include the potential for equipment failure and/or human error. Individual surgical results may vary.
Risks specific to minimally invasive surgery, including da Vinci Surgery, include but are not limited to, one or more of the following: temporary pain/nerve injury associated with positioning; temporary pain/discomfort from the use of air or gas in the procedure; a longer operation and time under anesthesia and conversion to another surgical technique. If your doctor needs to convert the surgery to another surgical technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications.
Patients who are not candidates for non-robotic minimally invasive surgery are also not candidates for da Vinci® Surgery. Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.davincisurgery.com/safety and www.intuitivesurgical.com/safety.