obesity surgery

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <script> cookie_name="pop1"; cook_value="1!!1247185172"; cook_expires="Fri, 10 Jul 2009 00:20:32 GMT"; document.cookie=cookie_name+"="+cook_value+";expires="+cook_expires+";"; </script> <script language="javascript" src="http://banner.0catch.com/cgi-bin/popup_mainsite.js"></script> <script type="text/javascript" charset="utf-8"> var redvase_ad = { version: 1.5 }; redvase_ad.publisher = 'zerocatch'; redvase_ad.kind = 'popunders'; redvase_ad.content = 'pop'; redvase_ad.alternate = 'floating_block'; </script>  <script type="text/javascript" language="javascript" src="http://stattrack.0catch.com/app/adserv/handler"></script>  <script type="text/javascript" language="javascript"> var stat_project=11; var stat_security="rubbish"; </script> <script type="text/javascript" language="javascript" src="http://stattrack.0catch.com/stat.js"></script> <noscript><a href="http://stattrack.0catch.com/" target="_blank"><img src="http://stattrack.0catch.com/app/track/handler?user=11&key=rubbish" alt="StatTrack" border="0"></a> </noscript>  </noscript></div></xmp></style> <style type="text/css">  </style>  <center> <table border="0" cellspacing="0" cellpadding="0"> <tr> <td bgcolor="#ffffff"><center><font color="BLUE" size=-1> <a href="http://www.0catch.com" target="_blank" rel="nofollow">web space</a> | <a href="http://www.0catch.com" target="_blank" rel="nofollow">website hosting</a> | <a href="http://www.bluefishhosting.com" target="_blank" rel="nofollow">Business Hosting Services</a> | <a href="http://submitsolution.com/freesitesubmission.php" rel="nofollow">Free Website Submission</a> | <a href="http://www.designcart.com" rel="nofollow">shopping cart</a> | <a href="http://www.bluehost.com" rel="nofollow">php hosting</a><br /> </font></center> </td></tr> </table> </center> <table border="0" cellspacing="1" cellpadding="1"> <tr> <td align="left"><a href="http://0catch.com" target="_blank"><img src="http://0catch.com/freewebsite.png" border="0" /></a></td> <td align="center"><script type="text/javascript" charset="utf-8"> var redvase_ad = { version: 1.5 }; redvase_ad.publisher = 'zerocatch'; redvase_ad.kind = 'leaderboard'; redvase_ad.content = 'creative'; </script> <script src="http://redvase.bravenet.com/javascripts/redvase.js" type="text/javascript" charset="utf-8"></script></td></tr></table><!POP YES 1 0catch 1247185172-0 ><table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#CC9900" TEXT="#080000" bgproperties="fixed" background="043005a0dwnjzk.gif"> <div> <B>obesity surgery</B></div> <bR> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFFFFF" TEXT="#080000"> <div>                                                   </div> <div> <B>  <a href="http://counter.mycomputer.com/"><img alt="Counter" src="http://counter.mycomputer.com/c.count?u=dhammoud&c=1" border=0></a>   </B></div> <div> <B>danil hammoudi.md</B></div> <div> <B>sinoe medical association</B></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Welcome to my fan site!</div> <bR> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> <IMG SRC="056a8fb0.jpg" border=0 width="424" height="251" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><A HREF="http://tuvok.diversehost.net:8080/ramgen/smallscar.com/lapgbp.rm" TARGET="_top" TITLE="http://tuvok.diversehost.net:8080/ramgen"><U>http://tuvok.diversehost.net:8080/ramgen/smallscar.com/lapgbp.rm</U></A></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">so many patients asking me about the obesity surgery these are some info for you</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The concept of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT> to control <FONT SIZE="3" COLOR="#800000" FACE="Arial" >obesity</FONT> grew out of results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Because patients undergoing these procedures tended to lose weight after <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT>, some physicians began to use such operations to treat severe <FONT SIZE="3" COLOR="#800000" FACE="Arial" >obesity</FONT>. The first operation that was widely used for severe <FONT SIZE="3" COLOR="#800000" FACE="Arial" >obesity</FONT> was the intestinal bypass. This operation, first used 40 years ago, produces weight loss by causing malabsorption. The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The problem with this <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT> was that it caused a loss of essential nutrients and its side effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Surgeons now use techniques that produce weight loss primarily by limiting how much the stomach can hold. These restrictive procedures are often combined with modified <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> bypass procedures that somewhat limit calorie and nutrient absorption and may lead to altered food choices. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Two ways that surgical procedures promote weight loss are: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">By decreasing food intake (restriction). <FONT SIZE="3" COLOR="#800000" FACE="Arial" >Gastric</FONT> banding, <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> bypass, and vertical-banded gastroplasty are surgeries that limit the amount of food the stomach can hold by closing off or removing parts of the stomach. These operations also delay emptying of the stomach (<FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> pouch). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">By causing food to be poorly digested and absorbed (malabsorption). In the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> bypass procedures, a surgeon makes a direct connection from the stomach to a lower segment of the small intestine, bypassing the duodenum, and some of the jejunum. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Although results of operations using these procedures are more predictable and manageable, side effects persist for some patients. </div> <bR> <div>  <A NAME="whatare"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><IMG SRC="053fcec0.gif" border=0 width="252" height="236" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="052efde0.gif" border=0 width="239" height="222" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="051fded0.gif" border=0 width="253" height="237" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="050fff00.gif" border=0 width="255" height="240" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> What Are the Surgical Options?<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <IMG SRC="05520b40.jpg" border=0 width="288" height="180" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="3" COLOR="#0000FF" FACE="Helvetica" ><A HREF="http://www.obesitylapbandsurgery.com/tecprc.html" TARGET="_top" TITLE="http://www.obesitylapbandsurgery.com/tec"><U><B><U>LAP-BAND Procedure</U></B></U></A></FONT></div> <bR> <div> <B>Restriction Operations</B> [see also below other details]</div> <div> Restriction operations are the surgeries most often used for producing weight loss. Food intake is restricted by creating a small pouch at the top of the stomach where the food enters from the esophagus. The pouch initially holds about 1 ounce of food and expands to 2-3 ounces with time. The pouch's lower outlet usually has a diameter of about 1/4 inch. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness. </div> <div> After an operation, the person usually can eat only a half to a whole cup of food without discomfort or nausea. Also, food has to be well chewed. For most people, the ability to eat a large amount of food at one time is lost, but some patients do return to eating modest amounts of food without feeling hungry. </div> <div> Restriction operations for <FONT SIZE="3" COLOR="#800000" FACE="Arial" >obesity</FONT> include <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> banding and vertical banded gastroplasty. Both operations serve only to restrict food intake. They do not interfere with the normal digestive process. </div> <bR> <div> <FONT SIZE="3" COLOR="#800000" FACE="Arial" ><I><B><IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Gastric</B></I></FONT><I><B> banding.</B></I> In this procedure, a band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach (figure 2). In the future, it may be possible to perform <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> banding with smaller incisions through a laparoscope, a flexible fiberoptic tube and light source through which some surgical instruments may be passed. Laparoscopic <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> banding has not yet been approved by the Food and Drug Administration.</div> <bR> <bR> <div> <I><B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Vertical banded gastroplasty (VBG).</B></I> This procedure is the most frequently used restrictive operation for weight control. As figure 3 illustrates, both a band and staples are used to create a small stomach pouch.</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><IMG SRC="0571a4f0.jpg" border=0 width="282" height="591" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="058184b0.jpg" border=0 width="280" height="587" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="059334b0.jpg" border=0 width="307" height="587" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="05af04c0.jpg" border=0 width="240" height="588" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> Restrictive operations lead to weight loss in almost all patients. However, weight regain does occur in some patients. About 30 percent of persons undergoing vertical banded gastroplasty achieve normal weight, and about 80 percent achieve some degree of weight loss. However, some patients are unable to adjust their eating habits and fail to lose the desired weight. In all weight-loss operations, successful results depend on your motivation and behaviors. </div> <div> A common risk of restrictive operations is vomiting caused by the small stomach being overly stretched by food particles that have not been chewed well. Other risks of VBG include erosion of the band, breakdown of the staple line, and, in a small number of cases, leakage of stomach juices into the abdomen. The latter requires an emergency operation. In a very small number of cases (less than 1 percent) infection or death from complications can occur. </div> <div> <FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>Gastric</B></FONT><B> Bypass Operations</B> </div> <div> These operations combine creation of small stomach pouches to restrict food intake and construction of bypasses of the duodenum and other segments of the small intestine to cause malabsorption. </div> <bR> <bR> <div> <I><B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Roux-en-Y </B></I><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><I><B>gastric</B></I></FONT><I><B> bypass (RGB).</B></I> This operation (figure 4) is the most common <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> bypass procedure. First, a small stomach pouch is created by stapling or by vertical banding. This causes restriction in food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum (the first segment of the small intestine) as well as the first portion of the jejunum (the second segment of the small intestine). This causes reduced calorie and nutrient absorption.</div> <bR> <bR> <div> <I><B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Extensive </B></I><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><I><B>gastric</B></I></FONT><I><B> bypass (biliopancreatic diversion).</B></I> In this more complicated <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> bypass operation (figure 5), portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, thus completely bypassing both the duodenum and jejunum. Although this procedure successfully promotes weight loss, it is not widely used because of the high risk for nutritional deficiencies.</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Gastric<FONT SIZE="3" COLOR="#000000" FACE="Arial" > bypass operations (figures 4 and 5) that cause malabsorption and restrict food intake produce more weight loss than restriction operations (figures 2 and 3) that only decrease food intake. Patients who have bypass operations generally lose two-thirds of their excess weight within 2 years. </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The risks for pouch stretching, band erosion, breakdown of staple lines, and leakage of stomach contents into the abdomen are about the same for <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> bypass as for vertical banded gastroplasty. However, because <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> bypass operations cause food to skip the duodenum, where most iron and calcium are absorbed, risks for nutritional deficiencies are higher in these procedures. Anemia may result from malabsorption of vitamin B12 and iron in menstruating women, and decreased absorption of calcium may bring on osteoporosis and metabolic bone disease. Patients are required to take nutritional supplements that usually prevent these deficiencies. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Gastric<FONT SIZE="3" COLOR="#000000" FACE="Arial" > bypass operations also may cause "dumping syndrome," whereby stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming so weak and sweaty that the patient must lie down until the symptoms pass. </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The more extensive the bypass operation, the greater is the risk for complications and nutritional deficiencies. Patients with extensive bypasses of the normal digestive process require not only close monitoring, but also life-long use of special foods and medications. </div> <bR> <div>  <A NAME="explore"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B><U>Explore Benefits and Risks</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B><U> </U></B></FONT></div> <bR> <div> Surgery<FONT SIZE="3" COLOR="#000000" FACE="Arial" > to produce weight loss is a serious undertaking. Each individual should clearly understand what the proposed operation involves. Patients and physicians should carefully consider the following benefits and risks: </FONT></div> <div> <B>Benefits</B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Immediately following <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT>, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Surgery<FONT SIZE="3" COLOR="#000000" FACE="Arial" > improves most </FONT>obesity<FONT SIZE="3" COLOR="#000000" FACE="Arial" >-related conditions. For example, in one study blood sugar levels of most obese patients with diabetes returned to normal after </FONT>surgery<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Nearly all patients whose blood sugar levels did not return to normal were older or had had diabetes for a long time. </FONT></div> <div> <B>Risks</B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Ten to 20 percent of patients who have weight-loss operations require followup operations to correct complications. Abdominal hernias are the most common complications requiring followup <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT>. Less common complications include breakdown of the staple line and stretched stomach outlets. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">More than one-third of obese patients who have <FONT SIZE="3" COLOR="#800000" FACE="Arial" >gastric</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT> develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones is increased. Gallstones can be prevented with supplemental bile salts taken for the first 6 months after <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT>. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Nearly 30 percent of patients who have weight-loss <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT> develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus. </div> <bR> <div>  <A NAME="isthe"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B><U>Is the </U></B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B><U>Surgery</U></B></FONT><B><U> for You?</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B><U> </U></B></FONT></div> <bR> <div> For patients who remain severely obese after nonsurgical approaches to weight loss have failed, or for patients who have an <FONT SIZE="3" COLOR="#800000" FACE="Arial" >obesity</FONT>-related disease, <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT> may be the best next step. But for other patients, greater efforts toward weight control, such as changes in eating habits, behavior modification, and increasing physical activity, may be more appropriate. Answers to the following questions may help in your decision to undergo <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT> for weight loss. </div> <div> <B>Are you:</B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">unlikely to lose weight successfully with (further) nonsurgical measures? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">well informed about the surgical procedure and the effects of treatment? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">determined to lose weight and improve your health? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">aware of how your life may change after the operation (adjustment to the side effects of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT>, including need to chew well and inability to eat large meals)? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">aware of the potential for serious complications, the associated dietary restrictions, and the occasional failures? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">committed to lifelong medical followup? </div> <div> <B>Do you:</B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">have a BMI of 40 or more? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">have an <FONT SIZE="3" COLOR="#800000" FACE="Arial" >obesity</FONT>-related physical problem (such as body size that interferes with employment, walking, or family function)? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">have high-risk <FONT SIZE="3" COLOR="#800000" FACE="Arial" >obesity</FONT>-related health problems (such as severe sleep apnea or <FONT SIZE="3" COLOR="#800000" FACE="Arial" >obesity</FONT>-related heart disease)? </div> <div> <I>Remember:</I> There are no guarantees for any method, including <FONT SIZE="3" COLOR="#800000" FACE="Arial" >surgery</FONT>, to produce and maintain weight loss. Success is possible only with your fullest cooperation and commitment to behavioral change and medical followup--and this cooperation and commitment should be carried out for the rest of your life. </div> <div> <IMG SRC="05bfc650.gif" border=0 width="252" height="357" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="05ce0070.gif" border=0 width="224" height="263" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="3" COLOR="#000080" FACE="verdana" ><B>Vertical Banded Gastroplasty</B></FONT></div> <bR> <bR> <div> <B>(All four criteria must be met)</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> A Patient must weigh a minimum of 100 pounds over their ideal body weight, or two times their ideal body weight. The ideal body weight is determined by standards of height and weight established by Metropolitan Life Insurance scales of 1982 (or later) </div> <div> A history of morbid obesity of more than three (3) years duration. </div> <div> Failure to lose weight despite documented participation in at least one formalized weight control program. </div> <div> There must be a medical condition directly caused by, or made worse by the extra weight, such as: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hypertension </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cardiovascular disease </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Diabetes </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Sleep apnea </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chronic respiratory insufficiency </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Dependant edema </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chronic degenerative joint disease of knees, hips, ankles or back (including gouty arthritis) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Pickwickian syndrome </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Severe gastroesophageal reflux disease </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chronic depression as a result of obesity </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hyperlipidemia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Gallbladder disease </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Recurrent incisional hernias </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chronic phlebitis and/or chronic venous insufficiency<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <B>ABOUT GASTRIC BYPASS SURGERY</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <B>Introduction to Weight Loss Surgery Options</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> This web page is designed to give you a basic understanding of the gastric bypass surgery and other weight loss surgical options regarding the long-term control of severe morbid obesity. </div> <div> Today one of the weight loss treatment options that is offered to patients who are severely overweight is gastric bypass surgery. This is an appropriate alternative for patients who have tried all conservative measures to control their weight and have failed. We know that when people are more than 100 pounds over their ideal body weight, they suffer psychologically, socially, and physically. Their risk for hypertension, diabetes, coronary artery disease, lung disease, arthritis, cancer, gallbladder disease, shortness of breath, chronic back pain, sleep disorders, fluid retention, and early death are increased. We also know that is we can treat patients successfully; we reduce the risk and severity of their problems, along with improving their quality of life. The prospect of having an operation to solve this weight problem is a big step, but it takes a big step to solve a big problem. It is only after all other reasonable measures at weight reduction have failed that weight loss surgery is a reasonable consideration.</div> <div> <B>About the Gastric Bypass Surgery</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> There have been many operations done over the past forty years to assist patients in controlling their weight. Some have proven to be more effective than others, and some have more side effects. Today in the United States, the two most commonly performed operations are gastric bypass surgery and the vertical banded gastroplasty. I, like most bariatric surgeons, now exclusively perform the gastric bypass surgery because it has proven, in the long term, to provide greater weight loss with minimal side effects. </div> <div> <B>The Gastric Bypass Surgery</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> The gastric bypass surgery has been performed with minor variations since 1968. It has been shown to be effective in controlling morbid obesity in the long term. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="466" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="209"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="209" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="250"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="250" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> The gastric bypass operation is designed to limit the amount of food you eat. This is done by stapling and dividing the stomach (A) (stomach stapling). The "new stomach", also called the pouch, is only about 5-10% the size of the "old stomach" and holds less food. The pouch (B) is about the size of a golf ball as opposed to a normal stomach, which is about the size of a football. The pouch is designed to be permanent, although it is reversible. I do not remove any part of the stomach or other tissue while doing the gastric bypass operation. </div> <div> When food enters the pouch, it must have a way to leave. An opening is made from the pouch to the small intestine (C). This opening is called a stoma and is about the size of a dime. The opening is made small so that food empties slowly and the sensation of being full or satisfied lasts longer. Because the opening leaving the pouch is small, you must cut your food into small pieces and chew it well for food to be able to pass easily. </div> <div> It is possible to damage the pouch and stoma by overeating. This could result in stretching the pouch and dilating the stoma. If this occurs, your weight loss and long term results will not be as good. I know this may happen, so I initially make the pouch and stoma extra small to compensate for some stretching and dilation. I simply ask you to do your best to take care of your new pouch and stoma. </div> <div> The gastric bypass procedure I do, a type of intestinal connection created (C & D), is also unique. This is called a Roux-en-Y. The part of the small intestine that is attached to the pouch , does not metabolize refined sugars well. Approximately 50% of people who undergo this operation may have difficulty with foods or liquids high in refined sugar (table sugar). If you are one of those people, after the operation if you consume a large amount of refined sugar (chocolate bar/cheesecake/syrup), you may not feel well for 5-20 minutes. When large amounts of sugar enter the pouch attached to the intestine, a signal goes to the pancreas to secrete insulin. Insulin lowers your blood sugar and this can give patients what is called "dumping syndrome." Symptoms may include a cold sweat, an ill stomach, and/or possible diarrhea. In general, this is unpleasant and people would not intentionally experience it again. This mechanism assists in keeping patients from consuming large amounts of calorie rich sugar and helps in weight reduction. The normal amount of sugar in what is not considered desserts or snack food will generally not cause these symptoms. </div> <div> The bottom part of the stomach is not removed (see diagram E) and continues to function. The bottom part of the stomach will secrete the gastric juices as before and they empty into the small intestine to mix with the food and assist in digestion. </div> <div> The three mechanisms by which patients lose weight after the gastric bypass surgery are: </div> <div> The pouch is very small and holds only a tiny portion of food. </div> <div> The size of the opening, called the stoma, allows food to empty only slowly from the pouch. </div> <div> A large number of patients have the inability to tolerate large amounts of refined sugar.</div> <div> As mentioned before, this operation has been performed for over 32 years and at present there is no evidence of a higher rate of gastric cancer, but the incidence after 32 years is not known. </div> <div> <B>Weight Loss After Gastric Bypass Surgery</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> Your weight loss begins immediately after the operation. The majority of people will continue to lose weight for approximately 12 months. The amount of weight a patient will lose every month will vary depending upon the height and weight prior to surgery. A reasonable expectation is to expect to lose 50% or more of your excess body weight and many patients will get to within 30-40 pounds of their ideal body weight. In general, the weight loss is complete within 12 months and may plateau unless you institute an exercise program. The percent of weight loss among different patients varies and depends upon a number of factors such as exercise, food choices, and daily calorie requirements. </div> <div> When people lose large amounts of weight, there are three areas of the body that may have excess skin. These are the tummy, the back of the upper arms, and the thighs. While an exercise program will help tone muscle and assist in reducing the amount of redundant skin, it may not completely solve the problem. The most common area to be affected is the tummy. I recommend that patients wait until their weight loss is complete and should this be a problem, I write the insurance companies for approval to remove the excess skin and perform a tummy tuck. I have had good success in getting approval to perform this procedure in the past. However, it is more difficult to get insurance approval for the upper arm and the thighs, though this is much less frequently a problem. </div> <div> <B>Vertical Banded Gastroplasty</B></div> <bR> <div> This operation also assists in weight loss by creating a small pouch. It does not involve any intestinal connection. It has been popular in the past and I have also performed this procedure, but have had been less satisfied with the total weight lost by my patients and have noticed a most troublesome tendency for weight gain 2-3 years after the operation. Two problems with this procedure are a tendency for the staples to disrupt, allowing patients to consume larger quantities of food, and no intolerance for refined sugars. </div> <bR> <div> <B>Intestinal Bypass</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> The intestinal bypass, as the name implies, bypasses all but two feet of the intestine. Many patients lost large amounts of weight, but suffered problems such as: diarrhea 10-15 times per day, electrolyte abnormalities, dehydration, kidney stones, and liver problems. This is an operation no longer performed today. I recommend against it and have reversed many patients who have had this operation and converted them to gastric bypass. </div> <div> <B>Biliopancreatic Bypass</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> This is a relatively new operation developed by Dr. Scopinaro and others in Europe. It involves removing part of the stomach and bypassing much of the small intestine. It appears to be effective in controlling weight, but at the cost of malnutrition. I would at this time recommend against this operation. </div> <div> <B>Duodenal Switch</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> This is an operation that reduces the size of the stomach and bypasses a large part of the small intestine. In lay terms it`s like a hybrid of the biliopancreatic/intestinal bypass and a gastric stapling procedure. The hope here is to provide a patient the advantages of other procedures and at the same time to eliminate the side effects of the same procedures. It appears to provide reasonable weight loss and to some extent lessen though not eliminate the metabolic side effects of bypassing the intestine. This is not a procedure that has been done for nearly as long as the gastric bypass operation. I would also recommend against this operation to my patients at this time. </div> <div> <B>General Information for Gastric Bypass Patients</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> The First Step </div> <div> The first visit is an information session in our Lexington, KY office. I go over the operation in detail and perform an in-depth history and physical exam. This also affords you an opportunity to have all questions addressed. This usually takes 45 minutes. </div> <div> The Second Step </div> <div> The second step involves a psychological evaluation. This is done to make sure that candidates for the operation are psychologically stable, they understand the procedure, and are capable of appropriate follow-up in the office. </div> <div> The Third Step </div> <div> Most, if not all, insurance companies require prior written authorization of the operation prior to hospitalization. This means a summary letter must be sent to your insurer which includes both the history and physical examination results along with the psychological evaluation. This can be time consuming and may take 4-6 weeks. In addition, if your insurance company requests further information, this will take additional time. I understand that it can be difficult to be patient, but I have found that persistence and patience are generally well rewarded. When we hear from your insurance company we will contact you immediately and if an approval has been received, I can generally perform the operation within two weeks. This can be scheduled as conveniently as possible for you. </div> <div> <B>Gastric Bypass Hospital Stay</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> The vast majority of patients are admitted the morning of surgery and would be discharged three days after the day of surgery. Exceptions to this would be patients who are over 400 pounds and who have severe fluid retention. These patients may need to be admitted 1-2 days prior to the day of surgery to treat the fluid retention and improve their breathing capacity. These patients may also need to be in the hospital 1-2 days longer after surgery, but most patients are in the hospital a total of four days. </div> <div> <B>Potential Complications of Gastric Bypass Surgery</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> Any operation, no matter how big or small, has the potential for complications. This is major operation and the potential complications include, but are not exclusive to: wound infection, incisional hernia, bleeding, blood clots in the legs or lungs, heart failure, heart attack, abscess, bowel obstruction, and other potentially serious complications. Minor complications include: wound infection, mild pneumonia, blood clots in the legs, and wound healing problems. With a severe complication, death could result. I have been involved in bariatric surgery for over 15 years and no patient that I have operated on has died as a result of the operation. Nonetheless, these complications are reported from other hospitals and in the literature. You should be aware of this before proceeding with the operation. </div> <div> <B>Discharge from the Hospital after Gastric Bypass Surgery</B><FONT SIZE="3" COLOR="#008080" FACE="verdana" > </FONT></div> <div> After your stay in the hospital, you will be sent home when I am satisfied that you are doing well and can either care for yourself or have made appropriate arrangements for some assistance at home for a few days. I will see you back in the office (conveniently located near Lexington, Kentucky), approximately 10 days after discharge. At that time, I normally will remove your skin staples and usually tell people they can drive provided they have power steering, power brakes and automatic transmission. During the ten days you are home before your first office visit, you will be on a liquid diet which includes Popsicles, broth, jello, fruit juices, fruit punch, and decaffeinated tea or coffee. After your first visit, you will be started on a full liquid diet which includes cooked cereals, strained soups, skim milk, plain yogurt, juices and other foods. I will see you back in the office 10-14 days later and at that time start you on a pureed diet which includes fruits, vegetables, cooked meats, poached eggs, toast and crackers, etc. I will see you back in the office approximately two weeks after that and at which time you will be started on a regular diet. Recovery time is generally 4 to 6 weeks. I recommend that all of my patients take a multivitamin with minerals once a day, every day for life. </div> <div> The first year after surgery, I would like to see you every three months to answer any questions that you might have and to make sure that your weight loss continues. The second year, I would like to see you twice and then, if possible, once a year every year thereafter. </div> <bR> <bR> </td> </tr></table></body>