Hello everyone! Here's the link to the newest episode of the #AskDrA show. I hope you enjoy it and find it useful. 

https://youtu.be/FG99A0Z43vA

regards, 

Dr. Alvarez

It's up and running! Thank you everyone for your questions this week! Obesity Chat with Dr. A

http://guillermoalvarez.podomatic.com/entry/2013-11-19T08_53 _19-08_00

Here is this week's Obesity Chat with Dr. A episode! I hope you enjoy it!

http://guillermoalvarez.podomatic.com/entry/2013-11-05T08_37 _54-08_00

Here's yesterday's Obesity Chat Episode! I hope you enjoy this one as much as I did! :)   http://guillermoalvarez.podomatic.com/entry/2013-10-22T11_08_36-07_00

Hello everyone! Just wanted to let you know that we just uploaded this weeks episode of ObesityChat. I hope you enjoy it!

http://podOmatic.com/r/0JkB

 

Warm regards, 

Dr. Alvarez

Good Afternoon to everybody: In response to Ms. PeloRojo's post: My leak rate is 0.32% in the VSG procedure. I hope this sets your mind at ease. Regarding the case of Jeannie where a "leak" was presented 2 weeks postop and was not treated with surgery, she developed pneumonia and was treated as such with success. My team and I were in continuous contact with Jeannie in and out of the hospital until she was safe and sound. As far as leaks... I'm still in Portugal were we had the IFSO world congress of WLS this week and here are a few facts FYI. - The majority of leaks are presented in the immediate postop (<1 week) - Leaks are treated surgically in first instance. - In second instance can be treated endoscopically with the use of a stent. - It can be of course related to the surgeons technique, staple line, suturing over the staple line, etc. but that is not everything... Even with all this done perfectly  a patient can still develop a leak. Why? Patients are different in all ways and also respond differently to the surgery. I hope this helps with your doubts about leaks. My team and I will always respond to your questions in an honest and truthful way. Leslie, Annie, Marcella, Cathy, Sherri and Lisa I want to thank you guys for being excellent patients and congratulate you for being so educated in the VSG. This will help you along your journey with excellent outcomes. with warm regards, Dr. Alvarez & Endobariatric.com staff.

Hi Anna! Sorry for the delay in answering your question. It's been pretty busy. Anyways here goes. There are several studies out there that have the comparison of the size of the bougie and the WL the patient has. It is very well know that the larger the Bougie, the less  WL.  The only big difference is that when the Sleeve started out a lot of surgeons used bigger bougies (42,46,48). Now most of the surgeons use 32,34 or 36. Why? Well with those sizes the patient will have more WL. You can go a bit further using a 28 Fr Bougie but now you will be looking for some trouble. Patient could develop strictures, etc... Problems that can be avoided if we stay with the 32, 34 or 36. I Prefer to use the 32 because the patient will have the most WL possible without looking for trouble. Now the sizes of the bougies are made in Fr (French). So you can have a slight idea 3 Fr equal 1 mm aprox. So if you use a 32, 34 or 36 you are looking at 1 or 2 mm difference.  Hope this helps. Let me know ok? If you have any other question feel free to ask, with warm regards, Dr. Alvarez

Hi Betty, That's a great article Marcia found. Indeed Vagus nerve cutting has been used to treat gastric or duodenal ulcers many years ago. Today there are several studies including this one to see the effects on weight loss. Another interesting study is done with the gastric pacemaker which also involves the Vagus nerve. The pacemaker is implanted close the the Vagus nerve which stimulates it's branches to decrease hunger. Well at least that's the idea. But up to date, with this procedure alone, there hasn't been any excellent results as with regular WLS (Gastric Bypass, VSG, Lap-band, etc.). Some surgeons routinely cut or clipp the Vagus nerve, specially in the RNY. I personally cut certain branches when I do the VSG, but not the main trunks of the nerve. This gives an extra plus on diminishing the hunger. Studies are continuing and we'll have to wait on the results to see if it convenient for us to do this "extra step". Hope this helps! Happy 4th of July! with warm regards, Dr. Alvarez

Hello, I'm Dr. Alvarez. I did a case like your a couple of weeks ago. She also had trouble finding someone to do a revision surgery. She got rejected many times because it is a difficult case. She also had a previous stomach stapling (not laparoscopic). Which I assume is what you had. Send me an email at [email protected]. I can probably help you.  (Great your in TX!) Do you have a barium swallow? How about your previous OR report? with warm regards, Dr. Alvarez

Try Metamucil. It should be OTC in the states. Use as directed twice daily. Morning and evening. Don't be impressed if the loose stools continue for a few more days. Just give it time to work. Probably a week. Let me know how it goes. Sorry I couldn't post any sooner. I've been busy in the OR. :) your friend and doctor, Dr. Alvarez P.S. for the shingles, you can use other pain medications, but local treatment is better to prevent excess NSAID's in your new banana.

Wow Dorothy! 40 lbs! Congratulations! Keep up the good work! I sure will tell Rosie ok? Take care and great hearing from you! :) I'll see you around here then! Dr. Alvarez

Thank you so much everybody for that warm and kind welcome!   Great to see a lot of my former patients and also patients from other colleges who are so intrested in the VSG and getting their weight off! Hope I can be of some help! Have a great day! Dr. A