Question:
Information and clarification

Help for all our new members and ones still deciding... I happened on these sites for some great description of the different procedures (with pictures).. I'm not pitching any particular procedure (that is your choice) all of these sites you need to read for yourself, gather all the information you can then once you decide on a surgeon discuss these with him/her..What is right for one may not be right for you. Read all the information and data collected and research the issues on each surgery procedure.. Good luck in your quest for knowledge on the best procedure for you.. The below paragraphs are from the first website listed below please visit all these informational sites.. I though I would pass these on to all the ones really confused by now.. (The article below is "Not" my view..this is the view of the writer of this article) I see lots of pluses with all types of this surgery each has their own complication and side affects as with any of the surgery) The bottom line is select which is right for you and fits with your goals and expectations!!! "Research the facts" There are many procedures available for weight loss. Most can be categorized as RESTRICTIVE: vertical-banded gastroplasty, roux-en-y gastric bypass, laparoscopic roux-en-y-gastric bypass) or MALABSORBTIVE: (biliopancreatic diversion, distal roux-en-y gastric bypass, jejuno-ileal bypass). The site below does not perform the malabsorbtive procedures as they have not found convincing evidence that they provide a more consistent weight loss or improved quality of life. They have converted many of these procedures to the Roux-en-Y Gastric Bypass because of severe metabolic complications and malnutrition. There are "many other procedures" that are touted as "unique". They are only presenting common procedures with known tract records and definable statistics. They advise you to use common sense in your educational process. If it sounds too good to be true, it generally is. (NOTE: Melanie this statement that was authored by the site listed below was not directed at DS from what I gathered maybe I'm wrong but it did not say DS it said, "many other") Malabsorbtive Procedures Common to all malabsorbtive procedures is the apparent shortening of the intestine in contact with food. Although seemingly logical at first, making the system less efficient in its absorption of nutrients requires continued overindulgence by the patient for survival. The "eat to live" configuration can be quite harmful if adequate volumes of food were not available or if you were to contract a simple case of the "flu". Because of the shortened intestinal tract, hospitalization may be required and therefore travel to certain countries that do not have the medical facilities here in the United States should be discouraged. Iron, calcium, protein, vitamin and mineral deficiencies mandate continued supplements and occasional intravenous therapy. Distal Roux-en-Y Gastric Bypass This operation is often confused with the Roux-en-Y Gastric Bypass. It is however, much closer to the biliopancreatic diversion. This operation attempts to combine a gastric restrictive and malabsorbtive procedure. A small gastric pouch is formed and over 50% of the small intestine is bypassed. This lends itself to a higher degree of protein-calorie malabsorbtion and marginal ulcer formation than the biliopancreatic diversion. Fortunately, in this case, the stomach pouch will continue to increase in size as long as the patient is encouraged to overeat. Jejuno-ileal Bypass http://www.valleysurgical.com/MorbidObesity/Procedures/other.htm#Jejuno This operation is of historic importance. This prototypical malabsorbtive procedure was performed from 1963 to 1980. The amount of small intestine in contact with food was severely shortened. Although this procedure was quite simple to perform, the metabolic complications were devastating. Protein-calorie malabsorbtion, diarrhea, vitamin and mineral deficiencies were common. In addition, kidney failure has been seen in patients ten years out from surgery. It is because of this failed procedure, that many physicians and insurance companies look down on all bariatric procedures. Biliopancreatic Diversion This operation was described in Italy in 1973 and is still being performed in a few centers. This operation consists of removing part of the stomach, leaving a 200-250 cc pouch and shortening the small intestinal food conduit to 250 cm. There is a 50 cm common channel in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs as a result of "dumping" most of the calories and nutrients into the colon where they are not absorbed. There is need for precise control of types of food ingested and an emphasis on protein load. Most patients require life-long nutritional supplements which can be quite expensive. Blood tests are required every few months. Weight loss has not been shown to be superior to the restrictive operations. The social aspects of intestinal gas, diarrhea and odor can be devastating. Most insurance companies will not authorize this type of procedure because of the high complication rates and metabolic problems following this procedure. Overview of Surgery types: http://www.valleysurgical.com/MorbidObesity/Procedures/index.htm Other Procedures: Results of Lap BPD/DS In a 1998 article in the World Journal of Surgery, Dr. P. Marceau of Laval University in Quebec published a study looking at outcome and patient satisfaction with the BPD/DS operation. The 465 BPD/DS patients participating in this study had their surgery performed through an open incision, not laparoscopically. Weight Loss Patients in Dr. Marceau's study lost an average of 73% of their excess weight. The average body mass index, or BMI, was 47 before the operation, and 30 after the operation. Eating Habits More than half (58%) of patients did not significantly change their eating habits after the operation. About one-third (32%) said they avoided some foods postoperatively. Side Effects Patients reported an average of 3 bowel movements per day after the BPD/DS operation. The stools have a fairly unpleasant odor which was considered to be a "major problem" by 43% of patients. The most frequent side effect of the operation was abdominal bloating, which was experienced by one-third of patients more than once a week. Heartburn and abdominal pain occurred more than once a week in about 15% of patients after BPD/DS. Laparoscopic Biliopancreatic Diversion (BPD) The laparoscopic biliopancreatic diversion, or Lap BPD, is a less-commonly performed surgical weight loss procedure. The full name of the procedure is: laparoscopic biliopancreatic diversion with duodenal switch, or lap BPD/DS. The principal advantage of this procedure is the excellent weight loss it provides: you may expect to lose from 80-90% of excess weight after this procedure! The operation is less restrictive than gastric bypass, so it does not change your eating habits as much. It is more malabsorptive than gastric bypass, so the risk of long-term nutritional deficits is relatively greater. This operation has been performed extensively in Europe, and has resulted in an average loss of 80% or more of excess body weight. Thus, it appears to provide greater weight loss than any other surgical weight loss procedure. Some important side effects to be aware of are: frequent, pasty bowel movements, foul-smelling stool, abdominal bloating, and heartburn. Because the pylorus, the outlet of the stomach, remains intact, dumping syndrome should not occur after lap BPD/DS. http://www.surgicallyslim.com/lap_bpd_results.htm See Gastric Bypass Types: http://www.angelfire.com/ok3/vbowen8/index.html The Mini-Gastric Bypass: http://clos.net/ Academy of Bariatric Surgeons - Suggested Links <~~Great links here..... http://www.obesityhelp.com/abs/links.htm Great abstracts from Surgeons of Surgery types: http://www.amedeo.com/medicine/obe/obessurg.htm Obesity Search Engines: http://www.loop.com/~bkrentzman/links/ob.search.html PLEASE GO BACK TO THE MAIN PAGE OF THIS SITE AND VISIT ALL THE LINKS IN THE LIBRARY... THERE IS A MULTITUDE OF INFORMATION THERE BY USING THE SEARCH ENGINE FEATURE: — Victoria B. (posted on March 20, 2000)

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March 20, 2000
More Information.... Open Roux en Y (Rny) The Stomach is separated into two parts. The small Stomach pouch(A)receives food. The lower part of the stomach(B) received most of the gastric juices coming from the liver and other organs. The small intestine is carefully measured and cut.One end(C) is connected to the small stomach pouch. The other end(D) is reconnected to the small intestine, forming a "Y". ==================================================== Laparoscopic Roux-en-Y same as open Roux-en-Y except instead of opening you with a long incision on your stomach, Surgeons use a pencil thin optical telescope, to project a picture to a TV monitor. Having surgery this way, smaller scars , usually 3 to 4 small incisions. Quicker recovery time and less pain. Roux-en-y Gastric Bypass Surgery offers a successful combination of weight control with minimal nutritional or other risk, when follow up and nutritional guidelines are followed. Many obesity experts consider the surgery to be the "Gold Standard" of modern obesity surgery the benchmark to which other bariatric operations are compared. The operation achieves its effects by creating a very small stomach, from which the rest of the stomach is divided and separated. The small intestine is "attached" to the new stomach, allowing the lower pan of the stomach to be bypassed. A thorough description, including diagrams, of the operation will be provided to you during your consultation or as part of the free seminar we encourage potential patients to attend. Suffice to say, that no bodily functions are altered as a result of the operation, and it is completely reversible if it ever needed to be. For complete descriptions with illustrations of the surgery go to (http://www.angelfire.com/ok3/vbowen/index.html)Following surgery, there is little interference with normal absorption of food. The operation restricts food intake and reduces the feeling of hunger. The result is an early sense of "fullness" followed by a sense of satisfaction. Even though the portion size is small (2 to 6 ounces per serving), there is no hunger and no sense of being deprived. Patients continue to enjoy eating all types of food after surgery. They just eat a much smaller portion than they used to. The Roux-en-y Gastric Bypass is an excellent tool for achieving longterm control of morbid obesity (the state of being 100 or more pounds over ideal body weight). Weight loss of 80-100% is achievable by most patients, as internal and external outcome studies demonstrate. And maintenance of that weight loss is likely with adherence to a straight forward behavior regimen. The Roux-en-Y Gastric Bypass Surgery helps you lose weight in three ways 1. You eat less (Volume restriction) With a separate small stomach pouch, you feel full after eating a small amount of food. This approach is much more effective in restricting food volume than other surgical techniques, such as stomach stapling. 2. Your appetite changes (Behavior modification) The procedure reinforces a change in your eating habits. After the procedure, most patients find that their body will not easily tolerate foods that are high in refined sugars and fats. With this built-in control, called "the dumping syndrome," which produces short-term discomfort and flu-like symptoms, you naturally learn to avoid these foods. (Our Bariatric Treatment Centers nutritionists help you avoid the foods that may cause discomfort and help you choose from a wide variety of foods you can enjoy.) Other surgical procedures don't provide this important benefit of behavior modification. 3. You absorb fewer calories (Malabsorption) Food bypasses part of the small intestine and digestion occurs in the lower part of the small intestine. These two factors reduce the amount of calories your body absorbs from the food you eat. The reduced stomach pouch size, change in eating habits and absorption of fewer calories allow patients to be successful at long-term weight loss, as opposed to short-term weight loss programs or diets that rely on willpower, costly meal replacements, or dietary supplements. What are the risks? Bariatric surgery is performed to enable patients to lose excess weight and reduce the serious weight-related health conditions they experience. Every surgery involves risk and bariatric surgery is considered a major abdominal surgery. Patients need to understand these risks and weigh them against the significant risks related to being seriously overweight. Bariatric Treatment Centers' surgeons review these risks in detail in their consultations with patients. For list of PRO & CONS... http://www.angelfire.com/ok3/vbowen/index.html
— Victoria B.

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