Gastric Bypass Surgery

One time, I took a class from some surgeons on gastric bypass surgery. I thought two to four important things: I could die. I won't be able to meet fitness goals later because probably, I won't be able to eat enough to build condition, only maintain. And finally, "How does THAT break my addiction?"

Here are the notes I took from that class on bypass surgery.

Risk of surgery should be less than the risk of not doing surgery
BMI over 25 is overweight.
Current BW minus Ideal body weight = Excess Body Weight

Good candidates:

BMI over forty

Comordities - diabetes, sleep apena and hypertension

> 100 lb over IDBW

Number of people with BMI over 40 has tripled

300,000 deaths per year directly attributable to weight.
Second only to cigarette smoking.

Chances of dying with BMI over 40 is 20-40 times the normal for the age, that year.
Cardiac, pulmonary, infection, Hernia, DVT = deep venous thrombosis, clots in the deep veins.

Open surgery carries much more risk of hernias and infections. Rate is less than 1% with lap surgery.


Not just surgery - results are better wth a "program"
Surgeon, nutritionist, psychologist, medical support, specialized nursing, committed anesthesia and radiology.

Patient has a responsibility: Diet, exercise and water
Emphasis is on the Program afterwards.

NOt for cosmetic result, it's for comorbidiites - doesn't cure obestiy or comordities, it reduces the severity and level of the comorbidities. Some people go off meds.
Statistics are that 95% of people get off meds.

Rou En Y procedure
Biliopancreatic diversion with duodenal switch.
Lap banding

1:200 to 1:500 will die as a result of surgery. (0.2 to 0.5%)

Operative morbidity, 2.0-5.0 %
Needing more O2 after surgery, heart attack, clots in deep veins, stuff like that.

Risk of leak, 0.5 - 1.0%

Dr Smith Hand sews bowel hookups and all staple lines and sutures are sealed, fibered sealant.

Surgical complications: Leaks, blood clots and bleeding.

You get people up right after surgery to keep the blood from pooling in the legs and clotting.
They prefer the blood on the thin side - and there's sometimes some oozing. No one has ever had to be reoperated.

Complications later:
Adhesions (inevitable)
Strictures (one reop) (Stretching is rare, but happens. Rarer in hand sewn bowel hookups in two layers)
Hernias - All gaps in the surgery are sealed with stitches and fibered sealant. So the loops don't strangulate later.

Nutritional deficiencies --> Especially fat soluble vitamins and such. Lab values track these from developing.

All are laparoscopic, have not had to open one - ever - But some are started open for other reasons.

They don't want:
Candidates with BMI over 70
Very large liver
"Very large" (not medium to small) hiatal hernias.
Or these cases have to be done open with greater risk.

Relationships post op: They all change. Some improve, some fail.

Depression - Less likely
See, many obese are depressed, and fixing the weight doesn't fix those depressions. Some people are disappointed that losing the weight didn't resolve their happiness.

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