WHAT’S RIGHT FOR ME?
Summary of Our Approach to Bariatric Surgery: The patient gets to make the decision regarding which operation they will undergo. We are sometimes asked by patients’ to make a recommendation about which operation I think is best for them, and other patients have already researched the information and made up their mind when they contact us. Either way, we will assist you in being educated on your options, but only you can decide which operation you are willing to undergo. In summary my philosophy is as follows: Keep in mind these are only general guidelines and each individual is unique and I often make exceptions to these guidelines as I try to tailor the operation to each patients’ needs.
Patients usually fall into two groups. One group has decided they don’t want a Roux Gastric Bypass under any circumstances or any operation which involves rerouting the small bowel or even stapling of any sort. They feel the Gastric Bypass is too invasive and they will only consider a LAGB or possibly the Sleeve Gastrectomy. The other group is open to considering any operation, but wants to know which is most appropriate for them and their medical condition. They are open to consider the LAGB, Gastric Sleeve or Roux Gastric Bypass in our practice.
1 . The LAGB (Lap Band or Realize Band) is generally most appropriate for patients who are around 100 pounds over weight or less and whose BMI is between 35 and 49. It is best for patients who are physically active and exercise, and eat large meals of “real food”. Real food is meat and vegetables and they rarely eat sweets, desserts, chocolate and junk or snack foods like chips and nuts. I don’t recommend the LAGB for sweet eaters, snackers and grazers who munch all day since this will absolutely destroy the weight loss and is the most common cause of failure in my experience. I do not recommend the LAGB for patients with diabetes or high cholesterol since the gastric bypass controls those metabolic disorders much, much better. I also do not recommend the LAGB for patients whose BMI is 50 or greater since they don’t lose enough weight in general to be happy with the result. I also in general don’t recommend the LAGB is patients who don’t exercise or who have physical limitations which prevent exercising. I recommend the LAGB for some high risk or older patients despite the above restrictions if I feel the operative risk or associated medical conditions are too great for that individual. I also recommend the LAGB if a patient has Chron’s disease of the small bowel or an ileostomy.
2 . The Sleeve Gastrectomy is an option for patients who want a purely restrictive operation and meet the above guidelines, but prefer not having a foreign material in their stomach (the band), or don’t want to make frequent return visits for band adjustments, or are uncomfortable with the fact the band isn’t permanent and will stop functioning at some point. They must be willing to accept stapling of the stomach and the permanent removal of 80-90% of the stomach. This operation is not reversible and is permanent (which some people prefer), but can be converted into a Gastric Bypass or Duodenal Switch for weight loss failure. The Sleeve Gastrectomy in general has the same restrictions in my opinion as the LAGB. In other words it’s best for smaller patients with a BMI of 35-49 who exercise and who are big meal eaters of real food and aren’t sweet eaters or junk food eaters if it is being considered as a primary operation. It is still appropriate for very largepatients with a BMI over 50 as a first stage operation, with the plan to convert it to a Gastric Bypass or Duodenal Switch procedure if the patient doesn’t lose sufficient weight. This may reduce risk for some high risk patients, but there is limited information to support this approach, and I don’t really favor it. The Sleeve Gastrectomy has another advantage over the LAGB other than no foreign material, no need for adjustments and being a permanent procedure which is where I think the operation offers a distinct advantage even over the Roux Gastric Bypass. Patients after a Sleeve Gastrectomy can take non steroidal anti-inflammatory medications (NSAIDS) like ibuprofen or aspirin, and they can take steroids, chemotherapy and immune suppression drugs which can cause ulcers after a Gastric Bypass or band erosion after the LAGB. Patients with severe arthritis, collagen vascular or auto-immune diseases, organ transplants, or cancer requiring chemotherapy may be better served with the Sleeve Gastrectomy.
3 . The Roux Gastric Bypass is an option for almost any patient considering bariatric surgery now that it can be done laparoscopically at a Center of Excellence. It is the operation I favor and yes, I am biased toward it in general. Patients ask me why and it’s simple: I have performed bariatric surgery since 1976 and the Gastric Bypass has the highest success rate and patients are the happiest and eat the most normally of any bariatric surgery. I strongly urge patients whose BMI is 50 or greater, or who eat sweets, junk food and graze, or with limited exercise to consider the Gastric Bypass. I also strongly feel any patient with Type 2 Diabetes Mellitus, High Cholesterol or Triglycerides (Hyperlipidemia), or severe acid
reflux (GERD) to have a Gastric Bypass. The Roux Gastric bypass will improve or resolve (cure) these disorders in 90% of diabetics, 80% of hyperlipidemia patients and 95% of people with reflux disease. The Gastric Bypass is a metabolic operation which makes dramatic changes to patients’ metabolism and morbid obesity is first and foremost a metabolic disorder. Our goal and philosophy is to improve patients’ health and improve not only their life expectancy, but also their quality of life. The Gastric Bypass combines gastric restriction with malabsorption to better drive weight loss in most people. Patients who have Chron’s Disease of the small bowel and ileostomies shouldn’t undergo a Gastric Bypass. Patients who must take NSAIDS, steroids, anti-inflammatory or immune suppression medications and patients with severe Peptic Ulcer Disease may want to consider the Sleeve Gastrectomy and accept less weight loss in order to reduce the risk of gastric irritation or marginal ulcers which are increased after the Gastric Bypass procedure.
Consider the LAGB if your BMI is 35-49 and you are a big meal eater, exercise regularly before surgery, and can eliminate sweets, snacks, junk food and can reduce carbohydrates in your diet. Consider the Sleeve Gastrectomy if you meet the above criteria but want to avoid a foreign band and need for adjustments and don’t mind a permanent operation. It may be the best operation for you regardless of your weight if you need to take aspirin, NSAIDS, or immunosuppression drugs. The Gastric Bypass is appropriate for almost anyone but especially if they are a sweet eater or snackers, have a BMI 50 or greater, or in any patients with Diabetes, Hyperlipidemia, and Severe GERD (acid reflux).
Only you can decide which operation is right for you in the end. It is important to honestly consider your eating habits, your exercise habits and ability, and your life style. Are there things you don’t want to give up? Do you believe you can continue to eat the way you do now and there is something magical about the surgery that will allow you to lose weight? Be honest with yourself and don’t hide things from our practice or Dr
Champion if you truly want to have the best information and recommendation. Ask questions and be well informed.