I have heard of a new weight loss operation called "sleeve gastrectomy". What is it and does it cause weight loss?
Is it true that my insurance company may have a say as to what procedure that I can undergo?
What happens if I eat sweets after I have a gastric bypass?
If I have problems after my weight loss surgery, whom should I call?
What is "dumping syndrome" and what causes it?
Vomiting is normal after weight loss surgery, isn't it?
What sort of vitamin and mineral deficiencies could I get after undergoing a gastric bypass procedure?
Is it true that the risk of dying after a gastric bypass is really 2%?
I have heard about 'robotic' gastric bypass surgery. Can you explain what this is and how is it different from the normal gastric bypass?
I have been told I can develop "internal hernias" after gastric bypass surgery. What are these, and how can they be avoided?
I am a woman of child-bearing age who is thinking about getting pregnant in the next few years. Can I still have weight loss surgery?
I am interested in the 'Lap-Band' for weight loss. But how often and by whom do I see for post-surgery follow-up and adjustments? Do I have to see a dietitian after a Lap-Band?
I have had a gastric banding performed, and I have lost all of the weight that I seek to lose. Can I have the Band removed?
Is it true that there are more complications after weight loss surgery if I smoke?
I'm considering bariatric surgery for morbid obesity. How important is dietary counseling during the pre-certification process?
I am having trouble deciding between gastric bypass and gastric banding surgery. What should I do?
How do I know whether or not my Lap-Band needs to be filled?
I have heard of a new weight loss operation called "sleeve gastrectomy". What is it and does it cause weight loss?
 | Dr. John Romanelli says: |
Sleeve gastrectomy refers to the surgical removal of the great curvature part of the stomach, reducing the gastric volume by about 75% and can be done to cause weight loss.
Initially, surgeons were doing this as a component of a larger, malabsorptive operation called biliopancreatic diversion. They discovered that this part of the procedure caused significant weight loss all on its own.
It is a restrictive procedure only – like gastric banding – in that its primary function is to cause weight loss by restriction of the amount of calories that you eat.
While early studies appear promising, sadly, most insurance carriers refuse to pay for this operation.
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Is it true that my insurance company may have a say as to what procedure that I can undergo?
 | Dr. John Romanelli says: |
Unfortunately, yes, this is true. Different companies have different rules, and there is no clear consensus as to what is correct. None of the rules seem to follow the established medical evidence.
Tufts, for example, is passing new guidelines that require one year of their own nutritional counseling – and then patients who have a body mass index (BMI) of 40-49 can only undergo gastric banding.
Other insurers will not pay for gastric banding in BMIs greater than 50.
MassHealth will not pay for gastric banding at all.
The era of patients and their doctors has ended, and third party interference has become a more prevalent occurrence in medicine.
You should discuss this with your bariatric surgeon prior to agreeing to surgery.
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What happens if I eat sweets after I have a gastric bypass?
| Dr. John Romanelli says: |
You may develop a condition called "dumping syndrome", which consists of abdominal pain, nausea, vomiting, diarrhea, flushing, and palpitations, among other symptoms.
This is a very unpleasant situation which we urge you to avoid. It is possible that this physiologic safety net may bias gastric bypass patients into having healthier diets, which will aid in long-term weight loss.
Unfortunately, this effect may go away in time and may be a factor in weight regain after gastric bypass surgery.
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If I have problems after my weight loss surgery, whom should I call?
| Dr. John Romanelli says: |
Your first call should always be to your surgeon's office. Regular follow-up with your bariatric surgeon is critically important in the post-operative period, and it is important to realize that not all health care providers are familiar with the altered anatomy after a gastric bypass.
If you are having an emergency, and you are taken to a medical facility other than where you had weight loss surgery, you should let your health care providers know that you had weight loss surgery.
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What is "dumping syndrome" and what causes it?
| Dr. John Romanelli says: |
The term “dumping syndrome” applies to a constellation of symptoms such as abdominal pain, nausea, vomiting, flushing, chest pain, palpitations, and rapid heartbeat. It can occur in gastric bypass patients and is caused by the rapid entry of undigested sugars or carbohydrates into the jejunum.
Most gastric bypass patients know that the threat of this unpleasant complex of symptoms serves as a good reminder to avoid sugars. Many who undergo weight loss surgery suffer from it once. Very few suffer from it again.
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Vomiting is normal after weight loss surgery, isn't it?
| Dr. John Romanelli says: |
Vomiting is always abnormal after any kind of surgery.
- Certainly, a gastric bypass stomach is very small, and if it is overfilled with food, vomiting may ensue. If the connection between the stomach and intestine becomes scarred down, vomiting may occur frequently, and this needs urgent medical attention.
- A gastric band may be overtightened and can be a cause of vomiting.
- Chronic vomiting may also be a sign of abnormal eating behavior developing in response to weight loss surgery.
If you are vomiting more than occasionally, you need to see your bariatric surgeon to ensure that there is not a serious problem.
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What sort of vitamin and mineral deficiencies could I get after undergoing a gastric bypass procedure?
| Dr. John Romanelli says: |
After a gastric bypass procedure, patients are exposed to the possibility of acquiring several different vitamin and mineral deficiencies.
The most frequent ones that we have seen in our practice are deficiencies with Calcium, Iron, Vitamin D, Vitamin B12, Folate and Thiamine.
We're discovering that even patients who have not had a gastric bypass can be deficient in these substances as well. This is why it is very important after undergoing any surgery for obesity that patients follow up on a routine basis with their surgeon and dieticians who are knowledgeable with these types of procedures.
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Is it true that the risk of dying after a gastric bypass is really 2%?
 | Dr. Jay Kuhn says: |
Most gastric bypass surgeons report a mortality rate of 1% or less.
An important study published in the Journal of the American Medical Association in October, 2005, studied over 16,000 patients in California who underwent gastric bypass surgery, and found that the mortality rate within 30 days of the procedure was actually 2%. It is important to note, however, that these patients all were Medicare patients, which means that they were either over age 65 or had a medical condition leading to permanent disability. This may have biased the study somewhat. In addition, most of these patients did not undergo laparoscopic surgery, which in some series has a lower complication rate.
Nonetheless, it is important to discuss all of the risks of gastric bypass surgery, including mortality, with your surgeon.
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I have heard about 'robotic' gastric bypass surgery. Can you explain what this is and how is it different from the normal gastric bypass?
| Dr. Jay Kuhn says: |
Gastric bypass surgery is done in a select few institutions with the aid of the DaVinci surgical robot. The robot is a device that allows the surgeons to see in 3-D and to have instruments that bend at the “wrist”.
The intent is to give surgeons the ability to operate laparoscopically, but yet feel like their hands are inside the patient’s body. The major task that is facilitated with the robot is suturing.
The robot is not like what we envision from Isaac Asimov or The Jetsons – it is a machine that helps surgeons.
Most gastric bypasses are done laparoscopically nowadays, but in select few centers such as Baystate Medical Center, it is offered with the aid of the robot. The size of the incisions and recovery time is about the same for both techniques.
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I have been told I can develop "internal hernias" after gastric bypass surgery. What are these, and how can they be avoided?
| Dr. John Romanelli says: |
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I am a woman of child-bearing age who is thinking about getting pregnant in the next few years. Can I still have weight loss surgery?
| Dr. John Romanelli says: |
Yes, but you probably should undergo gastric banding surgery as the procedure of choice in this situation.
- If you become pregnant, the band can be deflated, and you can gain weight at the direction of the obstetrician.
- If you become pregnant in the weight-loss period after a gastric bypass, it can be difficult to give the baby adequate nutrition, and you are at risk for having a low-birth weight baby or fetal loss.
If you are planning to have a gastric bypass, you should wait at least two years before trying to get pregnant. Also, it is important to note that fertility improves dramatically with weight loss, so attention to this is critical during the weight loss phase.
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I am interested in the 'Lap-Band' for weight loss. But how often and by whom do I see for post-surgery follow-up and adjustments? Do I have to see a dietitian after a Lap-Band?
| Dr. John Romanelli says: |
There are two sizes of Lap-Bands, and the volume difference that they accommodate accounts for a variable amount of adjustments.
That having been said, you can expect somewhere between three to five adjustments in the first year and you should see your bariatric surgeon six to eight times in the first year.
You should only have your band adjusted by your surgeon or someone who works in his/her office – going somewhere else to have your band adjusted can be dangerous as your surgeon many not be able to adjust correctly in the future.
Visits with the dietitian are critical in the post-operative period. If you do not eat correctly, you will fail at weight loss, no matter how tight the Band is adjusted.
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I have had a gastric banding performed, and I have lost all of the weight that I seek to lose. Can I have the Band removed?
| Dr. Jay Kuhn says: |
No. Removing the gastric band will allow you to go back to eating large portion sizes again, which will significantly increase your caloric intake. This will lead to weight re-gain.
The Band should only be removed for medical reasons.
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Is it true that there are more complications after weight loss surgery if I smoke?
| Dr. John Romanelli says: |
Yes, this is true. A recent study published in the Journal of the American College of Surgeons quoted an 18.8% overall complication rate in non-smokers who undergo gastric bypass surgery – a rate that increases to 26.7% in people who had smoked within one year of surgery.
Another recent study showed that the risk of developing an ulcer may be increased by as many as 30 times in smokers.
While there has never been literature to suggest that smokers do poorly after gastric banding, any good bariatric surgery program should include smoking cessation as a component to better health.
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I'm considering bariatric surgery for morbid obesity. How important is dietary counseling during the pre-certification process?
| Dr. Jay Kuhn says: |
In my opinion nutritional counseling is one of the most important components of the pre-certification process.
I also feel that spending time with a dietician who is familiar with the different types of procedures for obesity is vitally important after surgery to ensure you are losing the weight you want to lose and that you're losing it safely.
We've discovered in our practice that our patients who continue to work with our dieticians long after surgery are the ones who seem to have the greatest benefits with regard to healthy living and long-term high-volume weight loss.
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Gastric Bypass
I am having trouble deciding between gastric bypass and gastric banding surgery. What should I do?
| Dr. John Romanelli says: |
Both gastric bypass surgery and gastric banding surgery have been shown to help people lose weight. The amount of weight lost does vary between techniques, however, with most series reporting a higher weight loss result with gastric bypass.
The risk of complications is also higher after gastric bypass. In a sense, the gastric bypass is "higher risk, higher reward", and the gastric banding is "lower risk, lower reward".
Sometimes, there are medical reasons why one procedure is preferable over the other. A good, unbiased, informed discussion with your surgeon should take place before your operation to ensure the procedure selected is most appropriate for you.
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Lap Band
How do I know whether or not my Lap-Band needs to be filled?
| Dr. John Romanelli says: |
Adjustments to a Lap-Band are a decision that should be made between the surgeon and patient. This is why regular follow-up, preferably with the surgeon that placed the Lap-Band, is critically important.
Patients should be getting full after eating a small meal and be satisfied until the time of the next meal. Patients who are not losing weight and are hungry may need to be filled further.
Tighter is not necessarily better, however. A Band that is over tightened can cause maladaptive eating behavior to develop, and patients can actually gain weight. An over tightened Band can also be potentially dangerous.
Having a Band filled somewhere else other than your surgeon's office can lead to miscommunication between your care providers and lead to problems with the Band.
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