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Frequently Asked Questions


I have heard of a 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 which weight loss surgery I can have?


What happens if I eat sweets after I have a gastric bypass?


If I have problems after my weight loss surgery, who 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 having 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?


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 have heard of a 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 –  in that its primary function is to cause weight loss by restriction of the amount of food that you eat.

 

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Is it true that my insurance company may have a say as to which weight loss surgery I can have?

Dr. John Romanelli says:

All insurance companies differ based on which plan you have.  Some insurers fully cover weight loss surgery, some impose certain restrictions and others do not cover the surgery at all.  In order to determine if your insurance company covers weight loss surgery please call the insurance company directly. 

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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, who 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 having 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:

Internal hernias are spaces between loops of small or large intestine and/or the stomach that can develop after gastric bypass surgery.  The intestines can move into these spaces and become stuck (obstructed), which requires an operation to remove them and close the spaces.  They occur in about 5% of patients undergoing gastric bypass surgery.  These spaces are consequences of the new anatomy after gastric bypass and weight loss.

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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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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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