Bariatric And Diabetes Surgery

Our team of specialists, including a nutritionist, radiologist, pulmonologist, cardiologist, and psychiatrist, will perform comprehensive medical exams and evaluations. You will also be asked to attend intensive education and support group programs to learn what to expect during and after surgery.

Board-certified skilled surgeons trained in advanced laparoscopic surgery and bariatric care will work closely with anesthesiologists and highly trained operating room staff who are familiar with the special needs of bariatric patients.

Nurses trained in post-bariatric surgical care will work to prevent and manage possible complications. The surgeon, bariatric nurses, and nutritionist will follow you carefully throughout recovery.

you must commit to making profound lifestyle changes. To help meet this challenge successfully and safely, you will be closely monitored for nutritional deficiencies and will receive free counseling to help you manage post-operative dietary requirements. You will continue to attend our free support group meetings.

Sleeve Gastrectomy

The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 75-80% of the stomach. The remaining stomach is a tubular pouch that resembles a banana.

The Procedure

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggests the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Advantages

• Restricts the amount of food the stomach can hold
• Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with the maintenance of >50%
• Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
• Involves a relatively short hospital stay of approximately 2 days
• Causes favorable changes in gut hormones that suppress hunger, reduce appetite, and improve satiety

Disadvantages

• Is a non-reversible procedure
• Has the potential for long-term vitamin deficiencies
• Has a higher early complication rate than the AGB
• Weights regain issue.

The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.

The Procedure

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 ml in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of the small intestine will eventually mix with the food.

The gastric bypass works by several mechanisms.

First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into fewer calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of the small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.

Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Advantages

• Produces significant long-term weight loss (60 to 80 percent excess weight loss)
• Restricts the amount of food that can be consumed
• May lead to conditions that increase energy expenditure
• Produces favorable changes in gut hormones that reduce appetite and enhance satiety
• Typical maintenance of >50% excess weight loss

Disadvantages

• Is technically a more complex operation than the AGB or LSG and potentially could result in greater complication rates
• Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate
• Generally has a longer hospital stay than the AGB
• Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance

Mini-gastric bypass

Mini”- gastric bypass is a newer operation that is also called by various other names such as “loop gastric bypass”, “omega-loop gastric bypass” or “single anastomosis gastric bypass”. It is a simplified version of the gastric bypass that has recently started to be performed in many countries around the world. Because of its more recent introduction, our understanding and confidence in its longer-term results are still developing.

It differs from a standard gastric bypass in that it involves the surgeon making a long sleeve a pouch of the stomach and only one joins between along stomach pouch and the small intestine. here small intestine is bypassed around 200-300cm according to the patient morbid obesity and metabolic syndrome. It functions in almost an identical way to the standard gastric bypass. Because of the absence of a second join, there is a slightly higher risk that some patients will experience troublesome reflux after this surgery. But also, because this second join is not present, it reduces the risk of longer-term complications such as intestinal obstruction. It is also quicker and easier to perform than standard gastric bypass. Many weight loss surgeons around the world are now starting to report their experience with the mini-gastric bypass and the results are very similar to standard gastric bypass and sleeve gastrectomy. We expect that this type of surgery will become more widely used over the next few years.

Lap Sleeve Gastrectomy with Proximal Jejunal bypass: [LSG+PJB]

It is a novel technique of restrictive+malabsorptive procedure, a simpler and effective alternative to RYGB, with comparable short-term results. The procedure involves performing a regular sleeve gastrectomy with the addition of proximal jejunal bypass of 250-300 cm from the angle of Treitz and making anastomosis of jejunoileal anastomosis. The procedure is very safe and effective as a revision bariatric procedure for a failed sleeve gastrectomy or as a primary procedure in a patient with a BMI>45 in place of LSG.

Loop Duedono-Jejunal bypass with Sleeve gastrectomy [LDJB-SG]:

Sleeve gastrectomy with Loop Duodenal-Jejunal bypass– abbreviated as LDJB-SG is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.

The Procedure

First, the conventional sleeve gastrectomy was done. after that, the duodenum (the first portion of the small intestine) is divided just past the outlet of the stomach. A segment of the distal small intestine- distal jejunum (200-300 cm ) is then brought up and connected as omega loop fashioned to the outlet of newly created cut part of proximal duodenum so that when the patient eats, the food goes through a newly created tubular stomach pouch and duodenum, then empties directly into the last segment of the small intestine. Roughly 200-300cm of the small intestine is bypassed by the food stream.

Similar to the other surgeries described above, the LDJB-SG initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat-soluble vitamins and nutrients).

Lastly, the LDJB-SG, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The LDJB-SG is considered to be the most effective surgery for the treatment of diabetes among those that are described here.

Advantages

• Results in greater weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at 5 years follow up
• Allows patients to eventually eat near “normal” meals
• Reduces the absorption of fat by 70 percent or more
• Causes favorable changes in gut hormones to reduce appetite and improve satiety
• Is the most effective against diabetes remission and control compared to RYGB, LSG, and AGB
• No dumping syndrome and reflux issue.

Disadvantages

• Requires a longer hospital stay than the AGB or LSG.
• Long-term deficiencies of vitamins and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D.
• Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies.

BIMS Bariatric Surgery Program is pleased to provide patients, family, and friends with educational and support tools to help you maintain a healthy lifestyle. Support groups offer continued education through distinguished speakers and other post-surgery patients. The groups build a community for mentoring, additional support, and accountability.

Support group educational and fun events are coordinated by a licensed therapist. These groups can help you learn what to expect before, during, and after your surgery. We offer in-depth educational workshops on such topics as body image, weight maintenance skills, and relapse prevention. Specific groups for men, singles, couples, and families are offered.

Fun and interesting events planned on a semi-annual basis may include fashion shows, cooking demonstrations, and food shopping tips, a field trip, and holiday celebrations.

For convenience, evening support groups are held at several locations in the Dallas area. You may attend these support groups as often as you’d like at no charge.

• All patients are required to attend at least two before being scheduled for surgery
• Occur about every 2-4 weeks
• You’ll hear presentations made by clinical providers
• You’ll get answers to your questions and concerns
• You’ll learn about making positive changes to your eating
• You’ll learn what to expect after surgery
• Patients who already had the surgery answer your questions

• Offers a helping hand after your surgery
• Sessions dedicated to emotional issues
• Sessions dedicated to nutritional plans, concerns, and sharing of tips

Long-term follow-up care is the key to having the best outcome after bariatric surgery. Long-term success also depends on making life-long lifestyle changes, like diet and physical activity. Having regularly scheduled medical follow-ups will help you not only learn how to make these changes but sustain them as well.

Nutritional needs also change as weight loss occurs, and diet adjustments often need to be made without delay. Checking for and treating any vitamin and mineral deficiencies is also a must. Always check with your doctor before making changes to your diet, vitamins, and medications. Seeing your clinical team regularly allows them to work with you and provide excellent care.