This is David Kelly, again, director of the metabolic and bariatric surgery program here at OSF.
In this video, we'll be talking about types of weight loss surgery. So do you qualify? To qualify for bariatric surgery
you have to be have a BMI over 40 or a BMI of 35-
greater than 35, with an obesity related disease, specifically diabetes, high blood pressure, high cholesterol or sleep apnea.
Other requirements include being healthy enough to undergo a major operation. Had failed other attempts at medical weight loss.
Understanding the diet and exercise plan required. Able to buy vitamins, sometimes can be 40 dollars or more per month.
Understanding the surgery and the risks related to it.
Absence of drug use and alcohol problems. No uncontrolled psychological condition. You must be approved by a multi-disciplinary team.
Minimally invasive surgery can be done by a laparoscopic or robotic techniques.
Gas is used to create space inside your abdomen and a laparoscope or a camera is used to view the internal organs.
It's the same operation as the old open surgery, except using smaller incisions.
It's a less invasive approach. There are typically five to six small incisions, somewhere between a quarter to one inch in size.
The benefits of minimally invasive surgery over the open procedures are less pain after surgery,
more rapid recovery, smaller scars, fewer wound infections or problems related to the wounds.
A lower chance of a hernia developing and decreased mortality.
The sleeve gastrectomy, or gastric sleeve, has become the most popular bariatric procedure worldwide
over the past 15 years. It involves removing nearly 80 percent of the stomach and turning
the stomach from a football sized organ into a tubular pouch that resembles a banana.
This leaves the stomach with less room for food, but more importantly, it affects the gut hormones that affect hunger,
the sensation of fullness, blood sugar control and many more to help reduce your set point.
The pros of gastric sleeve offers effective and sustained weight loss, improvement and the metabolic syndrome and obesity related diseases.
It is the first step towards the duodenal switch, if you are unable to lose enough weight or if your medical issues present a long term problem.
It is essentially normal anatomy still, just with a smaller stomach and that you may continue to take instead type NSAID medications,
going forward. The cons to this procedure, it's not reversible.
There's less long term data than the gastric bypass. There is an increased risk of gastric reflux.
The risk because of that increased risk of gastric reflux,
there is an increased risk of esophageal cancer if that reflux remains untreated.
We'd like to intermittently surveil the lower esophagus to make sure that you don't
have any signs of silent reflux that can lead to esophageal cancer down the road.
It's less- slightly less metabolic and obesity related diseases are affected than in the bypass.
So you have slightly less resolution of your diabetes or your high blood pressure or other diseases like that.
The roux-in-Y gastric bypass or gastric bypass is the gold standard for weight loss surgery due to its lasting popularity and reproducible results.
It has long standing results since the 1950s, and it has been the most performed bariatric procedure in the world.
This procedure is performed by making smaller new stomach pouch about the size of your fist after we're done, out of
the old stomach and then the first part of the intestine is brought- is divided and brought up to this new stomach.
The divided intestines are put together downstream.
This allows for food to bypass the stomach and the first part of your intestines where it meets the digestive juices,
where the intestines are put together. And from there on, the food gets absorbed throughout the latter part of the intestines.
There's long term data showing the benefits of long term sustained weight loss with immediate,
strong metabolic changes that immediately improve obesity related diseases.
For both the gastric bypass and the gastric sleeve, most of these patients, if they came in with diabetes,
a lot of them will leave off of all of their medications and essentially cured of diabetes.
This procedure also affects the gut hormones that affect hunger, the sensation of fullness,
blood sugar control and many more to help reduce your set point.
The pros to gastric bypass. It effects-
It's effective and it causes sustained weight loss. There is lots of long term data on it.
It's been around since the 1950s. There are strong and immediate improvement in the metabolic syndrome and obesity related diseases.
It is potentially reversible.
Cons to this procedure. You may never take NSAID type medications or use tobacco products due to the risk of marginal ulceration.
Marginal ulcers will form at the point where we put the new stomach to the intestines.
The intestines in this region do not have the same protective mechanisms that the proximal intestines right next to the stomach do.
And because of that increased acid exposure and medications that decrease the blood flow to them,
which include NSAIDs and tobacco products, will cause ulceration of this tissue.
And that ulceration can cause debilitating pain.
It can bleed and it can perforate. There is a higher risk of vitamin deficiencies and anemia than compared to the gastric sleeve.
And there's a higher risk of dumping syndrome, dumping syndrome that's characterized by nausea,
flushing and sweating, light headaches and watery diarrhea.
This is typically managed by adjustment in the diet to avoid high carbohydrate meals and eat slower.
The bilio-pancreatic diversion with duodenal switch, or the "DS", or the "switch", is the strongest bariatric procedure that we perform.
It has the strongest weight loss and metabolic effects of any of the procedures that we do today.
But also causes the most nutritional and vitamin deficiencies.
The first stage of this procedure is performing the sleeve gastrectomy. At a separate procedure,
the duodenal switch is performed dividing the small intestine just past the outlet of the stomach, the segment of the last portion of the intestine
is then brought up to the stomach. And this is done in either a loop, or in a roux-en-Y fashion.
The procedure bypasses the vast majority of the intestines and leaves a short segment of the intestines to absorb nutrients.
This procedure also affects the gut hormones that affect hunger, the sensation of fullness, blood sugar control and many more to help reduce your set point.
The pros to the duodenal switch, the greatest- it's the greatest effective and sustained weight loss procedure that can be offered.
It's able to- You are able to eat more normal sized portions and meals than compared to the gastric sleeve or the gastric bypass.
But you should still reduce total portion size going forward.
The strongest and immediate improvement in metabolic syndrome and the obesity related diseases.
The cons to this procedure. There's higher operative risks for the procedure.
It's the highest risk of nutritional and vitamin deficiencies. You must take extra vitamin supplements that can get rather costly over the long run.
There is potential for frequent diarrhea and bloating after the procedure.
It is not reversible, but it is adjustable. Revisional or conversional bariatric surgery is the largest growing field in bariatric surgery today.
Whether you think you may need to be considered for revision because of a complication of your initial surgery,
inadequate weight loss or weight regain or worsening of your obesity related diseases.
We are here to discuss your options with you. With proper treatment and follow up or revisional surgery is usually not needed.
Most of the time, we are able to find a way to medically treat patients and avoid an operation, but sometimes a revision is necessary.
I received my training from the most active revisional bariatric surgery program in the country.
We received patients that required a revision from all over the country.
Now, I have a knowledge and skill to help you with this if it's if it's necessary.