- [Instructor] Welcome to the University of Michigan
Adult Bariatric Surgery Program.
We offer a comprehensive
and personalized weight loss surgery program
designed to help you reach your goals.
Success starts by learning more about obesity,
understanding the risks and benefits of surgery
and committing to lifelong habits
to improve your overall health.
Let's start with the facts.
Obesity is really common in the United States
and about 1/3 of people in Michigan
are living with obesity today.
As a result, many people are suffering
from diseases related to being obese.
These include diabetes, heart disease, high cholesterol,
sleep apnea, arthritis, fatty liver disease,
infertility, and even certain cancers.
It's clear that when you lose weight,
you can improve your overall health,
reduce your dependence on expensive prescription medication,
and even extend your life.
In fact, the National Institutes of Health
recognizes that bariatric surgery
is the most effective treatment for morbid obesity.
We perform two bariatric procedures
at the University of Michigan,
a gastric bypass and the sleeve gastrectomy.
Gastric bypass is also known as the Roux-en-Y gastric bypass
and the sleeve gastrectomy
is also known as the vertical sleeve gastrectomy.
Both of these procedures are performed laparoscopically,
which means we make small incisions along the abdominal wall
and use the camera and instruments to perform the operation.
It is very similar to gallbladder surgery
and removing your appendix.
Using these advanced techniques
results in shorter hospitalizations, quicker recovery
and less complications when compared to procedures
that were performed with a large incision.
If you've had previous surgery, like a C-section,
hysterectomy, or gallbladder removal,
it's important to know that in many cases,
bariatric surgery can still be performed laparoscopically.
So let's discuss each operation in a little bit more detail.
The first type of bariatric procedure we perform
is the sleeve gastrectomy.
In this operation we use special surgical staplers
to divide 80 to 85% of the stomach and remove it completely.
The operation is done under general anesthesia
and usually takes about one to two hours.
The hospitalization is two to three days typically,
and most people lose about 55 to 65%
of their excess body weight.
Depending on how much you weigh,
this is usually around 60 to 100 pounds.
It's important to know that weight loss is maximized
at one year after the procedure is performed.
Overall complications are low
and similar to that of gallbladder surgery.
Major complications such as leak
or bleeding along the area that is stapled is also low.
Remember that this operation is not reversible
since the stomach is removed completely from the abdomen.
It is also important to know that in some patients,
this operation can result in heartburn.
This animated video will provide you with an opportunity
to see how the procedure is performed
and how food will travel through the stomach
after a portion of it is removed.
The second type of bariatric procedure we perform
is the gastric bypass.
This operation is more involved
but it's still performed laparoscopically.
With this procedure, the stomach is divided
using surgical staplers
and separated from the remaining stomach,
thus creating a small gastric pouch.
This is about the size of an egg.
Next, the small intestine is divided
midway down the intestinal tract
and then connected to the stomach.
So when you eat food,
it goes straight into the small intestine
and this bypasses the stomach
and first part of your intestinal tract.
Bile, pancreatic and gastric juices
are still being made and they continue to pass
through intestinal tract as before.
This operation is also performed under general anesthesia.
But the operation is longer,
usually about two to three hours.
Most people lose about 65% to 75%
of their excess body weight or about 100 to 150 pounds
depending on how much they weigh before surgery.
As with the sleeve gastrectomy,
maximum weight loss happens at one year.
When compared to sleeve gastrectomy,
gastric bypass has a higher complication rate,
but overall major complications are still low.
One important difference to remember
is that after gastric bypass surgery,
some people can develop an ulcer
at the connection between the stomach
and the small intestine.
The risk is usually low, less than 5%.
But it's most common in people
who decide to smoke after surgery
or those who take nonsteroidal anti-inflammatory medication
like Motrin, Advil, aspirin or ibuprofen.
So after gastric bypass,
you can never take these medications again.
Other issues that are unique to gastric bypass surgery
is dumping syndrome, which results in sweating, diarrhea,
and gastrointestinal discomfort
as a result of eating certain foods
that are high in sugar or fat.
This often improves with a change in diet.
Finally, in rare instances,
some people can develop an internal hernia after surgery
that causes a serious blockage of the intestine.
This usually requires surgery to correct.
Together with diet and exercise,
bariatric surgery is extremely effective
in achieving weight loss.
However, it is not exactly clear why it works much better
than diet and exercise alone.
With a smaller stomach, many people do eat less
and there may be some decreased absorption of some food.
But recent research shows that these operations
fundamentally change your body's regulation
for gaining and losing weight.
In many cases, surgery changes tastes
and cravings for certain foods,
and even changes how you process these foods.
For some, the operation can cure diabetes
even before the weight loss is achieved.
However, in a small number of people,
bariatric surgery does not result in successful weight loss,
and in other cases,
some experience significant weight regain.
It is difficult to know why this happens exactly.
But it often has to do with our food choices,
our exercise tolerance,
as well as our genetics, gender and age.
For others, taking certain medications
or being ill for other reasons
may prevent the body from achieving maximal weight loss.
After surgery, most people stay in the hospital
for two to three days and are then discharged to home.
Main restriction is to avoid heavy lifting.
However, you can resume many of your usual activities.
Since the incisions are closed with absorbable suture
and covered with a waterproof dressing, you may shower.
You can also walk up steps and stairs
and we encourage you to walk
at least 30 to 45 minutes a day after surgery.
Driving is restricted
so long as you're taking narcotic medications.
The first follow up visit is two weeks after surgery.
During that visit, your surgeon and your dietitian
will see you in clinic.
You will follow up in clinic two months
after surgery as well
and again be seen by your surgeon and dietitian.
We usually get lab tests during that visit as well.
At the six month and yearly visit,
you will be seen by our physicians
in the Metabolic and Endocrine Clinic at Domino's Farms.
Using our multidisciplinary approach,
these doctors will work with you
to make sure you achieve your long-term weight loss goals.
The diet after bariatric surgery is very specific
and one of the most important parts to being successful.
Before surgery, you will need to be
on a calorie restricted high protein diet
for two or four weeks,
after surgery your diet will progress
from liquids, to purees, to soft foods
and ultimately to solid foods.
Our goal is for you to eat 70 grams of protein each day
as well as drink 64 fluid ounces.
This is not a simple task
and after surgery, sweets and carbonated beverages
are not tolerated at all.
It is also important to know that after bariatric surgery,
vitamins are not absorbed in the same way,
so it's important to take supplements.
As you can see the vitamin supplementation
includes a multivitamin, vitamin B12, and calcium.
If you have a gastric bypass,
you will need to take more supplements.
So what is the best procedure for you?
Well, in trying to answer this question,
you must always balance
the risks of complications with surgery
with the benefits of weight loss.
In order to help with this decision,
we use a special calculator
that give you the results of surgery
in other people who are just like you.
So each person that goes through our program
will get a personalized risk benefit profile
that gives us the best guide
for which surgery is the safest and most beneficial.
So before considering bariatric surgery,
it is important to think about your goals.
In many cases, the amount of weight loss is not as important
as the reduction of comorbid conditions,
improved mobility and cutting out prescription medication.
Regardless of procedure, undergoing bariatric surgery
is a life changing experience
that requires a careful consideration of your overall health
as well as understanding of the non-surgical alternatives.
If you're struggling to lose weight
after multiple attempts, are over the age of 18
and are willing to make lifelong commitment to your health,
bariatric surgery may be for you.
In order to be a candidate for surgery,
you'll need to first calculate your body mass index or BMI.
This can be done from our website calculator.
You're a candidate for surgery if your BMI is over 40
or if your BMI is over 35
and you have certain weight-related illnesses
like diabetes or high blood pressure.
You will also need to be able
to tolerate general anesthesia,
you must be able to walk to your clinic visits
and also commit to a daily exercise program.
Finally, you'll also need to commit
to lifelong dietary changes
and stop using any form of tobacco product
as we are a substance free program.
The road to surgery is not always simple,
but we're here to help.
It starts with watching this video,
as it gives you the necessary information to proceed.
After careful consideration, the next step
is to schedule a medical and dietary evaluation.
Once these are complete,
you'll need to schedule a psychological evaluation next.
Since we wanna provide a comprehensive approach to your care
each one of these evaluations is mandatory.
After these initial evaluations,
our multidisciplinary review committee
will assess your candidacy for surgery,
and we may require additional task for you to complete.
These often include cardiac clearance, labs, endoscopy,
or other imaging studies.
You will receive a personalized letter
that will include your risk benefit profile,
detailing your estimated weight at one year after surgery,
as well as your risk for complications.
Finally, this letter will also include
additional requirements and some recommendations
that will be presented in a checklist format.
We will also ask you two attend to support group meetings
so that you can meet other people
that have undergone surgery.
This is really important to fully understand
the lifestyle changes necessary after surgery.
For some people, your insurance carrier
may also require that you undergo three, six or 12 months
of medically supervised weight loss documentation
before undergoing surgery.
Once all these requirements have been completed,
you will undergo a separate nutrition class
that will detail the pre and postoperative diet.
You'll also meet with your surgeon in clinic
so that you may ask them specific questions about your care.
Finally, you will undergo a pre-operative history
and physical exam in which our anesthesiologist
will make important recommendations
about which medications you will need
the night before surgery.
Insurance coverage for bariatric surgery varies,
so it is important that you contact your own provider
to get the specific details.
In order to help, we've provided a list of questions online
that you can use when you contact your insurance carrier.
It is also important
to document medically supervised weight loss appropriately.
So we've provided a sample form online
in order to help you do this.
Ultimately, we want you to succeed.
And in order to ensure your success,
we offer a comprehensive approach
with a multidisciplinary team of experts.
Our experienced surgeons are trained
in bariatric procedures,
and are always available for emergencies,
providing coverage 24 hours a day and seven days a week.
We also offer a secure online site
with resources at your fingertips,
as well as a weight loss conditioning program
that is designed for your needs in mind.
Finally, we also offer a specialized nutrition program
that explores core reasons
for overeating and emotional eating.
Our clinic is located at Domino's Farms
and surgery is performed at the university hospital.
If you're interested in taking the next steps
towards undergoing bariatric surgery,
please answer the quiz questions below
and provide us with contact information
so that we may schedule your first evaluation.
If you'd like to learn more,
you may attend an informational meeting.
This is a two hour group session
that allows you to meet one of the surgeons
as well as dietitians.
You'll be given the opportunity to ask general questions
about surgery as well as our program.
Thanks for listening and we look forward
to helping you lose weight and improve your health.