Everything You Never Wanted to Know about Weight-Loss Surgery.

Originally posted on my Face-book page.

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1:30 AM 10/19/2012 — I haven't weighed in on my weight loss saga in a while, and some recent conversations with people I've met along the way tempts me to vent on some issues that have been rolling around up there in my much smaller head—yes, believe it or not my head is a lot smaller, so much so that I've had to give away all of my hats, and I am a hat person.
     To set the record straight: I started the bariatric program at Sacred Heart Hospital at 302 pounds. As a result of the preoperative program, I was at 292 on the day of surgery, March 6th. Because I don't have an accurate scale, I can only estimate my weight today; but, based on the discrepancy the last time I was weighed by my surgeon and what my scale said that day, I estimate my weight today at around 155.
     Although these kinds of results are not necessarily typical, they are not unheard of, either. There are three different procedures available: (1) full gastric bypass, (2) gastric sleeve surgery (incorrectly referred to by some as a “stomach staple”), and (3) gastric banding (a.k.a. “lap-band”). My procedure was the first: full gastric bypass. Due to the amount of weight I wanted to loose, and the reason I had for wanting to loose it, it was the only procedure that was recommended for me. Let's compare and contrast them:


Official name: Roux-en-Y.

Can be performed lapacroscopically: In most cases, but not always.

Description: This is major surgery, even when performed laparoscopically. The stomach is divided into a large pouch and a much smaller pouch about the size of a golf ball. The large pouch is sealed shut and completely disconnected, never to be used again. The small pouch is then rerouted to a lower part of the small intestine, bypassing most of the upper small intestine. The weight loss, therefore, is the result of both the inability to take in more than a miniscule amount of food combined with the inability of the new intestinal track to absorb what is eaten. When performed laparoscopically, there are five incisions: four small ones on the front of the abdomen, and one large one near the colon.

Insurance company track-record: Almost always approved, with a mandatory waiting period of six months on average to allow for evaluation and pre-op education.

Advantages: Very rapid weight loss, with little chance of putting it back on. Following this surgery, there is no desire to eat, if you can believe that (but it happens to be true). For the rest of your life, the maximum amount of food you can eat at any one time is about 1/2 cup.

Disadvantages: The most invasive of the three procedures. Requires the most intense preparation. Results in the most dramatic changes in life-style. For those whose weight is related to psychological issues, there can be a concern regarding how they will react to never being hungry again, which is why a psych work-up is required beforehand. For the rest of your life, you must force yourself to eat, supplemented by vitamins and protein supplements. You'll need a full month afterward to recover.

Reversible: Officially, no, but my surgeon says yes, though no insurance company will pay to reverse it. While most of the stomach is isolated and most of the intestines by-passed, nothing is actually removed; so, it may be possible in some cases to simply reverse the procedure.


Official name: Sleeve Gastrectomy.

Can be performed laparoscopically: Yes.

Description: The stomach is divided and 75% of it is removed. What remains is shaped like a tube or “sleeve.” That's about it.

Insurance company track-record: Most insurance companies will initially question whether Roux-en-Y would be better, though it will usually be approved if there is sufficient reason not to pursue the more invasive one.

Advantages: Very simple surgery, with little recovery time or discomfort.

Disadvantages: Weight loss after this procedure takes a long time, not much quicker than you would get through diet and exercise. The chance of putting the weight back on is high, particularly in someone of less than optimal self-control. This procedure does not curb your appetite. The new stomach can easily stretch out to form a new full-size stomach in those who do not stick to the diet required afterward, making the whole thing a waste of time and money.

Reversible: No.


Official name: Adjustable Gastric Banding Surgery.

Can be performed laparoscopically: Yes.

Description: A silicon-filled band is placed around the stomach to create two pouches, a small upper one and a lower larger one. The band helps slow the emptying of the small upper pouch into the larger pouch, restricting the amount of food that can be eaten at one time, creating an artificial feeling of “fullness.” The tightness of the band is adjusted by injecting or removing fluid as needed through a port located just beneath the skin in the abdomen. Definitely not for anyone who doesn't like needles, as the necessary injections are frequent.

Insurance company track-record: The companies liked this procedure when it first became available, but have soured on it since due to its poor track-record and high incidence of complications. Many bariatric surgeons refuse to do this procedure, considering it a relic of the past.

Advantages: Not many, it spite of the fact that most bariatric patients seem to want it. This is usually because they don't understand it, thinking that it's quick, easy and non-evasive.

Disadvantages: Weight loss after this procedure is very slow. Post-operative complications are almost expected, given that a foreign object has been introduced into the body. A valve used to regulate the fluid in the band is located right under the skin on the abdomen, which requires regular injections of fluid to maintain. In an alarmingly large number of cases, the band becomes dislodged, which can cause pain or even death, requiring surgery to reposition or remove it.

Reversible: Yes, but most insurance companies will not pay to remove the band, even if they paid to have it inserted.

     You've probably guessed that I'm biased in favor of Roux-en-Y. Most of the people who show up to the Bariatric Support Group are women, and almost all of them are interested in what they call the “lap-band.” When they find out the lead surgeon in the department refuses to do it, they leave without wanting to hear about anything else. I've often speculated about why so many people think they want this outdated and risky procedure; I'm guessing it's because popular culture has convinced them that its easy, cheap and safe, none of which are true. I used to get the same kind of reaction when meeting new diabetics who tell their doctors that they'll do anything he says so long as they don't have to go “on the needle,” which almost always results in a short life-span which includes the loss of limbs and eyesight, all due to overly-obliging doctors who convince them that they can control it with diet and pills. I'm sorry, but anyone who told you that your Type 2 diabetes can be controlled with diet and pills is going to get you killed, no matter how “mild” your diabetes is. The same is true of bariatric surgery: no matter what you've been told, run from the “lap-band” as fast as your pudgy legs can carry you. Bite the bullet and go for the whole enchilada if you want real results that will really change your life.
     Here's a tip: When you talk to the shrink (which you will have to do before the procedure is approved), tell him you're doing it for health reasons. Never tell him that it's about your appearance. In my case, my spine had been so completely destroyed by my weight that I could no longer walk, and my diabetes was becoming so difficult to control that the pills and shots were starting to do more harm than good. Since surgery, I'm walking pretty well, albeit with the cane, but walking. My diabetes is still there, but seriously mitigated, with no shots and only one oral medication, and easily controlled. I went from two cholesterol medications to none, two blood pressure medications to none. Relatively speaking, I'm now a healthy person. My endocrinologist says I've added ten years to my life.
     Here's another tip: If you want to get rejected for bariatric surgery, tell the shrink you want to wear a bathing suit again, or want to walk down the isle with a flat tummy. And if you're a woman thinking that you'll be able to attract a mate once you're thin and attractive, keep in mind that most men are not really that shallow. Bariatric surgery doesn't correct personality defects, only physical ones.
     You might find this emphasis on psychology a bit over-the-top; but, in the early years of weight loss surgery, it was neglected with catastrophic results. If you're a psych student looking for a topic for your dissertation, consider the psychological effects of rapid and permanent weight loss in someone who was obese for most of his or her life. For those whose over-eating is psychological or compulsive, the question becomes what will replace eating as the primary source of emotional consolation or compensation, and will that replacement be a negative one, such as drinking or sex addiction or domestic abuse. It also raises an interesting dilemma: on the one hand, no weight loss surgery should be performed on someone who is not well-adjusted; on the other hand, no one could be said to be well-adjusted if he's spent most of his life auditioning for the title role in the re-make of Moby Dick.
     Here's a final tip: Be aware that the insurance companies have doubled-down in the question of plastic surgery after bariatric surgery, to wit, they won't cover it. If you want to remove the excess skin hanging on your arms and tummy after you've lost all that weight, you'll have to pay for it yourself. Some people will tell you that all you have to do is get your doctor to tell them you're getting infections and so forth, but it won't work; they know better. Since I'm not much of a beach person, and wasn't worried about my appearance in the first place, it's not an issue for me.