Monday, 13 June 2016

The 3 main types of Operations and their differences

I had a Laparoscopic Gastric Sleeve done July 2013. At one stage this was the first step a super obese patient would take so their weight would go down far enough for the surgeon to do a bypass operation that would allow the patient to get back to the "normal" weight/height ratio. After a number of years they decided that it could be a standard weight loss surgery in its own right with no further operation needed.

The 3 main WLS surgeries are:

  1. Roux-en-Y Gastric bypass
  2. Lap-Band
  3. Vertical Sleeve Gastrectomy.


Comparison Chart

These operations all work. They vary in the amount of weight lost afterwards, possible complications,  how the food you eat is absorbed and how much supplementation of vitamins and minerals you may need. The majority of weight loss will occur rapidly after the operations as you can only tolerate limited amounts of food and drink. The weight loss by the end of two years usually slows down and you head into a more maintenance phase. In New Zealand the Gastric Sleeve is more frequently done. 

It is a combination of the surgeon's ideas on the weight loss surgery they think is best for your problems and what your life is like/how it will be affected. It can depend on the amount of weight needing to be lost and the health problems caused by your excess weight. We all know that diabetes, heart problems, breathing problems, fertility problems, mobility problems and even some cancers can be affected by excess weight. The chances of dying earlier rise. The majority of people who try diet and exercise to lose large amounts of weight find it very hard to keep the weight off. Often they find they end up gain more than they lost. Mentally they feel a failure and get depressed. Your own body seems to work against you. Having WLS surgery gives a greater weight loss and if you do regain later on it is never as much as you lost. You can see the effects of the changes in diet and exercise you may make much more rapidly too.

Gastric sleeve

So, Laparoscopic Gastric Sleeve:
Between 60-80 percent of the stomach is removed. It is stapled and cut laparoscopically then removed through a large port site. This is the one that gives you some discomfort for a short while after the operation as there is often an internal dissolving stitch. The large area of the stomach that is removed means that you feel full very quickly. The fact you still have the rest of the structure means that the absorption of food is more normal. Some supplements are still needed as you can't eat enough food to get all the vitamins and minerals your body needs. Drinking alcohol will show up very quickly in how you feel. No more bingeing as even 1 drink will feel like 4 to you.

It cause changes to the levels of hormones made within your gut, you feel full for longer and it aids in the controlling of blood sugar. There is nothing foreign in your body. You can lose up to 50% of your excess weight and keep at least 50 % of that off. My own surgeon said that the minimum weight loss for her patients was usually 35kg (77 lb) and after that it was up to you and your actions. This is a major incentive as that much weight off can get you back out there allowing you to walk, swim, cycle or whatever exercise you enjoy. With the operation being done by laparoscopy the incisions are small and you can soon return to your normal life. If you don't want people to know they don't have too.

Lap Band

Next, Lap Band:
This is done laparoscopically as well. An adjustable band is place around the top area of the stomach. It is connected to an access port placed lower in the abdomen that is used to insert or extract saline to create a small pouch for your food. This limits severely how much you can eat and what sort of food will go through more easily. There is often a delay between insertion of the Lap Band and port to allow healing and insertion of the saline to create the pouch. The amount of saline can go up or down depending on weight loss needed or too much nausea and vomiting of the food you are eating. It is done by the doctor as needed. This means until the band has the saline put in you won't have weight loss occurring from the operation.


Gastric bypass pre- and post-op
Last, Roux-en-Y Gastric bypass:
This operation creates a small pouch of your stomach (by stapling) and then directly connects it to your small intestine. This often means that your weight loss is more and quicker as a large part of the digestion is no longer in use. Some loss of nutrition occurs needing supplements. You are more likely to get dumping syndrome with carbohydrates and high sugar foods.This is often used for people with the larger amounts of weight to lose. This can be done laparoscopically but may need to be done with open surgery (open meaning cutting a large site on your abdomen rather than 4-7 small slits for the laparoscope gear).

In my next post I will talk about the average weight loss from these operations and probably possible complication vs benefits. On the Internet there is a lot of information available about these operations and even Youtube has videos and animations that show you what happens.
https://www.youtube.com/watch?v=0RQzqUQ2QtU shows a gatric sleeve being done. Don't worry you are fully asleep while they are doing this. If you are squeamish don't bother but if you want to know what they have done within your body this will show you. Have fun researching the other.

When you go to see your surgeon have a written list of questions you may want to ask him/her. Take another person with you as they will remember things you don't. Don't be afraid to ask as they are happy when you understand what is ahead. Get through this and your life will open up for you. It is up to you as to whether you tell people or not. Some are supportive some are not. It may surprise you who is and who isn't. It is your life though. Who doesn't want to live longer than they might have? I want to live as long as I can and feel good while doing so. That is the main aim of weight loss surgery. To live a long healthy life filled with the things you enjoy doing and with the people you love.

Tell me about your operation and how it went, please.