Questions

Does Dr. Sweet do laparoscopic gastric bypass? Compare laparoscopic gastric bypass (lap GB) to Dr. Sweet's "micro-pouch" RYGB.

Dr. Sweet has chosen not to do lap GB. The rationale for a lap GB has been that it cuts down the incidence of wound infections and incisional hernias in "open" series. Dr. Sweet's rate of wound infection is less than 1%, and he's had only one incisional hernia in his series of more than 400 GB patients, dating back to 1995.

Experience in bariatric surgery has documented that smaller initial pouch sizes generally dilate less. Dr. Sweet typically makes pouches of 5 ml (one teaspoon); laparoscopic pouches are generally 20-30 ml.

Lap GBs are longer operations, averaging over four hours and 15 minutes in the data of the Pittsburgh group in their first 230 patients. The anastomotic leak rate for lap GB ranges widely, especially depending on a surgeon's experience. Initial series results have been reported as high as 7%. Dr. Sweet has not had a patient with a leak.

Recently submitted data by the Richmond group documents marginal ulcers (ulcers occurring at the stapled anastomoses between the pouch and the bypass segment) at a rate of 15% in their lap RYGB series, and outlet stenosis (narrowing of the anastomoses resulting in excessive vomiting, requiring endoscopy and dilatation) occurring at a rate of 25%. Dr. Sweet has had two patients with an ulcer, and none with outlet stenosis, in his open GB series. Ulcers frequently necessitate long-term medical therapy, and occasionally, surgery that is technically difficult. Generally, the larger the pouch, and the greater its length down the lesser curvature from the esophagus, the greater the acid output in the pouch, and ultimately the ulcer risk. Dr. Sweet makes a very small pouch, with the lesser curvature length of the pouch not more than 1 cm. That small a pouch, with that configuration, is generally not accomplished by most surgeons laparoscopically.

What do I have to do after bariatric surgery?

Generally, the patients who lose the most weight work hard at increasing their exercise patterns in the first 6 months especially, and then maintain a regular exercise habit at least four days per week. In addition, they focus on eating wholesome foods-not fast foods-at mealtimes, stick to no or low-cal drinks, and control their snacking. Also, individuals who attend the Surgical Weight Loss Center Support Group tend to do better than those who do not.


Will I be less hungry after surgery?
Most individuals, especially those who have had gastric bypass, find that they feel full, or satiated, longer after eating. They do so by drinking very little during and just after, meals. Instead they drink between and before meals. Avoiding drinks high in artificial sweetening is important because they are appetite stimulants. Also, some find that their tastes for sweets often diminish. There are some people whose lifelong compulsions to snack may continue even if they are not hungry. Counseling may be recommended to help these people achieve their goals for weight loss and improved health.

What is an appropriate follow-up schedule?

Within the first six weeks of the operation, two visits are recommended. After these initial visits, patients are advised to return at six month intervals in the first two years, and annually thereafter.

How long will I need to be out of work?

Most individuals return to work within two to four weeks following the operation. Those with jobs requiring vigorous activity are back generally in six weeks.

Will my health plan cover bariatric surgery?

Most traditional indemnity plans will cover both the physician (surgeon and anesthesiologist) and related hospital expenses. HMO coverage is quite variable. Your best bet is to check with your benefits office at work, or contact your health plan directly. We will also answer your questions, and see what we can do to make sure you are eligible, and to pursue an appeal if necessary.

How do I know if bariatric surgery is a good option for me?

Candidates for bariatric surgery should be 100 pounds or more overweight, have tried unsuccessfully to lose weight through diet and exercise, and may also have medical conditions associated with excess weight. If you meet these criteria, please contact us. First, you will talk with our program coordinator-a person who has successfully undergone bariatric surgery-who will answer your questions, and help you decide if you want to learn more at a free informational meeting. If you decide to pursue surgery, we make an appointment for you to meet with Dr. Sweet and the staff of The Surgical Weight Loss Center.

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