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Month: May 2011

Is my weight loss surgery reversible?

May 23, 2011 2:39 am

“The LAP-BAND® System is reversible and, if necessary, can be removed — with the stomach usually returning to its original shape.”

This is a direct quotation from the manufacture’s website. It is a statement of its reversible state that is usually used to promote the adjustable gastric banding procedure compared to other surgical alternatives. In my practice I am a very strong advocate of the Duodenal Switch operation and as a distant second, I offer Sleeve Gastrectomy. I do not offer or recommend the Gastric Bypass (RNY, proximal or distal) procedures because of their well known complications of dumping syndrome, weight regain, inadequate weight loss, as well as anatomical complication of stricture or marginal ulcerations that are seen.

I would only assume that the reversibility issue is to be discussed if the procedure is expected to fail frequently . As a surgeon who performs the duodenal switch operation as a primary weight loss surgical procedure, I have rarely had to reverse the procedure. In my opinion, the physiologic reversal of the duodenal switch operation is by far the easiest of all surgical procedures. It involves creation of a side-to-side anastomosis between the alimentary and the biliopancreatic limbs.

The following are images of a Lap-Band® being removed because the patient kept suffering from persistent nausea and vomiting. The operation was performed laparoscopically. The operative finding identified a significant amount of reactive tissue (scar formation) that represented substantial difficulty in the operating room from a technical point of view. The long term damage done to organs by the Lap-Band makes it not easily reversible.

My recommendations for any individual considering a weight loss surgery is not to focus on the ease of reversibility of the procedure, but rather its long-term outcome data as the basis for choosing an operation.

Does duodenal switch correct dumping syndrome and the hypoglycemic complication of The RNY-gastric bypass, and it variations? A patient’s story

May 20, 2011 7:13 pm

On 10/28/2009 I had a variation of the RNY gastric bypass known as the Fobi pouch. I lost over 270 pounds, but I had debilitating complications of dumping syndrome, reactive hypoglycemia, acid reflux and vomiting.

My entire day was pretty much controlled by dumping syndrome. Due to the hypoglycemic episodes that resulted from dumping syndrome, I was constantly in a binge cycle, because I constantly needed to stabilize my blood sugar. I would eat breakfast and need to lay down. Once I started having hypoglycemia, I would get up and splurge on carbohydrates.

Note that my dumping syndrome was not caused by poor food choices. I only splurged off carbohydrates in a desperate attempt to quickly get my glucose levels up. This did work, but it lead me to dumping syndrome again. I then had another episode of hypoglycemia, which lead to more binging which resulted in more dumping, more binging and weight gain. Here is a diagram of the cycle I was constantly in:

Eat –> dump –>hypoglycemia –> binge –>redump –> more hypoglycemia –> binge –> dump

This was a constant cycle I was in, and as you can see here, my entire life became controlled by dumping syndrome, and it eventually caused me to become disabled. I am a full time student and was not able to go to school in this state. I would eat lunch and then go to class only to start dumping ten minutes into lecture, and I ended up dropping my classes for the semester.

I went to my bypass surgeon and told him of the problems I was having, and he told me that I was anorexic. I was also told that it was “…all in my head.”

After doing much research, I consulted with Dr. Keshishian. I handed him a list with the problems I was having and asked if revision to the duodenal switch would resolve these problems. Dr. Keshishian drew out a diagram of the anatomy of my surgery and showed me exactly why I was having these complications. I remember him saying, “There is a physiological explanation for why you are having these problems. It is not in your head. Yes, revision will resolve these complications.”

I had my revision on 4/11/2011, and all the complications I had with my bypass have been resolved, and I have had no complications with my duodenal switch. Now that my pylorus is working again, I can eat without becoming ill. I have now gone back to school, work, and have resumed back to a normal life.


Vitamin A

May 17, 2011 7:20 pm

Vitamin A occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Disorder yellow and red carotenoid pigments can be changed to vitamin A in the liver.
A number of functions for vitamin A have been found, including defense mechanisms, maintenance of healthy epithelial tissues, and most importantly, a function in the visual system.  A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle.  A deficiency may also represent a decreased visual acuity, and more specifically, night blindness. This was found in a patient who complained that they were unable to read a particular sign at night while driving, but was able to read it during the day
Over the last few decades, the incidence of vitamin A deficiency in the United States has significantly decreased. It is only when the patient shows signs and symptoms associated with the malabsorption of fat soluble vitamins that he or she may be diagnosed with a deficiency.

Vitamin A Deficiency Treatment

Injectable Vitamin A
When a patient is diagnosed with a deficiency, the treatment will require aggressive oral supplementation. For cases in which vitamin A levels do not respond to “Dry” Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize their level, as well as resolving the symptom of night blindness.
When taking oral vitamin A, it is important for patients who have had the Duodenal Switch operation to specifically look for a “Dry” or water miscible form. This is to maximize the amount of vitamin A that can be absorbed even in the presence of reduced fat absorption.