Category: Lap Band
Weight Loss before Weight Loss Surgery?
October 19, 2014 2:54 pm
I am frequently confronted by the question “Are you going to make me lose weight before I have weight loss surgery”? My answer is no, for several reasons, it makes little or no sense and there is scant scientific data to support it.
1-Anatomical and 2-psychological-behavior related variables have been suggested as the reasoning for the recommendations for diet before weight loss surgery.
Let’s see what the scientific evidence says about this.
1-Liver can be divided into two anatomical lobes. The tail end of the left lobe may extend all the way to the upper left side of the abdomen covering the upper 1/3 of the stomach, the gastro-esophageal junction (GEJ) and the esophageal hiatus. It was suggested that the access to the GEJ could be made easier, if the left lobe of the liver was smaller.
“A decrease in the size of the liver by 18% was shown in patients who were subjected to a very low-energy diet for 12- weeks.” This was published by Colles et.al in a small study of 39 subjects.
It is important to appreciate that this reduction in liver size meant that a patient would have to tolerate an ultra low caloric diet (less than 500/day) for 12 weeks. The interesting observation was that even with this reduction in the size of the liver there was “… no difference shown in morbidity, mortality, hospital stay, and decrease in morbidity- associated diseases whether there is preoperative weight loss or not.”
2-Behavior modifications have been entertained as a necessary element to the success of adjustable gastric banding. Numerous studies have shown that there is no predictive value of preoperative weight loss in relation to the weight loss after surgery.
The overwhelming scientific data suggest that there is no value to subjecting a weight loss surgical patient to a pre-surgical ultra low caloric diet.
“The California Department of Managed Health Care recently conducted a review of weight loss prior to bariatric surgery and concluded that “there is no literature presented by any authority that mandated weight loss, once a patient has been identified as a candidate for bariatric surgery, is indicated. This comprehensive review states that mandated weight loss prior to indicated bariatric surgery is without evidence-based support, is not medically necessary, and that the risks of delaying bariatric surgery are real and measurable.” Published by the American Society for Metabolic and Bariatric Surgery in March 2011.
Slipped Band
November 02, 2012 10:40 pm
Yearly lab and medication requests
October 17, 2011 5:28 pm
First, we now have preferred laboratories that have partnered with us. The laboratory results are expected to be sent to us electronically, which should cut down on the time between the blood draw and when the results are available to us. The information on the preferred labs is located at: https://www.dssurgery.com/lab. Needless to say, there are no financial incentives for us. You should also check with one of the labs, as well as with your insurance company, to make sure that they are a contracted facility and that the order is covered under your policy. It is your responsibility to make sure that your insurance company will pay for the labs ordered. We are in no way responsible for the verification of benefits for the laboratory services that we order.
Second, we have had to change the way we order our yearly lab work. As most of you are aware, it is critical that weight loss surgical patients have continuous yearly follow-up care and monitoring. It is critical that the patients continue to receive yearly follow-up care, not only by doing their scheduled laboratory studies, but also by a yearly follow up in office exam. We provide a comprehensive follow-up plan to the patients who have had the the Duodenal Switch or Revision from other failed weight loss surgical procedures. This includes ordering the laboratory studies, review and interpretation of the results, as well as office visits as frequently as required or deemed necessary.
Vitamin D supplements
August 01, 2011 1:12 am
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
Vitamin A Deficiency Treatment
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.
Obesityhelp.com revision Forum information
November 08, 2009 9:00 am
I am not sure what has happened over the past two weeks or so, but I have received a number of inquiries from patients who have had questions about the revision of RNY or Lap Band® for weight regain, inadequate weight loss, or other complications. I finally had to ask one of the patients where he got his information and heard about our practice. His source of information was the obesityhelp.com website.
I have spent some time looking over and responding to several postings on the forum sites. I have referred to a number of publications in some of my postings on obsityhelp.com.
Nishie et.al. (Obesity Surgery, 17, 2007 1183-1188) reported:
“Pouch size area, measured by routine UGI on the first postoperative day does not influence short term postoperative weight loss. “
Cottam et.al. (Obesity Surgery 2009, 19:13-17) concluded:
“The level of restriction or the presence of stenosis achieved by different stapler sizes does not have a significant role in weight loss.”
O’Connor et.al. (Surgery for Obesity and Related Dis. 4(2008) 399-403) summarizes:
“With construction of divided, vertical, lesser curvature based small-volume (less than or equal to 20 cm gastric pouches, the actual size of the gastric pouch did not correlate with the %EWL at 1 year laparoscopic GB.”
I am a firm believer that the best patient is the most knowledgeable patient. It is always safer to spend as much time as needed to ask questions and investigate all options. If I can provide any information, please contact us at contact@dssurgery.com