Lap-Band, Roux-en-Y gastric bypass, or duodenal switch? They can all be done laparoscopically. That is what my partners and I specialize in.
which is the best ?
Haglet, that discussion is far beyond the scope of this chat room. Look over my website for a more comprehensive discussion. Good Luck.
ok..thanks
what is your website ?
www.LapSF.com
KIMWARD, YOU HAVE THE NEXT QUESTION.
Dr. Cirangle I am 36yr/ 5'3"/ 230lbs/ BMI 40.9 - do you recommend LAP BAND over LAP RNY for my configuration? And does Hypothyroidism play a BIG role in failed diet attempts
Hi Kimward...
hello
You will do fine with either the Lap Band or RNY...It depends on your motivation...
I am worried that my thyroid will slow me down..that so?
Kimward, the Lap-Band operation requires a person to use the sensation of early fullness to stop eating... However it does not prevent a person from absorbing/digesting liquid sugar foods such as milkshakes, honey, ice cream, etc. If you do ingest these types of food, you would not lose any weight. For patients who undergo the gastric bypass, the dumping syndrome that occurs in many patients limits that kind of food intake. Good luck.
Thank you Dr. Cirangle >^,,^<
DOLLIE, YOU HAVE THE NEXT QUESTION.
does zoloft affect the way you are put to sleep in the o.r.?...........
No.
KERRIANN, YOU HAVE THE NEXT QUESTION.
Hello My name is kerriann.. My surgery is sceduled march 27th.. My doctor waits till time of the surgery to decide if he is going to do proximal/ or Distal.. do you know which is better or is there one choice better than the other.. what criteria do you use to choose distal or proximal?. My weight is 356, and i am 30 years old.
Each surgeon has a different definition for proximal or distal. In general,... If your BMI is greater than 50, surgeons may perform a distal gastric bypass (Roux limb at 150cm)...For all of my patients, I choose to do a standard length.In a study performed in open gastric bypass patients in the 90's, for patients with a BMI >50 those who had a limb at 150cm lost more weight than those at 75cm. However, those who had the 75cm did not lose as much as many of my patients. I had a patient who saw me today who lost 69 pounds at 3 months after a gastric bypass. Starting BMI 41, now 29. She and I are very happy
My BMI is 54.. thanik you for answering my ?'s tonight doctor
MARY MT, YOU HAVE THE NEXT QUESTION.
Hi Dr. Cirangle, I have glomerul necrosis, from unknown origin.. my only clinical manifestation is proteinuria (.9g/24hours down from 5g/24 hours) and HTN.. other than watching my protein intake.. monitoring my BP.. and labs.. is there anything else specific that i should monitor post surgery?
.
I don't have any patients with glomerular sclerosis...I have all my patients take 70g of protein a day...
my nephrologist has limited my protein intake to 1g/kg. and that's generous..
Does he know you are having surgery? I don't have any patients who have to limit their protein intake....
yes and supports it whole heartedly.. and i don't think i'll get below 70kg.. so it probably won't affect my protein intake..i guess i just wonder if the malabsorption will have any effect on my kidneys
I would be worried about malnutrition and balancing that with limiting protein.... There is minimal malabsorption in the gastric bypass operation. Drink lots of liquids every day. Good luck.
yes.. i'll have my labs looked at more frequently than most pts i';m sure, thank you Dr. Cirangle
KATHYMM, YOU HAVE THE NEXT QUESTION.
Hi Dr. Cirangle! I have had a total hysterectomy with ovaries removed and I am on Premarin .625. In general, should I expect to see a big difference in the symptoms of menopause after the RNY WLS? I am only 40 yrs old.
Hi KathyMM, Good question. I don't believe that there will be any significant differences.
< KathyMM> Thank you...don't care for those hot flushes!
MOM LAVENDAR, YOU HAVE THE NEXT QUESTION.
What is the 5 year post op weight loss maintaninence prognosis? - 10 year? I'm 5'2", 320 lbs, and seriously considering surgery.
It depends on the type of surgery you undergo. My website is pretty clear on the details of the expected outcomes for each of the procedures we perform laparoscopically.
Basically, I guess I'm curious if the weight loss stays off - or if it is gradually regained??
Again, it depends on the type of procedure. Which one are your interested in asking about?
The doctor was talking about the RnY - I think I have that right. He though it would be better for me then the banding type
I had a patient of another surgeon email me the other day. She said that she never had dumping after her gastric bypass... and has regained all her weight, but...she can eat a 13inch cheesecake without trouble.
YIKES!!!!!
Imagine how much weight you can lose with that kind of diet. Of course she hasn't lost any weight long term. Obviously, she did not receive the proper counseling before or after surgery. For all of my patients, I emphasize that I provide a surgical weight loss PROGRAM. It's not just the surgery. It's just 1/3 of the equation with DIET and EXERCISE completing the picture.
ANISSA, YOU HAVE THE NEXT QUESTION FOR Dr. Cirangle.
Hello, what do you for a patient with a iodine allergy, can't take mulivitamins..worry about not getting enough of what I need. I am waiting on insurance so no surgery yet.
Would that patient be you?...
yes
Are you allergic to intravenous iodine? or topical? or both?
both
There are other skin preparations one can receive for surgery... Why can you not take multivitamins? That is very unusual.
They have kelp, natural iodine...break out in hives
Every patient after weight loss surgery must take vitamins twice a day. The amount of food ingested/absorbed is so limited..That a person must supplement....There MUST be some preparations that do not contain any iodine.... Have you checked with a pharmacist or nutritionist?
not on the open market. I see a nutritionist tomorrow, Ill ask, don't know of black market, thought you might...lol
Sorry. Ask the nutritionist. Perhaps you may do better with a Lap-Band.
thats what I want but insurance won't pay
THEA PA, YOU HAVE THE NEXT QUESTION.
hello doctor ...during wls ...1. during wls why not take out the gallbladder even if there aren't any problems.. wouldn't this reduce having to go in and remove it later due to complications( reduce getting stones in future).. almost like a precautionary measure? 2. also how can i prevent hernia's...3. my BMI= 58.2 , 350lb, 5'5".. i am apple shaped but proportioned well... should I have open or lap rny?.. thank you Dr. Cirangle!
1. In an open duodenal switch procedure or revisional procedure, I pretty much take out the gallbladder. The issue with the gallbladder otherwise is that it is unnecessary and adds to the operative time...The longer you are on the table, the more likely you can have problems...
oh ok...
Remember, a gallbladder operation is not without it's own risk - namely, bile duct injury...The risk is not zero and if you have an injury you must undergo a major liver operation to fix it...
2.
oh.... so open might be the best then shorter time on table...oh ok
In a laparoscopic operation (which is what I specialize in), hernias are almost a non-issue...
but with a person over 350 can they have lap r ny surgery?
In an open operation or hand-assisted laparoscopic operation, hernia formation can occur in up to one-fourth of the patients. Binders postop may help somewhat but are not a guarantee...
oh ok....
Even with your weight, you should be able to get a laparoscopic gastric bypass...
oh ok... thanks..very much
Just 2 weeks ago, we did a lap gastric bypass on a patient with a BMI of 60 weight 365 height 5'5". You should just find the right surgeon. Good luck.
thank you!!!!
MODERATOR> KATHERINE, YOU HAVE THE NEXT QUESTION.
Hi Dr. Cirangle , what is the best way to set a goal weight for a patient getting RNY? I'm 5'4" , 300, and 41 years old...?
Your BMI is 51.5 kg/m-squared. You goal is to get in the range of a BMI of 25-30...You need to lose 125-155 lbs...
ok thank you
You Ideal body weight is 122 lbs and thus your excess weight is 178 pounds...Thus you need to lose 71-87% of your excess weight...However, the newer data (but not as long-term as the older data) suggests that gastric bypass patients can lose and keep off anywhere from 65-70% of their excess weight, and the duodenal switch patients probably lose more and are better at keeping it off. It has a lot to do with the recommended diet postop. Hope that helps.
ANN R, YOU HAVE THE NEXT QUESTION FOR Dr. Cirangle.
Hi Ann R.
Hi Dr. Cirangle.You asst with my surgery on 9/25/02, my question is how long before I stop losing my hair?
During you period of greatest weight loss you can lose hair...
The Weight loss is slower now but the hair loss continues.
Short of making sure that you keep up with your protein intake, and trying other things such as those suggested by your primary surgeon, you will have to weight it out. It can go on for months.
SASSY, YOU HAVE THE NEXT QUESTION.
Hi Dr. Cirangle, I am 15wks PO and never feel full, food has never bothered me, I have had an upper gi, endoscopy and gastro emptying, don't know results yet of gastro emptying, but endoscopy showed normal pouch and stoma, why don't I feel full? I can eat alot,but I choose not to...and I don't dump and I have never thrown up, I feel like I have not had surgery
Hi Sassy_...What kind of surgery did you have and may I ask by whom?
Dr Derrick Martin in Dayton Ohio, open rny
What does Dr. Martin say? I have not seen this so soon after surgery. What are your eating?
mainly protein, some veggies, not many carbs, around 30g carbs day, I drink water, I exercise. He says, I just need to try hard. he says I am fine and the surgery went well, but I feel like I have no tools
Any history of Prader Willi in your family?
who?
It's a specific eating disorder. Just curious...
I am adopted
That is a tough one. What is your starting BMI and have you lost weight?
I weighed 267 preop and now weigh 223
That's great. You have lost 44 lbs. Are you taking protein drinks?What is your overall caloric intake?
yes, I drink Designer Whey, and my daily caloric is 1000 cal. I just wish I could feel full, or dump or something
You need to stick with moving on to solid foods completely. How much solid food can you eat? Chicken, fish etc? per meal?
alot, I can eat 3 slices of pizza and feel nothing
Do you drink liquids with your meal?
I can eat a shrimp cocktail, lobster tail and veggies and feel nothing...... no, I don't drink with my meals
How big is your pouch? I make my gastric pouches 20 cc or 3/4 of one ounce...
he said he made it about 20 cc too, I had an endoscopy last week, showed normal pouch and normal stoma, I also had gastro emptying test, will find out results tomorrw
You had a gastric emptying study you said?That may shed some light. I have not hear of this. How long does it take to complete 3 slices of pizza?
the technician who did test, said it looked like things were going through pretty fast.....one right after the other, 5 min
Do you vomit?
nope never, there just has to be something wrong
This doesn't make sense.
I know...if I didn't have scar, I would have thought I never had the surgery
if your stomach truly has only a 3/4 ounce capacity, you are physically able to ingest solid food and have it go through at the speed that you describe. Did he separate your pouch from the rest of your stomach or just staple it off and do the Roux limb?
SASSY_15wksPO> stapled it off, I am not transected
AH HA!
but apparently I have no sld...at least, that is what I am told
What is sld?
oh sorry, staple line disruption...ah ha? do you know something I don't?
That is the only explanation I can give.... You MUST have a staple line disruption. Perhaps he needs to perform a diagnostic laparoscopy if none of the studies are helping. I don't understand how a 20cc pouch can be made with just stapling. There must be some type of fistula that has formed or your pouch is larger than they can detect.
I wish they could detect something....thank you for your time and thanks to all in here for being patient
Again, it is physically IMPOSSIBLE to do what your are describing without a SLD. Good luck. Let us know what they find.
CANDLE CRAZY, YOU HAVE THE NEXT QUESTION.
Hello, my name is Robin. Not crazy about candles, just crazy from my customers who make them...What percentage of folks have the Gallbladder removed during or after surgery? Is it something i should worry about if i have never had problems with the GallBladder? Also whre are the doc's who take payments??? it would be alot better for many, many folks to get healthy and maybe even get better jobs to pay off faster when some of us have really bad insurance. and have to beg borrow and steal to get the funds. too cold to do any bank robbing here in Ohio right now.
Well, to answer your first question... I do not personally remove gallbladders in patients undergoing laparoscopic surgery for weight loss. Actigall works pretty well in preventing gallstone formation...
is that somehing they will put me on after WLS
Yes, actigall is a medication that you have to take twice a day for at least 6 months to drop your chances of forming stones from 26% to 2%. Good luck.
I don't have an answer for your second question. I'm sorry. In my humble experience as a weight loss surgeon, I cannot predict what any insurance companies will do. I do not understand (or perhaps I understand too well) what their motivations are.
thank you
RECHELLE, YOU HAVE THE NEXT QUESTION.
Is a BMI of 56 a qualifier for Rny, without any other apparent co-morbides? Should insurance cover this on that basis?
Rechelle, with a BMI of 56 you do not need to have any other medical diagnoses to be a candidate for weight loss surgery. There are other requirements such as not being severely disabled, psychologically cleared, etc.
ok, thank you
LORI, YOU HAVE THE LAST QUESTION FOR Dr. Cirangle
I had a lap rny done in nov 2002, ive lost 64 pounds so far. when will i stop losing weight. Also,what do u suggest for plateaus of no weight loss?
Lori, what does your surgeon say your goal is ?
70 to 75% ,which would put me at 178... im at 216 now
What is your starting BMI, weight?
45...he says he wants this done in 16 months...ive done all this in less than 4 months
You can lose most of your weight from 12-18 months... The weight loss curve does slow in that time. It doesn't continue to drop as it does in the first few months...
like sassy i can handle more sugar than most... he was not happy about that
Your stomach enlarges, your intestines grow thicker, longer to adapt, absorb more food, sugar, fat, etc...
Dr gomez in indiana did mine Indianapolis ,indiana
Your risk is not losing enough weight or even regaining it. Especially if you ingest more carbs than you should. Good luck.
Thanks
THANKS DOCTOR
Your welcome
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