Chat with Dr. Jossart, October 30, 2002
**MODERATOR**> MLWINN77 YOU HAVE THE FIRST QUESTION TONIGHT:)
How hard is it to stretch your pouch in the first year and after the first year?
Interesting question, MLWINN77. I'm presuming you're talking about the gastric pouch in the Roux-en-Y gastric bypass.
yes
I guess you are asking how likely it is to stretch your pouch. The likelihood of doing that is higher if you attempt to force foods down. In the first few months, because of swelling from surgery it is less likely, but as time progresses and as one attempts to force foods down pouch dilation is very likely and weight loss not as satisfactory.
<**MODERATOR**> JEAN YOU HAVE THE NEXT QUESTION:)
I have been overweight for ten years and need to lose #140 pounds (starting at 263). Is it automatic that I will need reconstructive surgery?
Most likely you will find that after losing over 100 lbs, most people do need a panniculectomy or arms/legs redone or reconstructive surgery. These procedures are probably done at separate times, with the panniculectomy first and other things later. It is not an automatic need.
<**MODERATOR**> JENNIFER YOU HAVE THE NEXT QUESTION:)
My question is two-fold: I had lap RNY in March and am down from 340 to 230. I am thrilled with my results, but I have heard conflicting advice on "maximizing" weight loss. Do you believe that one should "diet" or really "watch" consumption in order to take advantage of the first year, or do you recommend moderation, the occasional splurge and a slower weight loss? I keep telling myself that I am trying to develop eating habits that I can live with forever, but the angel on my shoulder thinks it's a poor excuse for a Heath bar. If I do splurge, and my pouch stretches, can it shrink back?
Congratulations on your outstanding results! I would agree with sticking to a low calorie, low fat and higher protein diet. Some would even consider following a diet similar to the Atkin's diet, where carbohydrates are very restricted...
yes, that's what I do if my weight loss slows or I show a slight gain...
... I believe that once an individual has surgery, that the habits they begin during the first few months should be continued for the rest of their life...
ok, and the occasional splurge shouldn't ruin the surgery?
... There is data that specifically in the Roux-En-Y gastric bypass, that there may be some late weight regain, most likely related to pouch enlargement or dietary changes which may include increased carbohydrate intake...
is any of that reversable w/o reoperation?
...Remember, to lose weight with any of the 3 bariatric procedures, what you take in must not exceed what you expend.
<**MODERATOR**> KD YOU HAVE THE NEXT QUESTION PLEASE:)
what are the pros and cons of stapling vs banding the stomach?
I presume that you mean comparing the laparoscopic Roux-en-Y gastric bypass versus the Lap-Band...
yes
I actually spend at least an hour in consultation with most patients, going over the differences, pros and cons among all 3 procedures: Lap-Band, lap RGB, lap BPD-DS.
In brief, the Lap Band involves a silicone band wrapped around the upper stomach that allows for adjustability so that patients who are not losing enough weight can be adjusted periodically to achiever better weight loss..
RGB = Roux-en-Y Gastric Bypass. The pros: faster operation, safer since there are no organs being divided so there is no chance for a leak. It is for patients with a lower BMI 35-45 or so. There are several surgeons in Australia and elsewhere who only place the Lap-Band for patients even up to BMI 75 kg/m2. Also, it can be removed so that another procedure can be performed ("reversible")...
Cons for the Lap-Band: A foreign body is being placed into the patient...
The band can erode into the stomach, shift around causing problems, or break in various areas...
Onto the Roux. Pros: Gold standard for decades, no foreign body, parts to break, causes dumping syndrome if sugars eaten thus preventing sugar intake which can slow or eliminate weight loss...Weight loss is probably better in the RGB than in the LapBand. If you eat sugars or enjoy carbohydrates, there is nothing to stop you from drinking sugary milkshakes in the LapBand so you would probably not lose any weight.
In the RGB, the dumping syndrome will limit such behavior...
Cons in the RGB: There are 2 connection (check our website for the specifics) that can possibly leak, it is not truly reversible in the true sense of the word, and you can develop narrowing at the upper connection. Hope that helps! What is your BMI kd?
38
Dr. Jossart> KD, you would be a good candidate for either procedure; if you'd like we can discuss more at our office. Again, everyone, for more specific detailed information about our program please look at the website and specifically the Patient Information Guide and Questionnaire.
<**MODERATOR**> CINDERZ CA YOU HAVE THE NEXT QUESTION
What has been the success rate, in percentages... and how about deaths. What is the main cause of death in this line of surgery?
Good question Cinderz! When anyone decides to undergo surgery they should know all the risk and benefits, including the risk of death and how successful each procedure is. The Lap-Band is for patients who qualify for surgery in the lower BMI range 35-45 or so, probably even up to 53. The average excess body weight loss is 40-50% over a 7 year period; weight loss is gradual. The Roux en Y success is in the 60-75% excess body weight loss and the DS for heavier patients 75-85%. Risk of death: LapBand extremely rare; RGB very low <1% and DS <2%. Remember, I can quote all the statistics you'd want but if happens to someone you know it's 100%.That is why we spend a significant portion of our consultation time talking about risks. Death can be from many causes including but not limited to pulmonary embolism, heart attack, massive abdominal infection from leakage. These are real entities, but remember, the risk of surgery is outweighed by the benefits if your BMI is in the appropriate range. Hope that helps Cincerz.
<**MODERATOR**> LINDA 6 WEEKS POST OP YOU HAVE THE NEXT QUESTION:)
I'm 6 weeks out and still have gallbladder I heard if I take the medicine to help make it empty it will cause you to gain weight is this true? and if I don't take it how good are my chances of being okay?I'm so confused! help & how much should I be eating at a meal a 1/2 cup or a less?sometimes I can eat more if its a soft food less if it is a solid food sometimes a few bites is that normal?
Linda, it is important to take the Actigall. The risk of gallstone formation during you weight loss period is reduced from about 20% to 2%. You should take the medication as your surgeon has prescribed.
does it cause weight gain & for how long do you take it?
Next part, Linda, you should be taking in good amounts of protein and minimizing fat and carbohydrates. We tell our patients to limit their calorie intake to 800kcal a day, eating 3 meals a day, in between drinking liquids and protein supplements. Liquids usually go down better than solids but you should use solids in your meal. Now, remember in the first 4-6 weeks, in the RGB or RNY (same surgery), you are at risk for narrowing of the stomach connection. If you find yourself with severe difficulty swallowing you may want to get looked at. Good luck! You can look in our Dietician's Corner for some advice about meals and definitely talk to your surgeon.
<**MODERATOR**> DIANE AGUADO YOU HAVE THE NEXT QUESTION:)
i had gallbladder surgery 23 yrs ago what are my odds of getting rny lap i'm 43 now surgery date 11/06/02 i have a 12 inch scar on my stomach
Diane, good question. Is that your gallbladder scar?
yes
Have you asked your surgeon about his conversion to open rate? And when he does so? Do you mind telling me who your surgeon is?
Dr. Madura at Rush in Chicago. He said he wouldn't know till he is in there.
Usually, if you just have a scar in the right upper portion of your abdomen, it is pretty straight forward to perform the RNY totally laparoscopically in our hands.
<**MODERATOR**> BARB YOU HAVE THE NEXT QUESTION:)
How many weight loss surgeries have you performed?
Our practice works together as a group and we have together performed over 500 bariatric procedures
THANK YOU Dr. Jossart! THANK YOU MEMBERS! FOR MORE INFORMATION, PLEASE VISIT Dr. Jossart AT WWW.LAPSF.COM
<**MODERATOR**> THANK YOU Dr. Jossart FOR TAKING THE TIME TO JOIN US HERE TONIGHT! AND THANK YOU TO OUR MEMBERS AS WELL
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