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Chat with Bariatric Surgeon, Dr. Cirangle, 02 December 2003

<**MODERATOR**> HELLO AND WELCOME TO DR. PAUL CIRANGLE

Do you see many ulcers that start at the stoma and spread through the pouch? I may be having surgery soon to repair this condition, can you tell me anything about it? Recovery, difficulties? anything, thanks!

Marginal ulcer happens rarely (7%) and usually is caused by a pouch that is too large or excessive use of drugs such as motrin, aspirin etc

usually it will heal on its own

Hello I am strongly considering the surgery but conserned about a heart condition that I received from taking the diet drug Phen-Fen I have minor Mitral Valve reguratation would this be a problem in the surgery?

it should not - as long as the regurgitation is mild or minimal

good evening, I weigh 207 and am 5'3 1/2 inchs what is my best option surgically?

that depends on your lifestyle and personal preferences. It would be a good idea for you to speak with a bariatric surgeon who offers several different types of weight loss surgery

the band or RNY are probably the most common

Is it usually hard to get the surgery approved by your insurance company?!?

most insurance companies approve weight loss surgery... although many make it quite difficult for patients

many hoops to jump through and often times requiring a fight

What's the size of a "normal stomach" (pre-surgery)?

1- 1.5 quarts

(64-80 ounces)

Hello Dr. How are you? I just need to know how long is Open Gallbladder surgery. And how long is the Hospital stay?

why would you have open gallbladder surgery??

traditionally, the operation takes 1-2 hours and the stay is 3-5 days

no - but you can have too many medical problems to make it safe

Which is better of the 2 ....For faster weight lose?......Distal or Proximal?

very few surgeons perform the distal gastric bypass - there is a significant problem with nutritional and vitamin deficiencies after it. It should probably be reserved only for revision of previously failed weight loss procedures....

the most important issue is not the speed, but the total weight loss and whether it lasts for the rest of your life

With my heart bypass they pulled my arms over my head and I still have trouble with arthritis due to that. What position will my arms be in during surgery?

that depends on your surgeon

I place them to your side in a natural position

I've gotten different information on the mortality rates with bariatric surgery, please give me what you think to be an accurate death rate. Thank you.

that depends on your surgeon....

the death rate is actually probably going up because many inexperienced surgeons are now trying to perform weight loss surgery.

in my opinion...

a good surgeon should have a death rate of 1% or less....

make sure you ask your surgeon about his experience

I hear there is a new surgery called MGB..What are the risks or cost?

this is a procedure which is performed by only 1 surgeon in the country.....

all of the other surgeons abandoned this because of long term complications and problems

How long will it be before I can drink a coke?

coke is not a nutritious food - In my opinion there is no good reason to drink coke

try tea

How do you feel about the Lap Band procedure?

I think it is a great option for the appropriate patient....

It works very well if placed in the right person

< LizInJersey> I am 2 weeks out and can eat two soft boil eggs. Is my pouch stretching?

I don't know how large your pouch was originally made. Most of my patients could not eat even 1/2 of an egg at 2 weeks out

I had an intestinal bypass done 25 years ago. The following year I had surgery for a bowel obstruction caused by adhesions. Would it be possible for me to still have a gastric bypass as a revision?

Yes, a revision is still possible. Make sure you chose someone who is experienced as revision surgery carries a much higher complication rate

My biggest fear is blood clots. I heard they can be fatal. What can I do in the hospital to make sure that blood clots are not going to present a problem for me?

although the risk of blood clots can never be completely removed, getting up and walking as soon as possible is very important...

in addition, make sure that you wear the special calf or foot massagers as this will also help

< Kissaredhead> I am having a revision. Will I lose weight like everyone else or will it be slower?

it depends what type of revision that you have and how well you follow your post op dietary instructions. Revision patients can loose just as much or more weight than individuals who are having the surgery for the first time

Is there more risk for open rny than for lap?

there is a much higher incidence of wound complications in the open RNY than in the laparoscopic.

What advice would you give someone who was just starting to think about gastric surgery?

Do your homework. Sites such as ObesityHelp are very helpful to gather information about the procedure.....

Pick an experienced surgeon who has a large experience with this type of surgery and gets good results.

How much does this type of surgery usually cost and how do you determine which type is best for each person?

Participate in support groups as well even before your surgery

cost varies from one place to another and also depends on your insurance coverage...

A good Bariatric surgeon can help you decide which procedure is right for you.

Do you perform all types of weight loss surgery? If so, do you leave it up too your patients to make their own individual decisions?

I do perform 4 different types of weight loss surgery including the DS, RNY, Band and Vertical gastroplasty. I generally rely heavily on patient preference as to what type of surgery that I perform, however, I always make sure that the one that they select will be safe for them and effective

My friend had her stomach stapled 12 years ago and she has since stretched it out to where she has gained all of her weight back, Is it possible for her to have the Lap Band surgery today?

It is possible, however, the results of that have not been studied long term. They may be better off with another procedure instead.

I am 6 weeks post op and I have had my incision reopened due to an infection and it has statred to close and I was wondering it looks like the muscle r coming outside the whole what could that be

it is probably just healing tissue called granulation tissue

I am interested in having the surgery done, but I was wondering from the initial appointment, how long do you have to wait and are there certain steps before surgery you must take... like a special diet or something?

that varies from surgeon to surgeon. Most of our patients are able to get to the OR within 6-8 weeks.

What are the chances of staple leakage?

again, this depends on your surgeon - some may be as high as 4-5%. In our practice it is less than 0.5%

I am scheduled for surgery next Friday and my biggest fear is blood clots. How long does it take for a blood clot to form (how long off your feet?) Is it hours, days, etc? Thank you!

Blood clots can form as soon as you lie on the OR table - that is why it is important for your doctor to take precautions to minimize this risk.

I will finally have insurance effective in January of 2004, I know that it covers WLS, but how do I find out what is or is not covered and will they tell me if I have to have previous visits with my physician?

you will need to talk with one of the insurance representatives and hopefully they can tell you

How concerned should I be, if my surgeon doesn't use heparin shots?

usually insurance companies have customer service people

not all patients need heparin shots

generally, I only use them on high risk or very heavy patients

What kind of preop tests are required for lap RNY?

that depends on your age, your surgeon, and your level of health. Most doctors require blood tests, x-rays, and a visit to a psychologist as a minimum

Good evening. I am scheduled for a Lap RNY next Tuesday here in Augusta Georgia by Dr. Stephen Gooden. I will see him pre-operatively this Friday. My question is with the Lap will any hernias be visible and do they interfere with Lap approach?

hernias can be seen very easily with the laparoscope and should not interfere with your procedure

Where my incision is..... on the side of it...it hurts and is hard.what could that be?

it is probably just an area of healing - but if you have a problem, you should see your doctor because he obviously will know best

What are some of the post life changes after surgery?

more energy, ability to exercise and participate in activities.... the sky is the limit and it depends completely on you

What are the chances of a hernia with lap rny?

that depends on how the operation is done, but generally less than 1-2%

How can food get stuck before getting to your stomach if that part wasn't altered in any way? I hear many people say that food gets stuck, but I don't understand why it would happen after surgery.

It gets stuck because they eat too much or too fast. It gets stuck in the channel which goes between the pouch and the small intestine.

< Rose in Ga.> For the patient with fibromyalgia and taking anti inflammatory medications, does the surgery help in controlling the disease or reducing medication needs?

there is no scientific evidence to support that - I don't think anyone knows

<7 days to go> Regarding Motrin - What types of pain killers both OTC and script can we take if necessary in the future.

I tell my patients that they should not take Motrin, ibuprofen, aleve, aspirin etc after the surgery because it increases the chances for ulcer. Tylenol is OK and celebrex or vioxx in limited amounts

Exactly what function in the body does the gallbladder control?

it stores bile

not necessary

each year more than 1/2 million people have it removed without future problems

After bariatric surgery, What are the absolute no no's when it comes to food & drink?

Here is what I tell my patients:.....

no carbonated beverages, sugar, or high calorie liquids. Keep your carbohydrate intake less than 40-50 grams and always eat your protein first (a minimum of 70 grams each day)

I am 6 wks post op RY revision from gastroplasty in 93 - due to continuous vomiting. I am finding it almost too easy for food to go down and this is concerning me. My physician did not give me quanity limited or intervals of those limits.

don't drink with meals

exercise 4-5 days per week for at least 40 minutes

never eat more than 3-4 ounces at a time for the first year after surgery

those are the major rules

With the malabsption aspect of the RNY surgery in mind, how will my body adjust to different nutritional needs as I age? I am 41 years old & preop.

the malabsorption in a RNY is very minimal. If it is performed correctly, there should be no long term problems

I am 3 months postop Rny distal and very hungry. Is there anything I can do to stop the hunger?

you are probably hungry because you may be malnourished. That operation requires very close follow-up by your doctor. You should probably have nutritional labs drawn to make sure you are not having a problem.

Are all of your patients that you have performed surgery on non-smokers? I am considering the open RNY but do not think I can quit smoking. Cut down yes, but not quit. What have other patients done in this case?

I will not operate on a smoker. Having weight loss surgery is about health, not being thin. Smoking is not only unhealthy, it causes post operative problems. Smokers have higher complication rates.

<**MODERATOR**> THIS IS OUR LAST QUESTION FOR TONIGHT:)

I heard your on a liquid diet after surgery how long is that for?

that varies somewhat. I ask my patients to stay on liquids for the first 2 weeks after surgery. This gives the pouch a chance to heal and minimizes problems with nausea and vomiting.

<**MODERATOR**> THANK YOU SO MUCH TO DR. PAUL CIRANGLE FOR TAKING THE TIME TO BE HERE WITH US TONIGHT. AND THANK YOU TO OUR MEMBERS AS WELL!

<**MODERATOR**> TO LEARN MORE ABOUT DR. CIRANGLE AND THE PROCEDURES HE PERFORMS, PLEASE VISIT http://www.lapsf.com OR CALL 415-561-1310 TO SCHEDULE A CONSULT.

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