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Chat with Bariatric Surgeon, Dr. Cirangle. 23 October 2002

**MODERATOR**> LISA~BOSTON YOU HAVE THE FIRST QUESTION:)

Hello Dr. Cirangle, I just wanted to know if you see more complications with Lap vs Open surgery? In your opinion which do you prefer?

I believe that laparoscopic surgery is better overall for the patient - less pain, quicker recovery and far fewer wound complications. If I were to have a surgery it would only be laparoscopic

<**MODERATOR**> DAR YOU HAVE THE NEXT QUESTION:)

I'm scheduled for open rny on 1-3-03 and I have PCKD, my concern is with the dye that they use to check the pouch for a leak, I've heard before with people with Kidney Disease they won't do certain dye tests. What do you think the chances of my Kidneys shutting down would actually happen and I'd need dialysis. And is there another way to check the pouch for leaks, other than injecting dye?

The dye that is usually used is not injected into the blood stream, but rather into the stomach pouch. There is very little chance of having any problems. Air can be used instead of dye if necessary

<**MODERATOR**> KATHY YOU HAVE THE NEXT QUESTION:)

Kathy> I am 54 years old and scheduled for RNY on 10/28/02. Is my age putting me at additional risk? I would also like to know how much protein is a safe amount to consume per each protein "shake." post-op after "food" can be consumed. My dr. will not do it lap...should I be concerned? He also will not be doing the leak test, but uses 8 rows of staples...is that good enough?

You have many questions. Your doctor should spend a significant amount of time with you so that you feel comfortable with these issues prior to your surgery. Many surgeons still perform "open" surgery despite the advantages of a laparoscopic approach. It is usually because they do not have enough experience with the laparoscopic procedure. If you have doubts, ask you Dr. about his leak rate and problems that he has had in the past. Protein supplement - 70-80 grams per day

**MODERATOR**> SHELLY YOU HAVE THE NEXT QUESTION:)

is there any thing to prevent most of the hairloss either before surgery or after?

vitamin and protein supplementation should minimize hair loss

<**MODERATOR**> HONEYBUBBLES YOU HAVE THE NEXT QUESTION:)

do you have to have drains and ng tube after surgery ? im quite gaggy and am afraid of ng tube

I do not use either - they are usually unnecessary

<**MODERATOR**> LISA~BOSTON YOU HAVE THE NEXT QUESTION:)

Hello again Dr, If a person has a history of anemia could they still be considered for surgery?

Patients with anemia generally do better with a duodenal switch - especially if they have a heavy menstrual period

<**MODERATOR**> ANNE YOU HAVE THE NEXT QUESTION PLEASE:)

What is the % of adhesions and blockages post-op and when are you out of the woods?

post op bowel obstruction (blockages) occur about 3-5% of the time and can occur at any time, even many years after surgery

<**MODERATOR**> CHERYLW_FROMPISMO YOU HAVE THE NEXT QUESTION FOR OUR GUEST:)

If you had a BMI of 50, age 32, previous pelvic laparoscopy X2 for endo, would you choose DGB/DS or RNY? Why? Could either still be lap?

Either could be done laparoscopically most likely. The decision between which surgery is somewhat complicated - I tend to recommend the DS for patients with a BMI over 50-55

<**MODERATOR**> ROBIN YOU HAVE THE NEXT QUESTION:)

what age do u do surg on. do u use ng tube after surg how long do u keep them after surg in the hospital do u have trouble with insur comp with this kind of surg how come some doctor do not like during lap how long have u done this kind of surg

Sorry Robin, too many questions. I perform lap RNY, DS and Lap-Band procedures. I don't use an NG. I have been performing weight loss surgery for over 4 years now

<**MODERATOR**> SHELLY YOU HAVE THE NEXT QUESTION PLEASE:)

im 5ft 6 248#s what would be a guess weightloss at 6 months post op? i walk everyday.

after which surgery?

lap ryn

50 - 80 pounds

<**MODERATOR**> KATHY YOU HAVE THE NEXT QUESTION

specifically what vitamins and amounts should be consumed to prevent hair loss? My surgeon has been doing RNY's since 1970 and still will only do open. he checks gallbladder at time of surg. does open make it easier to check gallbladder and other internal "things?" I would like it done lap, but he WILL NOT.......yet I want him to be surgeon. Is there a safety difference between proximal and distal? thank you for your answers. I appreciate your help.

You should see a surgeon who specialized in this. I think it makes a difference. I recommend supplement with Biotin, a good multivitamin and flax seed oil. I would not recommend a distal RNY - many more complications possible. Results with the laparoscopic approach are at least as good as open and probably better.

*MODERATOR**> HOBERTA YOU HAVE THE NEXT QUESTION:)

what are the advantages of RNY over gastric banding? I've heard banding has a high rate of failure.

At 10 years after surgery, the weight loss after the band is essentially the same after the RNY. RNY adds the effect of....Dumping for patients who have difficulty giving up sweets

<**MODERATOR**> JANICE YOU HAVE THE NEXT QUESTION:)

what are the long term effects of bariatric surgery?

There is no way to answer this question effectively in this forum. My best suggestion is to discuss this with a qualified bariatric surgeon

<**MODERATOR**> PAMELA IN NEW ORLEANS YOU HAVE THE NEXT QUESTION:)

Is it possible to recieve calming drugs prior to surgery?

yes, a mild medication such as ativan or xanax can be taken for several days prior to surgery

<**MODERATOR**> DAVID YOU HAVE THE NEXT QUESTION:)

i work outside in the elements and consume a great deal of water. i am concerned about my fluid intake after surgery. Is this a problem?

It can be, especially if you work in a hot environment. I would not return to work until you are comfortable drinking 2-3 liters of liquid each day.

<**MODERATOR**> JULES66 YOU HAVE THE NEXT QUESTION:)

What would be the best things I can do to prepare myself for the lap/rny? my stats are: 5'8/275/bmi,41/sleep apnea, gerd, Rx controlled HighBP, border diabetes, severe neck & back pain, walking is hard to do for long periods, edema, and always tired.Thank You.

Start a very gradual exercise program (10-15 mins per day) and try and loose 7-15 pounds before your surgery. This will be the most helpful to your surgeon and to your recovery. Start taking a good multivitamin as well.

<**MODERATOR**> ARLY YOU HAVE THE NEXT QUESTION PLEASE:)

ArlyK I am concerned about being able to carry a normal pregnancy after the operation, my bmi is 46 , im 31 yrs what do you recommend

Avoid pregnancy for at least 2 years. You may want to consider the Lap-Band as an alternative if you are interested in having children.

arly> Arlyn K Two years , waht benefit of the lap band against tghe others thanks

the band is adjustable - if you get pregnant, the saline can be removed so that you can eat more normally and gain an appropriate amount of weight for your pregnancy

<**MODERATOR**> CATHY 10/29 YOU HAVE THE NEXT QUESTION:)

How long has the RNY been being performed? Is it true that 1 out of 200 people die from this surgery? One more question if I may, what is the best way to prevent hernias? Thank you for taking your time to help educate on this subject.

the RNY has been performed for more than 25 years. The death rate in the US for this surgery is about 1-1.5% The best way to prevent hernias is to have your procedure done laparoscopically

<**MODERATOR**> CHERYLW_FROM PISMO YOU HAVE THE NEXT QUESTION:)

How much is typical for an active 4-5X/week exercising DS pt. to lose at 6 months?

starting at what weight?

300

70-100 pounds if you follow the diet and exercise regimen

**MODERATOR**> HOOSIERHELEN YOU HAVE THE NEXT QUESTION PLEASE:)

I am 54 yrs old and scheduled for a LAP RNY in January. My BMI is abut 42 Any age specific problems for a woman in my age group? Do they check for healthy liver and gallbladder before surgery?

the preoperative evaluation for someone who is in their 50's will be more extensive than that for someone who is younger. It should include tests to make sure you have a healthy liver, heart and digestive tract. In addition, most doctors want a recent mammogram, pelvic exam/PAP and any other test for things that you have had problems with in the past. Most doctors check for gallstones if you have symptoms

<**MODERATOR**> TRACYM YOU HAVE THE NEXT QUESTION:)

I have a history of pulmonary embolism. Would you recommend Coumadin or Heparin before surgery? And if so, how soon before surgery? My surgery is scheduled for 12-2.

Patients with a history of PE are definitely at higher risk. At minimum you should have low molecular weight heparin and pneumatic compression stockings placed before you enter the OR.

<**MODERATOR**> MARY YOU HAVE THE NEXT QUESTION:)

is there a site that gives negative responses?

My web site has a list of possible complications of surgery www.LapSF.com

<**MODERATOR**> LISA BOSTON YOU HAVE THE NEXT QUESTION:)

Do you think symptoms of IBS or a Spastic Colon would subside after surgery?

Depends if they are related to the types of foods that you eat. I wouldn't count on that happening though.

<**MODERATOR**> EGYPT WATSON YOU HAVE THE NEXT QUESTION:)

Can spinal stenosis and mild scoliosis be concidered co morbidities?

no - not related to obesity

<**MODERATOR**> STACY YOU HAVE THE NEXT QUESTION:)

I have Alliance BCBS of Mo, they deny any weight loss meds or surgery, What should my first step be in getting approval. I'm 28, 5'3" and 305lbs, The only real problems I have so far is sever kidney stones, 8 removals in 5 years, but Diabetes runs rampid in my family....I really feel I need this surgery but I do not know where to begin with insurance....any help would be appreciated. Thanks

Your best bet would be to contact an attorney who specializes in helping patients fight insurance companies for medical care. This unfortunately is a difficult problem. One place you could start is www.obesitylaw.com

<**MODERATOR**> ANGELA H YOU HAVE THE NEXT QUESTION:)

I am 300 pounds and am 5'7 am I someone who could possibly get the surgery that I have been hearing about I have high blood pressure and I can't do any type of work with out chest pains. I have medicaid, can I do something about it?

It sounds like you probably qualify for surgery - I would suggest that you seek a consultation with a Bariatric surgeon and learn more about surgical options. Your primary care MD can probably help get you started

<**MODERATOR**> DONNAJO YOU HAVE THE NEXT QUESTION:)

i am almost 62 years old is that too old i dont think so[Wed Oct 23 21:52:44 CDT 2002] [] Darlene: peaches

It depends on your state of health. The risks definitely increases the older you are.

<**MODERATOR**> JULES YOU HAVE THE NEXT QUESTION:)

Does the fact that I've had 2 cesareans (1987&1993) and a lap/gallbladder removal in 1998 mean that I'm at higer risk for lap/rny; also, I've gained the last 40 lbs.of my 275 over the past year. Thanks so much for your time.

It doesn't make you higher risk, it just increases the possibility that your surgery may not be able to be done laparoscopically

<**MODERATOR**> KATHY YOU HAVE THE NEXT QUESTION:)

Can "dumping" repeatedly lead to lethal/serious complications? What besides sweets and fats can cause it? I am getting pretty nervous about my surgery on Monday...thanks for your answers!

dumping is usually caused by sugar or carbohydrates, not fats. It would be highly unusual for the syndrome to cause anything but discomfort (not life threatening) good luck with your surgery

<**MODERATOR**> THANK YOU TO DR. CIRANGLE AT WWW.LAPSF.COM!!! AND THANK YOU TO ALL OUR MEMBERS WHO HAVE JOINED US TONIGHT!

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