Seems you have unlimited amounts of cash to keep having surgery when the last one "doesn't work"....ain't that nice.....I need a boob job, a tummy tuck and a thigh lift. You can make the check out directly to Dr. Rottler in the St. Louis area...thanks! Good luck with your additional surgerys...

 I wish I had unlimited cash. I was self-pay until 1 yr ago when I finally got insurance that actually covers wls. I recognize that my ability to have any subsequent surgery will always depend in my insurance, that's a given. I need a tummy tuck and a few other things as well, but I don't see them happening anytime soon. Thankfully I'm blessed with a husband who married me at my highest weight and still loves me as I am now. frankly, my overwhelming priority now when it comes to surgery is to get my bladder fixed as soon as I can after this baby, because I pee every time I sneeze and that bothers me a lot more than my bat wings!

Risks of RNY:

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the legs (deep vein thrombosis, or DVT) or lung (pulmonary embolism). Some people develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

Other risks from Roux-en-Y gastric bypass include:

• Stomach pouch problems. You may need a repeat surgery to repair the stomach and/or the opening between the stomach and the intestine.
• Vomiting. If you eat more than your stomach can hold, you may vomit.
• Hernia. These can be related to the incisions that the surgeon makes or caused by the intestines twisting around itself.
• Kidney stones. Drinking enough water can help.
• Gallstones. Sometimes the gallbladder is removed as part of the surgery. But if your gallbladder is not removed, then you may need to take medicine to prevent gallstones.

Complications of gastric bypass

[edit] Anastomotic leakage

An anastomosis is a surgical connection between the stomach and bowel, or between two parts of the bowel. The surgeon attempts to create a water-tight connection by connecting the two organs with either staples or sutures, either of which actually makes a hole in the bowel wall. The surgeon will rely on the body's natural healing abilities and its ability to create a seal, like a self-sealing tire, to succeed with the surgery. If that seal fails to form for any reason, fluid from within the gastrointestinal tract can leak into the sterile abdominal cavity and give rise to infection and abscess formation. Leakage of an anastomosis can occur in about 2% of Roux-en-Y gastric bypass and less than 1% in mini gastric bypass. Leaks usually occur at the stomach-intestine connection( gastro-jejunostomy).There is a change in the drain fluid contents from serous ( before leak ) to fecal / bilious (after leak) .Usually significant leaks need urgent re-operation. Sometimes a minor leakage can be treated with antibiotics only. It is usually safer to re-operate if an infection cannot be definitely controlled immediately.

[edit] Anastomotic stricture

As the anastomosis heals, it forms scar tissue, which naturally tends to shrink ("contract") over time, making the opening smaller. This is called a "stricture". Usually, the passage of food through an anastomosis will keep it stretched open, but if the inflammation and healing process outpaces the stretching process, scarring may make the opening so small that even liquids can no longer pass through it. The solution is a procedure called gastroendoscopy, and stretching of the connection by inflating a balloon inside it. Sometimes this manipulation may have to be performed more than once to achieve lasting correction.

[edit] Anastomotic ulcer

Ulceration of the anastomosis occurs in 1–16% of patients.^[8] Possible causes of such ulcers are:

• Restricted blood supply to the anastomosis (compared to the blood supply available to the original stomach)
• Anastomosis tension
• Gastric acid
• The bacteria Helicobacter pylori
• Smoking
• Use of non-steroidal anti-inflammatory drugs

This condition can be treated with:

• Proton pump inhibitors, e.g. esomeprazole
• A cytoprotectant and acid buffering agent, e.g. sucralfate
• Temporary restriction of the consumption of solid foods

[edit] Dumping syndrome

Normally, the pyloric valve at the lower end of the stomach regulates the release of food into the bowel. When the gastric bypass patient eats a sugary food, the sugar passes rapidly into the intestine, where it gives rise to a physiological reaction called dumping syndrome. The body will flood the intestines in an attempt to dilute the sugars. An affected person may feel their heart beating rapidly and forcefully, break into a cold sweat, get a feeling of butterflies in the stomach, and may have a "sky is falling" type of anxiety^{[clarification needed]}. The person usually has to lie down, and could be very uncomfortable for 30–45 minutes. Diarrhea may then follow.

[edit] Nutritional deficiencies

• Hypoparathyroidism due to inadequate absorption of calcium may occur for GBP patients. Calcium is primarily absorbed in the duodenum, which is bypassed by the surgery. Most patients can achieve adequate calcium absorption by supplementation with vitamin D and calcium citrate (carbonate may not be absorbed—it requires an acidic stomach, which is bypassed).
• Iron frequently is seriously deficient, particularly in menstruating females, and must be supplemented. Again, it is normally absorbed in the duodenum. Ferrous sulfate can cause considerable GI distress in normal doses; alternatives include ferrous fumarate, or a chelated form of iron. Occasionally, a female patient develops severe anemia, even with supplements, and must be treated with parenteral iron. The signs of iron deficiency include: brittle nails, an inflamed tongue, constipation, depression, headaches, fatigue, and mouth lesions.^[9]
• Zinc deficiency may also occur, bringing: acne, eczema, white spots on the nails, hair loss, depression, amnesia, and lethargy.^[10]
• Deficiency of thiamine (also known as vitamin B₁) brings the risk of permanent neurological damage (i.e. Wernicke's encephalopathy or polyneuropathy). Signs of thiamin deficiency are heart failure, memory loss, numbness of the hands, constipation, and loss of appetite.^[9]
• Vitamin B₁₂ requires intrinsic factor from the gastric mucosa to be absorbed. In patients with a small gastric pouch, it may not be absorbed, even if supplemented orally, and deficiencies can result in pernicious anemia and neuropathies. Sublingual B₁₂ (cyanocobalamin) appears to be adequately absorbed. In cases where sublingual B₁₂ does not provide sufficient amounts, injections may be needed.
• Protein malnutrition is a real risk. Some patients suffer troublesome vomiting after surgery, until their GI tract adjusts to the changes, and cannot eat adequate amounts even with 6 meals a day. Many patients require protein supplementation during the early phases of rapid weight loss to prevent excessive loss of muscle mass. Hair loss is also a risk of protein malnutrition.
• Vitamin A deficiencies generally occur as a result of fat-soluble vitamins deficiencies. This often comes after intestinal bypass procedures such as jejunoileal bypass (no longer performed) or biliopancreatic diversion/duodenal switch procedures. In these procedures, fat absorption is markedly impaired. There is also the possibility of a vitamin A deficiency with use of the weight-loss medication orlistat (marketed as Xenical and Alli).

[edit] Nutritional effects

After surgery, patients feel fullness after ingesting only a small volume of food, followed soon thereafter by a sense of satiety and loss of appetite. Total food intake is markedly reduced. Due to the reduced size of the newly created stomach pouch, and reduced food intake, adequate nutrition demands that the patient follow the surgeon's instructions for food consumption, including the number of meals to be taken daily, adequate protein intake, and the use of vitamin and mineral supplements. Calcium supplements, iron supplements, protein supplements, multi-vitamins (sometimes pre-natal vitamins are best), and vitamin B₁₂ (cyanocobalamin) supplements are all very important to the post-operative bypass patient.

Total food intake and absorbance rate of food will rapidly decline after gastric bypass surgery, and the number of acid-producing cells lining the stoma*****reases. Doctors often prescribe acid-lowering medications to counteract the high acidity levels. Many patients then experience a condition known as achlorhydria, where there is not enough acid in stomach. As a result of the low acidity levels, patients can develop an overgrowth of bacteria. A study conducted on 43 post-operative patients revealed that almost all of the patients tested positive for a hydrogen breath test, which indicated an overgrowth of bacteria in the small intestine.^[11] Bacterial overgrowth causes the gut ecology to change and induces nausea and vomiting. Recurring nausea and vomiting eventually change the absorbance rate of food, contributing to the vitamin and nutrition deficiencies common in post-operative gastric bypass patients.

[edit] Protein nutrition

Proteins are essential food substances, contained in foods such as meat, fish and poultry, dairy products, soy, nuts, and eggs. With reduced ability to eat a large volume of food, gastric bypass patients must focus on eating their protein requirements first, and with each meal. In some cases, surgeons may recommend use of a liquid protein supplement. Powdered protein supplements added to smoothies or any food can be an important part of the post-op diet.

[edit] Calorie nutrition

The profound weight loss which occurs after bariatric surgery is due to taking in much less energy (calories) than the body needs to use every day. Fat tissue must be burned to offset the deficit, and weight loss results. Eventually, as the body becomes smaller, its energy requirements are decreased, while the patient simultaneously finds it possible to eat somewhat more food. When the energy consumed is equal to the calories eaten, weight loss will stop. Proximal GBP typically results in loss of 60–80% of excess body weight, and very rarely leads to excessive weight loss. The risk of excessive weight loss is slightly greater with distal GBP.

[edit] Vitamins

Vitamins are normally contained in foods and supplements. The amount of food eaten after GBP is severely reduced, and vitamin content is correspondingly lowered. Supplements should therefore be taken to completely minimum daily requirements of all vitamins and minerals. Pre-natal vitamins are sometimes suggested by doctors, as they contain more of certain vitamins than most multi-vitamins. Absorption of most vitamins is not seriously affected after proximal GBP, although vitamin B₁₂ may not be well-absorbed in some persons: sublingual preparations of B₁₂ provide adequate absorption. Some studies suggest that GBP patients who took probiotics after surgery are able to absorb and retain higher amounts of B₁₂ than patients who did not take probiotics after surgery. After a distal GBP, fat-soluble vitamins A, D, and E may not be well-absorbed, particularly if fat intake is large. Water-dispersed forms of these vitamins may be indicated on specific physician recommendation. For some patients, sublingual B₁₂ is not enough, and patients may require B₁₂ injections.

[edit] Minerals

All versions of the GBP bypass the duodenum, which is the primary site of absorption of both iron and calcium. Iron replacement is essential in menstruating females, and supplementation of iron and calcium is preferable in all patients. Ferrous sulfate is poorly tolerated. Alternative forms of iron (fumarate, gluconate, chelates) are less irritating and probably better absorbed. Calcium carbonate preparations should also be avoided; calcium as citrate or gluconate (with 1200 mg as calcium) has greater bioavailability independent of acid in the stomach, and will likely be better absorbed. Chewable calcium supplements that include vitamin K are sometimes recommended by doctors as a good way to get calcium.

[edit] Alcohol Metabolism

Post-operative gastric bypass patients develop a lowered tolerance for alcoholic beverages because their altered digestive tract absorbs alcohol at a faster rate than people who have not undergone the surgery. It also takes a post-operative patient longer to reach sober levels after consuming alcohol. In a study conducted on 36 post-operative patients and a control group of 36 subjects (who had not undergone surgery), each subject drank a 5 oz. glass of red wine and had the alcohol in their breath measured to evaluate alcohol metabolism. The gastric bypass group had an average peak alcohol breath level at 0.08%, whereas the control group had an average peak alcohol breath level of 0.05%. It took on average 108 minutes for the gastric bypass patients group to return to an alcohol breath of zero, while it took the control group an average of 72 minutes.^[12]

[edit] Pica

The have been reported cases in which pica recurs after gastric bypass in patients with a pre-operative history of the disorder, possibly due to iron deficiencies. Low levels of iron and hemoglobin are common in patients who have undergone gastric bypass.^{[citation needed]} One study reported on a female post-operative gastric bypass patient who was consuming eight to ten 32 oz. glasses of ice a day. The patient's blood test revealed iron levels of 2.3 mmol/L and hemoglobin level of 5.83 mmol/L.^{[further explanation needed]} The patient was then given iron supplements that brought her hemoglobin and iron blood levels to normal levels. After one month, the patient's eating diminished to two to three glasses of ice per day. After one year of taking iron supplements the patient's iron and hemoglobin levels remained in a normal range and the patient reported that she did not have any further cravings for ice.^[13]

And?

Duodenal Switch Risks and Complications

Potential Duodenal Switch risks and complications are listed below. Keep in mind all surgical procedures involve a degree of risk however this must be balanced against the significant risks associated with severe obesity without surgical intervention.

Possible Duodenal Switch Risks and Complications

Intra-Operative
 

• Bleeding
   
• Blood Transfusion
   
• Injury to Liver, Spleen, Esophagus, Large Bowel

Immediate Post-Operative
 

• Bleeding
   
• Deep-Vein Thrombosis (blood clot)
   
• Pulmonary Emboli (blood clot traveling to the lungs)
   
• Infection
   
• Abscess
   
• Bowel Obstruction
   
• Perforation involving small bowel, Duodenum, Stomach (leak)
   
• Pancreatitis
   
• Pneumonia

 

Long Term
 

• Hernia
   
• Bowel Obstruction
   
• Excessive Weight Loss
   
• Anemia
   
• Osteopenia/Osteoporosis
   
• Kidney Stones
   
• Malodorous bowel motions and flatus (stinky bowel movements and gas)
   
• Diarrhea

 

More on Malnutrition

Malnutrition is an uncommon and preventable risk after Duodenal Switch. [2] DS patients must be committed to taking vitamin and mineral supplements, consuming a high protein diet and having their blood tested each year. Deficiencies in vitamin D, vitamin A, calcium and protein can result in osteoporosis and anemia. Have your blood-work monitored and adjust your supplements as necessary.

More on Gas and Diarrhea

Remember back in the lesson on the History of Duodenal Switch we mentioned that DS is often confused with other surgeries? That confusion accounts for some of the exaggerated information about the frequency and volume of loose stools after the Duodenal Switch procedure.

Following Duodenal Switch, many patients experience excess gas if they eat too many carbohydrates or specific kinds of carbohydrates. Many will also experience diarrhea if they eat too many fats. In most cases patients have control over when and if this occurs because it can be controlled through diet. Patients have reported a varying degree of how much smellier their gas and bowel movements are post-op compared to pre-op and to control malodorous or loose stools patients are encouraged to frequently ingest yogurt and probiotics. [2] When necessary some are prescribed metronidazole (Flagyl). [2]

81.3% of Duodenal Switch patients experience normal gastric emptying according to Martínez et al. [36]

Anthone [9] reported the average number of bowel movements per day for 43 pre-op patients was 1.9, 421 patients six months post-op was 2.7, 316 patients twelve months post-op was 2.6 and 113 patients > thirty six months post-op was 2.8.

In a study by Wasserberg et al. [19] they found that although Duodenal Switch is often associated with more bowel episodes than gastric bypass, the difference is not statistically significant. Bowel habits are similar in patients who achieve 50% estimated body weight loss with duodenal switch surgery or gastric bypass.

In the Marceau et al. 15 year study Duodenal Switch: Long-Term Results [2] they say "The negative side-effects with DS were not benign. The unpleasant odor of stool and gas and the frequent abdominal bloating were the price to pay for these patients and it was a major preoccupation for many of them. However 95% of patients declared themselves satisfied despite this handicap and no one has required reversal of the procedure for this reason." (1428) In the same way that RNY patients accept "dumping", DS patients accept stronger odor of gas and stool.

 

Duodenal switch complications

Duodenal switch is a form of bariatric, or weight loss, surgery. It brings about weight loss by making two alterations in the gastrointestinal tract. In the first step, the size of the stomach is reduced and in the second, a connection is created from the stomach to the large intestine. Bile reaches the intestines from the liver and combines with the food. This means that fewer calories are absorbed. The absorption of fat is also reduced. Together, these things help to control weight gain. When accompanied by diet control and exercise, duodenal switch helps to achieve more effective weight loss. It is suited for severely obese individuals who haven’t been able to lose weight through other methods. Before surgery, you should have a thorough discussion with your surgeon about duodenal switch risks and complications.

The duodenal switch is a rather complicated weight loss surgery. While it offers many long-term benefits, duodenal switch complications are possible. In most cases, proper medical and nursing care helps to minimize the risk of duodenal switch problems. All surgeries involving the abdomen come with certain risks, such as infection in the incision site, bleeding, blood clots, pneumonia, adverse reactions to anesthesia, blockage in the intestines and heart attacks. Individuals who are severely obese tend to face a higher risk of these complications. One problem that specifically relates to a duodenal switch is spleen injury (which may then require removal of the spleen). The fluid from the stomach and intestine could also leak through the staples and lead to an infection. If this happens, you’ll need more surgery to drain the infection. The intestinal connections could become excessively narrow; again, this necessitates additional surgery to widen the connections.

Some duodenal switch side effects include vitamin deficiencies, anemia, peptic ulcers, intestinal obstructions, reduced level of blood proteins, hernia in the incision area, and thinning hair due to poor protein metabolism. You’ll need to follow a special diet after a duodenal switch procedure. Following the surgery, you will have to adjust your portion sizes, since the capacity of the stomach has been significantly reduced. It is also important to follow the doctor’s guidelines regarding intake of vitamin and mineral supplements.


 

So why don't you go put the Lap-Band info on the DS forum while you're at it, lol.

Cuz, I'm a busy person and I don't consider it my job to visit every forum and warn everyone of the risks associated with their surgery type. I barely manage to get to this forum to answer the occasional question. I do what I can, but it isn't actually my mission in life at this point.

 you're not very nice anymore, Maria  :(   why be antagonistic?  This woman already has the band.  WIll you attack me at some point?  Good bye

 
I do realize some of my responses to her are not very nice. Many of her responses to me in the past have been unkind as well.

Dev has had the band several years and she has seen MANY bandsters come on here with band issues, and see's how bandsters suddenly "disappear" when they start having issues (I could start naming names!) so she knows full well what the band outcome truly is. I realize that she hopes she is one of the lucky ones, but her continueing to downplay all these band complications and ignore them doesn't make them less likely to happen to her.

The post was about band complications. The post was not about how the other WLS's don't have complicatons. Whenever I post something about band complicatons she always wants to say that ALL WLS's have complications. No one has said that's not true, but when the post is about THE BAND and not about a different WLS, then it is IRRELEVENT!

 I don't really know Dev, but I know you.  I know you're kinder than that.  To wish all the bad karma on her and the band was just too much, Maria.  Take a step back and check yourself.  You're better than that.