David Syn Bariatric Surgeon M.D.

I recommend the Roux-en-Y gastric bypass as it has in-total the most favorable efficacy, durability and complication profile when done by a trained/experienced bariatric surgeon. The average person undergoing gastric bypass surgery should expect to lose approximately 50-75% of their excess body weight over a period of 1-2 years after the surgery, and can expect to regain on average 10-15%, over years after their initial weight loss. It is uncommon for people to reach their ideal body weight after this procedure; however there will be significant improvements in health and appearance for most. The health benefits usually begin during the first week after surgery with reductions in medications taken for conditions associated with obesity, such as diabetes and hypertension, and are fully achieved well before the loss of 50% of the excess body weight. Certain characteristics will affect the ease with which this operation can be accomplished. Being female is favorable as females tend to have more shallow abdominal cavities. Not having had previous abdominal surgeries is also favorable as there will be less scarring to deal with during the operation. Having a BMI in the 40 range is also favorable as the operation becomes more difficult as the BMI increases. Not having developed co-morbidities related to obesity (diabetes, hypertension, cardiovascular disease etc) is also favorable as this will decrease the risk of having complications related to the surgery. Being able to tolerate a certain level of discomfort is also favorable as this will make mobility after the operation easier and therefore decrease the chances of developing complications due to immobility. Every effort to decrease pain after the operation will be made. All patients will have a PCA (patient controlled anesthesia), which is a device that is controlled by the patient and delivers pain medication on demand at a press of a button. In my practice, the average operative time is between 1 and 1.5 hours, this time can be longer if there is anomalous anatomy or if you have had previous abdominal surgery. I generally do not place a “foley” catheter (a tube draining your urine through your urethra), unless indicated for some medical reason, as I would prefer for you to get up and out of bed to visit the bathroom. I do not routinely place patients in the intensive care unit unless there is a medical indication to do so. Once you have fully recovered from the effects of the anesthesia, I will expect for you to start moving around (at least sitting up in bed and dangling your feet off the bed) the same day of your surgery. The amount of pain experienced will vary from individual to individual and you will be connected to a machine that will deliver pain medication at your command, and then switched over to medication taken by mouth once you begin eating, if you still require pain medicines. I employ the minimal incision approach to accomplish the operation. The incision I generally make, barring the need to extend the incision, is approximately 4 inches long or about 10 centimeters, which is small for this type of operation. Size does matter. Smaller incisions result in less pain and faster recovery times. The time taken to do the operation also matters, as less time under general anesthesia results in fewer complications. After having gastric bypass surgery it is important to get up out of bed and walk, as this will help prevent serious complications that may result from immobility, such as blood clots and breathing problems. Attempts at mobility should begin the same day of the surgery once fully recovered from the effects of the anesthesia. The morning of the first day after surgery you will undergo a special X-ray of your new stomach to make sure the anatomy looks as it should, and once that is confirmed you will begin a liquid diet that morning. You will begin a blended diet later on that day. A nutritionist will be visiting with you before and after the operation and even after you leave the hospital, helping you with dietary adjustments. The second day after the operation you will continue taking liquids and a blended diet and receive more instruction on your diet. In my practice, most patients will have recovered sufficiently enough and feel well enough to leave the hospital the second day after surgery. Nausea and vomiting are not uncommon in the period immediately following gastric bypass surgery and can also occur later if recommended dietary regimens are not adhered to. If nausea and vomiting persist, and are associated with new or ongoing pain or discomfort, this may indicate a more serious problem and you should contact me as soon as possible. It will take time for you to adjust to your new dietary regimen. You will not be able to eat or drink very much initially but this will gradually improve. During the first 3 weeks after surgery, you will be on a blended diet that should have no particles in it. How this can be accomplished will be discussed in detail with you by the nutritionist. The Roux-en-Y gastric bypass is a very effective operation, however it is not foolproof. If recommended dietary regimens are not adhered to, expected weight loss may not be attained and more seriously, damage may occur to the stomach and intestine. Foods high in fats and simple sugars may cause "dumping syndrome" and should be avoided. Dumping syndrome, occurs as a result of highly concentrated fats and sugars pulling excess water into your intestinal tract resulting in severe diarrhea, cramping, blood sugar and insulin abnormalities and a general condition of feeling horrible. It can serve a positive role in that patients that eat what they shouldn’t highly concentrated fats and sugars, generally avoid those foods in the future. Dumping syndrome does not occur with the VBG, therefore patients that have the VBG face no consequences for "cheating" and therefore are more likely to eat unhealthier foods. Meals should be divided into 6 small portions throughout the day. You should eat 2 ounces of protein (lean meats, beans, tofu etc) with each meal. You should eat the protein first before carbohydrates or vegetables. Protein is very important to your nutritional status and is needed for your body to heal properly. At least 8 cups of water/liquids should be consumed daily to prevent dehydration and should be taken between meals. When starting solid foods, approximately 3 weeks after the operation, only one new solid food should be added daily. Solid foods should be chewed to the almost liquid state. Alcohol should be avoided. You will be started on multi-vitamins after your operation and may in addition need to take supplemental iron or vitamin B12. It will be important for you to continue on these vitamins indefinitely to prevent malnutrition and to follow up with me and your primary care physician so that your weight loss, overall health and nutritional status can be followed. You may also need to take medication to prevent the formation of gallstones after your operation, as gallstone formation is common in people that lose a drastic amount of weight. If you have had your gallbladder removed previously or during the weight loss operation, then you will not need to take this extra medication. This will be discussed further with you if you should decide to undergo weight loss surgery. You will need long term follow-up to watch for malnutrition and other possible complications as listed above.   When you have gone home and are adjusting to your new diet there may be questions that arise and concerns that you had not thought to ask about before. There will always be an open line of communication and either I or a qualified staff member will be available to speak with you or return your call in a timely fashion. Aftercare is coordinated through The Advanced Bariatric Surgery Center. Support groups are held on a monthly basis and attended by Dr. Syn, a dietician as well as support staff. It is a very helpful forum to share experiences, thoughts as well as give and receive support.