Anyone here have experience with patients with a history of gastric bypass surgery? I've noticed that they have chronic complications. I had one such patient the other day. He had to constantly eat to avoid malnutrition and he appeared malnourished.
He said that his weight ballooned after getting on psyche meds causing obesity related health problems, so then he got the gastric bypass.
It seems like Western medicine isn't particularly holistic. There must be a better way.
The roux etc is the most common procedure and is, indeed, a bypass resulting in malapsorption. I don't know to what you think I'm referring.
The Roux-en-Y bypasses most of the stomach and the duodenum. This bowel bypass left the stomach intact but reduced the small intestine to about 6 feet, thereby reducing the amount of food absorbed. In other words, these people had short gut syndrome, which can't be good for anybody.
And like many other people with short gut syndrome, they developed liver failure. That's why it isn't done much any more, at least not for weight loss.
I have known several people who used weight loss surgery as a tool of last resort, and were successful with it. And I'm sure there are other people I know who had a bariatric procedure and didn't tell me about it. For the right person, yes, it can be lifesaving.
Yes, you are correct. The Roux-en-Y is commonly performed, with excellent outcomes. The procedure leads to reduced food intake and malabsorbtion of food requiring lifelong use of dietary supplements. There are of course other techniques that are used including gastric bands etc.
A good review (Sugrical intervention for the treatment of the morbid obesity and the dyslipidemias. Buchwald. 2007) may be found on Medsacpe at http://www.medscape.com/viewarticle/564952
With respect to the friend I mention earlier, the procedure helped him make significant lifestyle changes (ie it made him physical able to undertake daily exercise after loosing more than 350 lbs) eliminated the need for medical management of hypertension, hyperlipidemia, type 2 DM, and obstructive sleep apnea. This is not insignificant list of conditions. Additionally, he is now able to go to the movies and fly in the economy class cabin (granted both of these are not much fun but it is nice to have the option). The psychological benefits have been significant.
I reiterate that I observed his path to be anything but "easy." The surgery and his post-operative life changes have been difficult. This is not a tummy tuck, but a potentially life saving intervention to a life threatening medical condition. Actually I think it might be useful if people thought of this like a CABG.
Specializes in Medical and general practice now LTC.
I have been fortunate on not having complications and although I do take a few tablets a day they are all supplements like Zinc, Ferritin, Folate as well as the B12 injections but being nearly 3 years out I have only just started them (this month). I have known a few people who have had the lap band done and found ways round to cheat but I also know someone who lost 11 stone (154 lbs) with the band but can not eat anything solid just liquid, will not have a great defill as she is worried she may put the wait back on. I think it also helps if you can find a good support group and support members I certainly found a good site here in the UK. Also in the UK very hard to get surgery paid for by the NHS as it will vary in areas and each area despite national guidelines will have their own. Reports in some places of people not being large enough at 33 stone (420 lb) or that they have no co morbidities. If you are lucky to get it paid then there are usually lots of hoops to jump through of which one is usually a psych evaluation. If people pay privately if the surgeon wants things doing they will get done otherwise usually operated on within a few weeks, they will make their own assessment
About 20-25% of post-surgical bariatric patients are treated for depression AFTER the surgery. Also, the patient is on a continual diet. For people who have life-threatening illnesses related to obesity the surgery is wonderful, but patients really need counseling before and after to be sure they get what they expect. I have seen some in our support group who were using their "fat" as a reason not to work or socialize. Now they don't have an excuse so are having to cope with things they never considered before the surgery. I believe every patient needs counseling before surgery. Regardless of their motive for having the operation.
The procedure that rph is refering to is the jejunoileal bypass procedure which was used between the 1960s and early 1980s. It was a true "malabsorption" procedure in that, since the stomach was left completely intact, patients were able to eat as much as they wanted.
However, as rph points out, it was essentially a surgically-induced short-gut syndrome and had significant morbidity & mortality due to profound electrolyte imbalances and liver failure. This procedure is no longer performed today in the United States.
When I worked as a Practice Administrator, I had a clerical employee who had bariatric surgery, and she developed one complication after another. She missed so much work, I had a huge battle with my own admin to justify not firing her. I am now working in Case Management and have had many patients in various stages of the bariatric surgery process. The complications are many, and some are potentially fatal, but it is the emotional complications that seem to do the most damage. A good bariatric program will require a patient to comply with a year-long program in preparation for surgery, but there are many others who offer little preparation. Most patients see bariatric surgery as a quick fix, believing that they will walk out of the hospital looking slim and trim, and this will solve all their problems. Few realize or accept that this is a life-altering procedure, and in many cases, it cannot be reversed. It has been my experience that few patients who are obese because they eat too much are going to benefit over the long run. Unfortunatly, it is only a quick fix, and many patients regain their weight or suffer complications trying.
Specializes in Gerontological, cardiac, med-surg, peds.
Discussion of complications from bariatric surgery in recent articles from Medscape:
Despite the various procedures, complications of bariatric surgery generally present in one of five nonspecific ways: abdominal pain, suboptimal weight loss, diarrhea, gastrointestinal bleeding, or wound infections.
Bariatric surgery among patients with class 3 obesity is associated with higher mortality than the general population, with higher rates of suicide and coronary heart disease as causes.
Roux-en-Y procedures drastically reduce the surface area for absorption. These changes may warrant manipulation in drug route or dose to ensure adequate delivery. Drugs with long absorptive phases that remain in the intestine for extended periods are likely to exhibit decreased bioavailability in these patients. The reduced size of the stomach after surgery can place patients at risk for adverse events associated with some medications. Medications implicated in such adverse events include nonsteroidal antiinflammatory drugs, salicylates, and oral bisphosphonates. Drugs that are rapidly and primarily absorbed in the stomach or duodenum are likely to exhibit decreased absorption in patients who have had combination restrictive-malabsorptive procedures. Because reduced drug absorption may result in decreased efficacy rather than toxicity, increased patient monitoring for therapeutic effects can help detect potential absorption problems.
Several years ago, two of my female coworkers had the Roux-en-Y gastric bypass surgery. This is the procedure in which the stomach is reduced to the size of an egg and the duodenum and part of the jejunum is bypassed, creating malabsorption. They were both morbidly obese and had tried numerous diets, but to no avail. One was relatively young - in the low 30's, and the other in her mid-50's. The younger woman fared marvelously and lost over 100 pounds in a little over a year. I believe her weight finally stabilized around 150 pounds. She did suffer one complication - a gastric ulcer which formed shortly after the surgery, with significant abdominal cramping. With a simple oral anti-ulcer medication prescription, this condition was completely alleviated and she healed without any further problems. The older co-worker had a more harrowing road to recovery. In addition to the morbid obesity, she suffered from multiple comorbid conditions (such as HTN, Type II DM, atrial fibrillation) and was taking numerous medications, which significantly complicated her recovery. At one point, the coumadin dosage that she was accustomed to taking before the surgery caused her INR to skyrocket to 11 and she was hospitalized to prevent hemorrhage. She had several other equally frightening episodes that resulted in hospitalization as well, but she survived. She also had bouts of explosive diarrhea and sometimes had a fecal smell. I have been out of touch with these two for almost two years, but people who have seen the older woman report she has lost a LOT of weight - over 100 pounds - but "is pale and looks really unhealthy."
I used to work in a unit where they did gastic bypass on high risk patients. These are the patients that wouldn't be accepted by the "normal" surgeons. Maybe there was a reason for that. I saw a lot of people die post-op for a surgery they elected to have done, and knew they were "high risk". I saw young people have to get their limbs amputated afterwards and have their entire buttocks area basically GONE because of post-op complications. There was someone who REFUSED to get out of bed and do the necesary PT/OT stuff... no cooperation as a pt resulted in major problems. So yes, in my eyes gastric bypass opens up a door to a whole set of new problems. Patients should really be prepared as to what they are getting into.
i do think it is somewhat an easy way out, what about exercise and eating right
not dieting, that helped for a friend of mine, she lost over 100p in a little bit over a year
and all with a conservative approach.
nici
That's great if a person can do it but 99% of people only get bigger by dieting, or not dieting, as the case may be.
I dropped 60 pounds with Phenteramin and only took 1/2 tab per day but I don't think I'd do it again. It didn't change my eating habits only stalled my appietite. I've only put 9 lbs back on since Aug but my old eating habits have returned.
IMHO For the morbidly obese there's really not any other options other than to die.
I'd love to drop another 40 pounds. Don't know how but as always I'm working on it.
Because our hospital like others jumped onto the bariatric bandwagon...we see them alot in our ER. Compared to the percentage of surgeries being completed, we don't have that many coming in with complications...that being said, I think, based on what I see, that it must be a miserable existance.
Those who do have abdominal problems accompanied by frequent vomiting and diarrhea usually look terrible. In addition, having lap band adjustments done by residents!!! HOW about NO! I want to tell these patients all the time to ask for the attending....instead they are tortured by residents guessing where and how to inflate/deflate the band. It wouldn't be me.
I think most people are overweight due to emotional eating...I just don't believe this will work for them permanently! That's why there are so many failures after an initial weight loss. A better choice would be to have a space filler in the stomach...leave the stomach intact, but have something to fill that bottomless pit. Leaves less room for food and calories. Maybe then portion control would work. How can a person go from plates of food and many meals to such small amounts? Of course they are depressed...food was their friend.
For the many it helps, and there are many....followup needs to be mandatory...I just don't know how you could enforce it. When you see shows like the "Biggest Loser"...you realize exercise and portion control works....people that say they can't lose weight haven't tried 100%. Unfortunately, people can't leave their lives to go to boot camp...although that's what they need. Weight loss is dictated by our families, friends, lovers, and lifestyle. Next thing you know, it will be family specials for surgery...misery loves company.
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rph3664
1,714 Posts
The Roux-en-Y bypasses most of the stomach and the duodenum. This bowel bypass left the stomach intact but reduced the small intestine to about 6 feet, thereby reducing the amount of food absorbed. In other words, these people had short gut syndrome, which can't be good for anybody.
And like many other people with short gut syndrome, they developed liver failure. That's why it isn't done much any more, at least not for weight loss.
I have known several people who used weight loss surgery as a tool of last resort, and were successful with it. And I'm sure there are other people I know who had a bariatric procedure and didn't tell me about it. For the right person, yes, it can be lifesaving.