Weight Loss Surgery (WLS) Frequently Asked Questions (FAQ)

goddess819 · 06-28-2008, 07:16 PM

Per Kat's request here are some of the most frequently asked questions regarding weight loss surgery that the WLS Divas thread has come across.

There are currently 4 major types of WLS being performed and we do our best to go into some detail with each surgery. If after reading this you still have questions please feel free to drop by the WLS Divas thread located under the Diet & Exercise buddies forum and ask them. We're more than happy to answer questions and share our experiences.

What is the RNY? RNY stands for Roux-En-Y and is typically what’s talked about when gastric bypass is talked about. The top of the stomach is sectioned off to create a 1 ounce “pouch”, the rest of the stomach and beginning of the small intestine (called the duodenum) is bypassed. The end of this bypassed section is reconnected further down “the line” to allow gastric digestive juices and enzymes to enter the small intestine. The small intestine is then brought up to the new stomach and attached. Once everything is rerouted it creates almost a “Y” letter (thus the name). This surgery is the most popular in the United States and is considered the “Gold Standard” when it comes to weight loss surgery. This surgery is both restrictive in how much a person can eat and also malabsorptive in how much the body absorbs. Potential complications for the RNY may include nausea, vomiting, leakage (internally from incision sites), vitamin deficiency, dehydration, “dumping syndrome”, anemia, lactose intolerance, stricture, incision infection, ulcer, and in extreme cases death. Many RNY patients experience few of these complications and many are easily treatable following dietary/vitamin guidelines. Other complications can occur from just going into surgery itself due to many people having weight loss surgery have co-morbid conditions that make any surgery more dangerous. This surgery is typically done laparoscopically but due to patient size and surgeon preference may be done as an “open” surgery.

What is the lap band? Lap band surgery is where a silicone ring is placed around the top portion of the stomach to create restriction of how much a person can eat at one time. There is no cutting of the stomach or intestines. This procedure is restrictive only and there is no malabsorption. This procedure is done laparoscopically and has the fastest healing time. This ring is filled with sterile saline fluid to increase resistance to how quickly food passes through. This is done through a “port” that is stitched into the abdominal wall and a needle is used to pierce the port and either inject or remove fluid to get the desired resistance also known as the “sweet spot”. These are called fills and unfills. Potential complications for the lap band include band slippage, band leakage, erosion of the band into the stomach, difficulty swallowing, dehydration, “sliming”, nausea, constipation, ulcer, weight regain, no weight loss, and in extreme cases death.

What is the Duodenal Switch (DS)? The Duodenal Switch (DS) is a both restrictive and malabsorptive procedure. In this procedure roughly 85% of the stomach is actually removed leaving a long sliver of a stomach and leaves both the sphincters (at the beginning and end of the stomach) intact. This stomach is roughly 4-5 ounces in size and empties into only the last 2-4 cm of the duodenum (small intestine). Patients who have this procedure are able to eat more at one time than someone who has lap band or RNY but compared to the RNY does not absorb as much of the nutrients consumed. Research has also shown that type II Diabetes is cured with the DS more quickly than it is with the RNY. Potential complications for this surgery are similar to the RNY with the exception that there is no “dumping syndrome” and constipation is rare. In contrast if a meal high in simple sugars is eaten many patients may experience abdominal bloating, foul smelling feces & gas. Diarrhea is also more common with this procedure.

What is the Vertical Sleeve Gastrectomy (VSG)? The Vertical Sleeve Gastrectomy (VSG) is essentially the same procedure as the Duodenal Switch (DS) without the bypassing of the small intestines. This procedure is restrictive only. Potential complications are the same as the lap band with the addition of leakage at the internal incision site.

How much time will I be off of work? How much time off of work depends on what you do for a living. The typical time off for a laparoscopic procedure is anywhere from 3-6 weeks. Of course if you have a desk job you may be ready to go back in 3 weeks but if you have a very physical job you may be out for 6 weeks. This will be determined by your surgeon.

How much weight will I loose? The average estimated weight loss for RNY is 75-85% of the excess weight, lap band is 55-65% of the excess weight, the DS is 85-90% of excess weight & the VSG is 75-85% of excess weight. Weight loss comes off fastest with the RNY, then DS, then VSG, then lap band. Weight loss of course varies person to person, some may loose more or less than the average for each surgery.

What insurance requirements will I need for approval for surgery? Typically an insurance company requires a Body Mass Index (BMI) of over 40 or between 35-40 with 2 or more co-morbid (medical conditions related to obesity) conditions such as diabetes, hypertension, sleep apnea, high cholesterol, high triglycerides and more. Many insurance companies also require a psychological evaluation, nutritionist evaluation, support group meetings, 6 month physician supervised diet, 5+ years of documented obesity, cardiology & pulmonary evaluation, and sleep study. Some insurance companies may require less or more than what’s been listed. To know for sure what your insurance company needs to approve weight loss surgery (WLS) call your insurance company directly and ask them what they need for approval.

What kind of vitamin supplement/exercise regimen is expected after surgery? This may vary upon which surgery you have but the standard is a multi-vitamin, iron, calcium, B1 & B12. Exercise is as tolerated. In the beginning you can expect walking until you’re cleared by your surgeon for all activity. At that time you can begin more intense workouts (cardio & weights).

Will I need protein shakes/bars forever? No. Supplementing your protein intake is typically only done in the very beginning when you are able to eat very little. Over time most surgeons expect you to get your protein from food sources (remember if it has a mom you can eat it!).

What is dumping syndrome? Dumping syndrome only occurs with the RNY and can occur when too much sugar or fat is consumed (sugar is the most common culprit). When the blood senses the quick rise in sugar/fat it triggers the pancreas to ‘dump’ insulin into the blood stream to combat the rise. It’s similar to a hypoglycemic episode. Sugar/fat tolerance varies upon the individual. Some patients “dump” easily while others have never done it. Dumping may include some or all of the following to varying degrees (depending on how sensitive you are to sugar/fat and how much you consume) of vomiting, diarrhea, dizziness, abdominal cramping, heart palpitations, nausea, hot flash, sweating, and fatigue. Dumping can be avoided by not eating high sugar items. Many RNYers can tolerate natural sugars as found in fruit more than they can tolerate processed sugars as found in candies and such.

What kinds of foods will I be able to eat after surgery? Protein is key in any WLS. There are essential amino acids you get from meats that your body cannot get from anywhere else. Remember that if it has a mom you can eat it. Overtime other foods can be eaten and another key thing to remember is “all things in moderation”. A person who is 2+ years post op should be able to eat just about anything a non WLS person can eat. Foods/drinks that are to be avoided vary per surgery. For instance RNYers and Lap banders are advised to stay away from carbonation. For the RNY it causes pain & discomfort as the stomach is so small there is no real room for the gas to expand, also it has the potential to stretch the opening at the bottom of the stomach leading to the intestines over time which can lead to overeating and that loss of feeling full. For the lap band carbonation can also lead to pain & discomfort as when the carbonation initially hits the pouch created by the lap band there is little room for the gas to expand. The typical post op diet begins with clear liquids and then moves on to full liquids, soft/pureed foods and then more solid/dense foods are added later on. Your surgeon will have an in-depth timeline of which foods to eat when for you. Post op diets not only vary depending on the surgery you have but also on your surgeon.

Can I drink alcohol after weight loss surgery? After some time yes. However it’s a very different experience having a drink of alcohol as a WLS post op than it is before surgery, especially for those who have the DS, VSG & RNY procedures. Alcohol enters the blood stream much more quickly which makes the person feel drunk very fast. You have to be extra careful when drinking alcohol as a post op. Also some alcoholic beverages may not be able to be consumed after surgery due to carbonation or sugar content. You definitely don’t want to have a drink of alcohol very early post op as the stomach is still healing and could be irritated by the alcohol. There should be no real difference aside from how much can be drank at one time with the lap band procedure.

How does weight loss surgery affect my PCOS? WLS affects PCOS in many different ways and many doctors still aren’t exactly sure as to how. But what we do know is that the weight loss helps hypertension (high blood pressure), diabetes, insulin resistance, fertility, hormone levels and more. Many women who loose a large amount of weight following WLS find their diabetes/IR resolved and that menses return to normal cycle lengths which then results in increased fertility. Many women are able to get pregnant fairly easily once a large amount of weight is lost.

I want kids, what about getting pregnant after surgery? You can get pregnant after surgery (all kinds) and have a healthy pregnancy & baby. Of course nutritional needs are a little different than having a baby prior to WLS. You will need additional vitamins and calories than the typical pregnancy. These guidelines should be established by both your WLS surgeon & OB/GYN. As for when you should get pregnant the longer you are able to wait the better. You should be at minimum 12 months post op (most surgeons prefer 18-24 months post op) so that you can not only maximize your weight loss for ideal health but also so that you are able to eat a descent amount of food and establish good eating habits. Of course getting pregnant early post op can happen (and does). Depending on how soon after surgery you get pregnant determines how “high risk” you are to your surgeon & OB/GYN.

Will I have excess skin? It’s possible. Excess skin mostly depends on genetics & secondly to how fast the weight comes off. Think of your skin like a balloon. If you have a balloon that’s been blown up for a long time it’s stretched. As you let the air out the balloon shrinks. Once all the air is out does the balloon look like it’s never been blown up? No. Of course if the air comes out fast the balloon is larger or more wrinkled. It does continue to shrink for a bit of time after all the air is out though. If the air comes out slowly…it’s still not the same size as before being blown up it’s just more likely to not be quite as wrinkled. Now some will have more excess skin than others. Water & exercise do help but if you have excess skin pretty much the only thing that is going to get rid of it for good is plastic reconstructive surgery.

How do I know which surgery is right for me? Choosing the right surgery is a personal decision. One that needs to be made by you and your surgeon to best suit YOUR needs. For one it may be the DS for another it may be the lap band and yet for another it may be the RNY. You need to evaluate your weight loss & health needs and compare it to each surgery and then of course consult with a licensed bariatric surgeon. Don't choose a surgery based on "stories" you've heard...same for not choosing a surgery.

Will I be able to stop taking my prescription medications? That is to be determined by your personal physician. However, most people who have WLS are able to reduce the amount of medication they take daily and some are able to eventually stop medications as directed by their physician.

Are there medications I cannot take after surgery? With the RNY & lap band you are not able to take any NSAID (non-steroidal anti-inflammatory drug) such as Advil, Aleve, Asprin, Naprosyn and other drugs along those lines due to the ulcerative properties of these drugs. All NSAID drugs reduce the production of mucous that coats & protects the stomach. If this mucous production is lessened it can make the pouch of the RNY & the ‘pouch’ created by the lap band more susceptible to ulcers or injury by a sharp piece of food like a tortilla chip. Some surgeons however will allow a short term NSAID use after 1 year post op only when used in conjunction with Protonix. With the DS patients should avoid time released medications. With the VSG there are no medication restrictions.

What is average time between surgeon consultation & surgery? Again, varies upon your insurance requirements and how quickly you can get appointments scheduled. This process can take anywhere from 4-6 weeks to 1 year or more.

Where can I research my surgeon? You can research your surgeon on www.obesityhelp.com as well as doing an internet search. You can also find a local support group to find other people who’ve already had surgery by the surgeon you’ve chosen.

Where can I learn more? You can check out the following links to www.lapband.com , www.duodenalswitch.com & www.obesityhelp.com to learn more. Obesityhelp.com has forms covering each surgery in addition to specific medical condition, surgery complications and a forum for each state in the US. Lastly there is a thread here on Soulcysters that is dedicated to WLS. This thread is called “WLS DIVAS” and can be found on the http://www.soulcysters.net/diet-exercise-buddies/ Forum. We offer information and support to all who have either had surgery or are looking into having surgery. If you have questions regarding any form on WLS please feel free to stop by our monthly thread. Thank you for taking the time to read all of this valuable information.

BeautifulStill · 09-13-2008, 12:50 AM

Thank you for all of this outstanding information. What a blessing to find so much here rather than worrying that what I have found scattered online may not be accurate, etc.

sahm22grls · 10-21-2008, 11:46 AM

I am considering wls and this is great info

Dusty_Rose93 · 10-22-2008, 04:32 PM

I have had it done this last March and am soo happy with my RNY. Do your research before you just dive into it. Join a support group they will be great help for any questions you might have as they are living it.
Teresa