Posts Tagged ‘bariatric procedure’

INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS

Thursday, January 12th, 2012

INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS

 

The internal hernias after a Laparoscopic Gastric Bypass may occur in 10 % of patients.  Early detection is important because they threaten the patient by causing intestinal obstruction, intestinal strangulation with perforation and peritonitis.

It is very important to know that the Internal hernias often pass unnoticed delaying the diagnosis and the treatment. 

The doctors either do not suspect the problem as a cause of the symptoms or the patients misunderstand the severity of their symptoms due to their initially vague clinical symptoms.

It is very common that the patients tend self medicate themselves delaying the prompt attention, not consulting with a doctor until symptoms are more serious with a higher risk of catastrophic complications.

Internal hernias in patients with Gastric Bypass occur most frequently 18 months after surgery, however there are reports from the first postoperative day up to 25 years after the operation.

It is important to know if your doctor completed a laparoscopic Gastric Bypassretro colic” or gastric Bypass “ante colic”.

There are 3 sites in the first case (retro colic) where hernia occurs: At the Petersen’s space, at level the jejunum-jejunostomy and at the mesocolon underneath the transverse colon; and there are two sites in the ante colic laparoscopic Gastric Bypass with a potential internal hernia presentation.

When a surgeon uses sutures during the bypass surgery the potential of a hernia space decrease the risk of the presentation of internal hernia.

In some private hospitals operatory time is very expensive and some doctors prefer to ignore this very important surgical step, on the other hand, to close these spaces also requires the development of advanced laparoscopic skills to do it correctly and in expeditious manner with intracorporeal stitches to close such potential hernia spaces and that has to be done by hand (not staplers), as a result, that explains some of the incidence of hernia with intestinal obstruction.

Common symptoms of internal hernia after a Laparoscopic Gastric Bypass are mild peri umbilical pain progressing to an intermittently cramping pain but increases in frequency and if not treated it will progress to the classic intestinal obstruction.

Occasionally the intestinal obstruction is mild and resolves quickly but may become a true surgical emergency where the life of the patient is at risk and surgical laparoscopic treatment has to be done without delay.

If you experience any of the described symptoms you must act quickly to resolve the hernia and need to be explore the area by laparoscopic means.  Closure of the hernia ring is very feasible in most cases, even more, when a bypass patient arrives with obstruction and it is diagnosed quickly needs to undergoing laparoscopic exploration to avoid complications.  If not treated immediately the chances increase due to the high possibility of a second catastrophic event.

Don’t expect that the hernia will be resolved with general measures because sooner or later the patient’s life is in jeopardy.

Dr. Arturo Rodriguez

Gastric Surgery and Obesity

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2010-01-10 19:59:05. Republished by Blog Post Promoter

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Life After Gastric Bypass Surgery

Thursday, December 15th, 2011

Life After Gastric Bypass Surgery

There are a number of important things to consider for patients after they have had Gastric Bypass Surgery. Take some time to read through the information and get informed if you are considering this procedure.

Diet

After having a gastric bypass, the modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss.  Without these necessary changes, such as decreasing or limiting your intake of high-fat, high-sugar foods, you may stop losing weight or even begin to gain weight again.  Limiting high intakes of sugary foods is especially important to decrease the chance of Dumping Syndrome, where these foods move too quickly through the digestive tract into the intestine and can cause cramping, pain and discomfort, among other related symptoms.

Post-surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their gastric bypass surgery. It is important to remember that every surgeon does not perform the exact same weight loss surgery procedure and that the dietary guidelines will be different for each surgeon and each type of bariatric procedure.

What is most important is that you adhere strictly to your surgeon’s recommended guidelines. The following are some of the dietary guidelines I recommend after a gastric bypass:

  • During 4 weeks you will go on a liquid diet and advance in steps to a puree/baby food type diet for one or two additional weeks and transition to an almost normal (solid food) diet after that.
  • When you start eating solid food it is essential that you chew thoroughly.
  • You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
  • Don’t drink fluids while eating. They will make you feel full before you have consumed enough food or they will flush down more food than you should be taking in.
  • Omit desserts and other items with sugar listed as one of the first three ingredients.
  • Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
  • Avoid alcohol.
  • Limit snacking between meals.

Going Back to Work

Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of gastric bypass you had (open or laparoscopic). Many patients return to full pre-surgery levels of activity within six weeks of an open Gastric Bypass procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a week.

Birth Control & Pregnancy

It is strongly advised that women of childbearing age use effective forms of birth control during the first 16 to 24 months after a gastric bypass surgery since the fertility increases during weight loss. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

Long-Term Follow-Up

Although the short-term effects of weight loss surgery are well understood, there are still some questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years are well known if you don’t take the recommended supplements. You will take supplements of Vitamins and Minerals (such as calcium and iron) for life and have a full blood work test done at least once every year.

Support Groups

The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various issues.  Most learn, from example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Most surgeons have support groups in place to assist you with short-term and long-term questions and needs. I highly recommend enrolling into a support group.

Be cautious when turning to message boards as they are full of doctor’s coordinators or brokers more concerned with increasing business in their direction than providing support. You have to be aware of their presence and not allow them to manipulate you; they are only interested in gossiping or scaring you when you are only looking for the right answers.

Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.

Arturo Rodríguez, MD

Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2008-10-26 07:45:58. Republished by Blog Post Promoter

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Bariatric Procedures: Being More than Fans

Monday, June 28th, 2010

Bariatric Procedures: Being More than Fans

The last 10 years I have been very busy participating in a lot of meetings around the world.  I have found, unfortunately, that we have spent such a long time discussing what procedures are the best for treating obesity that we have forgotten the main point, the core of any of the procedures’ success: the patient.

We all look like fans of a football team, cheering for their favorite team.  Some doctors cheer for the Gastric bypass as the best and only option to cure obesity. Then we have the doctors that prefer the lapband as the first option. In another corner, there are the doctors that promote the Gastric sleeve as the new treatment for obesity and Type 2 Diabetes.

There are several good medical reasons involved in the doctor’s preferences for one procedure over the other but also their preferences points toward which procedure the doctor feels more comfortable performing or is more skilful.  In Mexico, we have to add to this discussion, the place were the doctor was trained, for instance, if he was trained in the Mexican Health Care System they will know very little about the Lap band and would prefer to perform the Gastric Sleeve or the Gastric Bypass.  This is because the Lap band is not yet available for the government hospitals.  This means that these doctors started with Bariatric procedures such as the Gastric Bypass 3-4 years ago, and the Gastric Sleeve 1-2 years ago.

I personally recommend the Lap band as the first option. There is less risk for operatory complications involved, it is less expensive and it’s adjustable.   You don’t have to be overly obese to have the Lap Band.  You can have Lap band revision in case the lapband fails the first time or jump to any of the other procedures available including the Duodenal Switch. The Lap-band also helps in the control of co-morbidities related to obesity such as high blood pressure or Diabetes in almost 6 out of 10 patients.

The arguments against having the Lap band as the first option are valid with patients that have difficult behavioral control such as alcohol abuse. Arguments are also valid for patients that don’t like the idea of having lapband fills done periodically or when there isn’t a doctor or center to do the fills close to where they live.  The arguments against the Lapband that are not valid, are erosion rates (less than 2 %), slippage (less than 4 %), or obtaining insufficient weight loss as a strong argument for deciding on other surgical options such as the Gastric sleeve or Gastric Bypass.

There are no “complication free” bariatric procedures.  With any bariatric procedure there are advantages and disadvantages.  We also found that with all bariatric procedures, there is a chance for insufficient weight loss and a chance that patients may need revision surgery. Mean percent excess weight loss at five years ranged from 48 to 74 % after Gastric Bypass and from 50 to 60% after Vertical Banded Gastroplasty, the same results are for the Gastric Sleeve.

However, with all this in mind, we must remember that the best and most effective procedure will ultimately depend on the individual patient that is looking for a weight loss procedure.  The patient and doctor must work together to discover all the facts and make the best informed decision in order to be successful. Don´t rush your decision – get informed!

 

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2008-11-13 22:11:41. Republished by Blog Post Promoter

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