Transcription:

Bill Klaproth (Host): So, what is the gastric bypass and is it right for you? Hmm, well, here to answer that question is Dr. Michael Bilof, a bariatric surgeon. He is also the founder of Garden State Bariatrics and Wellness Center. Dr. Bilof, let’s jump right into this. What is that gastric bypass?

Dr. Michael Bilof, MD (Guest): The gastric bypass Bill, is a bariatric procedure that has been around for quite a long time and we in some sense would say is the sort of gold standard or granddaddy operation. If I could – many patients have seen sort of videos on YouTube or pictures on the internet of what we do which can sometimes be a little hard to figure out if you are not technically oriented so to speak. So, let me just go through exactly what the bypass does. We essentially, with this surgery, reduce your stomach from the size of a football to the size of an egg. That’s a little bit of a simplification but essentially that is what we are doing. So, you can just kind of in your own mind picture a football and then an egg sitting next to it. So, that’s – your stomach will be reduced down to that size. And then we sort of rearrange the intestines a bit so that we bypass about ¼ to 1/3rd of the intestines.

Those are essentially the two things that we do with this surgery and they will help a patient – by doing those things, we help the patient lose weight in several ways. One is your stomach is smaller, right we just cut it down to the size of an egg. Two, there is a pretty dramatic decrease in appetite with this surgery which we see with other surgeries as well, where patients just don’t really feel very hungry or have much of an appetite for about six to 12 months after the surgery. And then three, because we have rearranged the intestines, we decrease the absorption of nutrients and that helps patients lose weight, that helps patients lose more weight. That can also help with diabetes because it kind of directly interferes with the absorption of sugars and so through all those different mechanisms, this surgery will help patients lose weight.

Bill: I love that. What a great description and way to put that in terms that we can really visualize that. So, for someone evaluating this Dr. Bilof, can you just quickly share with us what the major differences are between the gastric bypass, the Duodenal Switch and the gastric sleeve?

Dr. Bilof: Sure. Let me compare the bypass and the sleeve first, because those are the two that most patients are fairly familiar with. So, the sleeve, if I could just go back to what I said before where the stomach is picturing the size of a football. So, that’s your stomach before any kind of surgery. And with the gastric bypass we reduce the size of the stomach to about the size of an egg. Well with the sleeve, we reduce the stomach to the size of a banana. Again, if you just kind of think of those two things sort of sitting on a table next to each other, you can kind of get a visual about that. In ounces it goes from about 30 ounces to about 7-10 ounces which is the banana size and the egg size is 2-3 ounces.

So, that’s one difference. The stomach is actually slightly bigger with the sleeve and then the other difference main difference is that with the bypass, we kind of rearrange the intestines somewhat and that decreases the absorption of nutrients which will oftentimes, which can help patients lose more weight and can also help a little bit with diabetes because it interferes with the absorption of sugars. The sleeve does not have that effect. With the sleeve we are simply working on the stomach and we don’t really touch the intestines and so because of that, the absorption of nutrients with the sleeve is essentially the same as it is before the surgery. So, there is no effect on the absorption of nutrients.

The technical medical term that patients may see when they are sort of out there researching is malabsorption and that’s simply a medical term that means less efficient absorption. So, with the bypass, there is a component of this malabsorption or decreased absorption and with the sleeve, there is not.

Bill: Okay, got ya. And what about potential downsides or complications and what is this thing we have been hearing about dumping syndrome? Can you tell us what that is?

Dr. Bilof: Sure, so there are complications with surgery obviously, with any kind of surgery. One that patients may have heard of with the bypass is this thing called dumping syndrome. I would say it’s actually – it’s not really a complication but it is something that can occur after surgery and it’s a thing where patients will oftentimes feel cramps, nausea, vomiting, sort of like a bad – the way I usually describe it to patients is it’s like you got a bad GI virus that lasts for- it doesn’t last for a day, it last for an hour. And this GI virus so to speak, is not particularly dangerous but it’s very unpleasant. So, you feel nauseous, you may have some vomiting, some cramping and it’s usually with the gastric bypass, it’s usually caused by foods that are high in sugar. So, we call them concentrated carbohydrates. So, something like soda or orange juice or ice cream, things that have a large amount of sugars in a very small volume can trigger this dumping syndrome. So, again, the key thing to remember is, it only happens – it typically only happens with the gastric bypass and not with the gastric sleeve and it typically occurs when patients consume very high sugar concentrated carbohydrates and it’s not a dangerous problem, but it’s just rather unpleasant and it’s usually caused by consuming things that we wouldn’t really recommend anyway.

Bill: Alright, so then let’s flip the coin. What about the health benefits of the gastric bypass?

Dr. Bilof: Yeah so, the health benefits are similar to the gastric sleeve in the sense that there is weight loss obviously. In general, I usually tell patients that the weight loss may be a little more with the bypass and also if someone is a diabetic, I think there’s a slightly better chance of the diabetes improving or even going away completely with the bypass as compared to the sleeve. So, those are two things to keep in mind if someone weighs a little more or if they are diabetic, the bypass might be something to consider. Those are the two main things that kind of sway people one way or the other. There are some other issues that are a bit technical that I don’t think we should get into right now, but if they pop up so to speak or we discover them during the preoperative workup, may cause us to advise a patient to do one procedure versus the other.

Bill: So, you already told us about the procedure, can you tell us what the typical recovery is like and then what about diet and life after gastric bypass surgery?

Dr. Bilof: Sure. So, with the gastric bypass, as with all of our surgeries, we do it laparoscopically. That is, we make very small incisions anywhere from ¼ of an inch long to about an inch, inch and a half long. So, the recovery after surgery is relatively quick because the incisions themselves are relatively small. And so, and in the hospital, I would say it is typically one or two nights in the hospital and two or three weeks before a patient is sort of fully recovered and back to their normal sort of everyday activities. In terms of dietary restrictions, I would say that the gastric bypass is similar to all of the procedures that we do. In the sense that we would recommend a high protein, moderate amount of fats and a low carbohydrate diet so to speak after the surgery and that advice is going to be the same pretty much regardless of which procedure you do. With the caveat that with the bypass itself, there is this risk of dumping syndrome if someone consumes something that is a concentrated carbohydrate or sweets that can definitely trigger an attack of dumping syndrome. One other thing I would mention, this is very specific, if someone is a smoker, I would not recommend the gastric bypass as there is a risk of ulcers with the gastric bypass and that risk in smokers is very high. So, we generally don’t recommend the gastric bypass if someone is a smoker.

Bill: I know this is a tough question to answer, but how much weight loss can someone expect with gastric bypass surgery?

Dr. Bilof: Right, I mean it is always a little tough to make a prediction and we don’t like to – in general, I don’t like to do that because everyone is a little bit different. There is a lot of variation in their outcome and the results. Having said that, I would say the bypass is somewhere between 50% and 2/3rds of excess body weight will be lost. So, again that’s not 50% of someone’s starting weight, but that’s 50% of the excess body weight above what is considered ideal for that particular patient. So, for instance, if someone ideally should weigh 150 pounds and they come in to our office weighing 250 pounds, that means they are 100 pounds above that ideal body weight, then the bypass, a reasonable expectation is somewhere between 50% and 2/3rds of that excess body weight which would be somewhere between say 50 and 70 pounds in our hypothetical patient who weighs 250 pounds.

Bill: Great explanation, very easy to follow Dr. Bilof. Lastly, is there anything else we should know about gastric bypass surgery?

Dr. Bilof: Yeah, I guess one other issue I would like to address is the safety issue. Sometimes patients come in thinking somehow that the gastric bypass is unsafe and that’s really not true. The gastric bypass just like really all of the bariatric procedures we do is quite safe. This issue has been very well studied in multiple studies, in multiple journals over many years and it’s a very safe operation. I would when I’m meeting with a patient one on one I generally say it’s comparable in its safety of having say gallbladder surgery or and certainly safer than having hip or knee replacement surgery which are surgeries that most folks out there are familiar with and may have even had themselves or know someone who has had it and are generally thought of as relatively safe procedures. And these procedures are as safe as those if not safer.

Bill: That’s a really important point and I’m sure that is at the forefront of a lot of people’s minds when they are thinking about doing bariatric surgery. So, thank you for sharing that with us Dr. Bilof and thank you as always for your time. For more information please visit the Garden State Bariatrics and Wellness Center website at www.gsbwc.com that’s www.gsbwc.com . This is Winning Through Losing a Weightloss Surgery Podcast with Garden State Bariatrics and Wellness Center. I’m Bill Klaproth. Thanks for listening.