Transcription:

Prakash Chandran (Host):  Deciding to have weightloss surgery is hard enough. But then you have to choose between several procedures. So how do you decide which one is best for you? We’re going to learn about it today with Terry McKenzie, a Bariatric Coordinator and Certified Bariatric Nurse at North Florida Regional Medical Center. This is Helmet of Health, the podcast from North Florida Regional Medical Center. I’m Prakash Chandran. So, Terry, can you tell us the different types of weightloss surgeries that are commonly performed and that people research?

Terry McKenzie, RN CBN (Guest):  Yes. We do three different weightloss surgeries here at North Florida. There’s the band which is called the gastric restrictive surgery. There’s the sleeve gastrectomy which is also considered a gastric restrictive surgery and then there’s the gastric bypass which is considered a gastric restrictive malabsorptive surgery.

Host:  I see so, I’m assuming that all of these surgeries make your stomach smaller but at a high level, can you explain the differences between the three?

Terry:  Yes. With the band, basically we’re putting a foreign object around the top portion of your stomach. We are creating a little pouch so it’s kind of like an unequal hourglass, so you fill up the little pouch, the food digests through the little tiny opening and into the larger portion of your stomach. Meantime, when you fill up that little pouch, it makes your brain say, I’m not hungry anymore.

The sleeve gastrectomy, we’re actually removing 80% of your stomach. We are removing the portion that has the gut hormones that increase your appetite and decrease your satiety so it kind of makes you feel full faster and then with the gastric bypass, we are creating a small pouch at the end of your esophagus, we’re cutting off most of your stomach and we’re rerouting about 120 to 150 centimeters of small intestine. So, you eat less because that pouch is small, but you also absorb less of what you eat because of bypassing that intestine.

Host:  I see. That’s a really good explanation. I’m curious as to what questions a person should ask if they are considering this surgery?

Terry:  I think one of the biggest questions is how they want their weightloss to work. With the band, it’s adjustable. But it does require a lot of effort on the part of the patient because they really do have to be cognizant of what types of food they eat, how fast they eat. It takes a lot more accountability. The sleeve is more invasive than the band. Not as invasive as of course the bypass. But again, it does require some dietary changes and it does require losing part of your stomach. The bypass is of course you are going to be needing to do vitamins, injections because of bypassing that small intestine. So, I think it’s how fast a patient wants to lose weight, how much they want to be accountable for their weightloss. If they want something that’s adjustable or not, there’s a lot of questions to ask which is why it’s important that they attend our orientation seminar to find out about the surgeries and the details.

Host:  And I’m sure you cover this in the orientation that you put together but of the three procedures; is there one that’s safer than another?

Terry:  Well the band is safer in the long run because it does not require cutting any of the intestines or the stomach. It does require a foreign body and it does require frequent adjustments. So, it is the safest of the three and they kind of go in rank. The band is the safest, the next would be the sleeve and then the third would be the bypass. But even with those; because of the techniques that we use here at North Florida as well as the fact that they are done laparoscopically; the chances are less than one percent of any kind of mortalities with any of the three surgeries.

Host:  Yeah, that’s good to hear. What about the success rate, does it also go in that order as well?

Terry:  It does. With the band again, there’s more accountability. You can expect to lose one to two pounds a week if you are doing what you should be doing with the band. With the sleeve, you can expect 40 to 50 percent of your excess weight in the long run and with the bypass, you are looking at 60 to 80 percent of your excess weight.

Host:  And how long does it take for the weight to drop once you have the surgery?

Terry:  Well again, it depends on the patient. We usually start seeing weightloss actually prior to surgery because we do require a presurgical diet for two weeks prior to surgery. It’s what we call the liver shrinking diet. And it’s a high protein, low calorie diet that helps remove some of the excess fat off the liver because in order to do these surgeries, the liver sits in front of the stomach and we have to gently be able to fold it out of the way to have a good view. So, we do require that our patients do this liver shrinking diet. But afterwards, bypass is a very fast initial weightloss, but I usually plateaus at about 18 months. So, that’s a good weightloss surgery for someone that needs to lose weight really, really fast. We see that a lot in folks that need joint replacements or other treatments that they are required to lose some weight in order to have.

The sleeve is a little not quite as fast but still like I said, you can end up losing 40 to 50 percent of your excess weight and then the band is like I said a slower weightloss. Because it is one to two, it’s mainly for I think for people that want something to assist them, but they don’t want the major surgery.

Host:  And I’ve always been curious about the excess skin that I’m assuming stays around after you lose all this weight. Are there procedures to I guess tighten the skin up? What normally happens with that skin once the weightloss is achieved?

Terry:  Yeah, with the excess skin, of course it depends on your genetics, it depends on your age, it depends on the amount of weight you are going to lose or need to lose. Unfortunately, it’s not a benefit that’s covered by most insurance companies to have the excess skin removed. They still consider it cosmetic in most cases. I do recommend that our patients go to a plastic surgeon for that procedure. I think they’re going to get a nicer outcome. But one of the things that we do recommend as well is that if you start having issues with the excess skin, if you start getting rashes or problems because of skin on skin; you need to have that documented every time you go to your physician’s office because then it doesn’t become a cosmetic procedure. Then it becomes something that’s more medical.

Host:  And the final question that I had is I’m sure a patient is going to do their own research and they’re going to go to the orientation but there are a number of different health factors that are involved that will probably factor into what recommendation a surgeon has in terms of the type of surgery that they get. Can you talk a little bit more about those health factors?

Terry:  Yes. We look at their surgical history and we look at their medical history. If they’ve had previous abdominal surgeries, that may exclude them from one of the surgeries they want to have. They may have – if they have had what we call a Nissan fundoplication in a lot of cases, we can’t do bariatric surgery. It just depends on how that was done. If someone has extreme severe acid reflux; we may not want to do the sleeve on that patient because sometimes that will make it worse. And of course the acid reflux can lead to the Barrett’s esophagus which is precancerous condition or can be. So, we want to look at this and make sure again, that the patient isn’t just choosing a surgery based on what they read or based on what someone told them but the surgery that’s going to be the best choice for them and give them the best chance for a positive outcome and to lose the weight and improve their health.

Host:  All right Terry, well I really appreciate your time this morning. Thank you so much. That’s Terry McKenzie, a Bariatric Coordinator and Certified Bariatric Nurse at North Florida Regional Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.nfrmc.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.