Chat with Bariatric Surgeon, Dr. Cirangle, 20 April 2004

Good Evening

What is the percentage of patients that gain weight back after wls?

in my experience (in my practice) less than 10% of patients will gain back a significant amount of weight

donna: starting at 240lbs and being 5.1/2 in tall how much weight can i expect to lose?

that really depends on your motivation. A recent review of all of our patients showed an average weight loss of 83% of their excess weight at 5 years following surgery.

IS IT NORMAL FOR WEIGHT TO SLOW DOWN TO ABOUT 2 POUNDS PER MONTH? I AM 2 YEARS POST OP?

this is the usual course - most patients weight loss drops off significantly after 12-16 months following the RNY gastric bypass

i AM HAVING SURGERY IN THE MORNING @ ST. AGNES IN BALTIMORE, DR. SINGH & AVERBACH TOGETHER BECAUSE MY BMI IS 70. MY QUESTION IS, HOW DO I KNOW FOR SURE THAT I DON'T HAVE ANY BLOOD CLOTS ANYWHERE IN MY BODY? I FEAR ONE DURING SURGERY.

blood clots are one of the risks of surgery. Your surgeon will take precautions to minimize your chances of developing blood clots. The most important thing for you to do is walk as much as possible following your surgery and minimize the time that you spend in bed.

I am 22 and am in the middle of having open distal RNY . At 300 lbs. 5'9" is there any chance my loose skin will bounce back and if not will insurance under any circumstance cover it.?

there is always a chance that your skin will return to a smaller size, this usually depends on your age and the type of skin that you have. Sometimes insurance companies will pay for "tummy-tucks" if you have alot of problems with rashes and skin infections because of this excess skin.

Which type of calcium is the best kind to use after surgery?

the one that you will take....

LOL

all are about the same. they should be taken with protein for better absorption.

DOCTOR CIRANGLE, i have lost from 350 to my now weight of 200 pounds,,,,,, is that normal ? or below normal.?

how far out from surgery are you? how tall are you?what is your current BMI?

2yr 5'5 and 44

Everyone does not lose the same amount of weight following WLS. The average weight loss across the country is about 70% of your excess weight. Your BMI is still 44 and therefore you are still at risk to develop all of the problems that are associated with obesity. You may want to consider a revisional surgery to lose additional weight to get your BMI below 30

How often do leaks occur and how far out from surgery can they occur?

the incidence of leaks varies from surgeon to surgeon. The average across the country is probably 1-3%. they generally occur in the first 10 days after surgery

Do all surgeons have restrictions as to the size of patient they would do LapRNY?

No - we perform laparoscopic surgery on all of our patients regardless of their size. The largest patient I have operated on laparoscopically was more than 600 pounds.

I am 2 1/2 weeks out of surgery and have been eating soft foods. Sometimes I have this feeling as if I am eating more than I should be. Is this normal in the beginning?

If you feel like you are eating too much, you probably are. Stop before you start to get that feeling.

I am doing bowel prep tomorrow morning (Fleet Phosposoda) Will I be able to work on Thursday?

you should be able to.

Have there been any log term studies involving gastric bypass? What are the effects on the body?

yes - we have data about this procedure for more than 30 years. It is an effective and safe procedure.

I am currently awaiting insurance approval. I've never had any type of surgery before and the only medical problems I've had is sleep apnea and degenerative joint arthritis. Would I be considered a good surgery candidate?

It would seem so. My idea of a good candidate is someone who is committed to the process.

How many procedures do you feel a surgeon should do (laparoscopic) before YOU would feel the doctor was expert enough to do YOUR surgery??

at least 100

I have just had some blood tests done and am very alarmed at the results of two liver tests, one was triple the normal level and the other was double the normal level. What info do you have for me as to whether my gastric on 04/98 could be related and what do I do? I am scared to death.

I would have to know more specific details to make any definitive comments. Elevation of liver enzymes can occur following surgery.

My hubby had a bypass RNY a few years ago and he developed a hernia. Had it fixed, and now has another abdominal hernia which needs to be fixed again. More mesh! What worries me is he wants to have his RNY revised as a barium xray revealed the opening to intestinal passage is too large and his food passes straight through him. He can eat like he never had surgery. In the first surgery he almost died (heart went into high speed for several days), and I worry about him having such inv

regular yearly follow up is critical with these types of surgery

surgery again. Do you advise it?

I Take each of these cases individually. Revisional surgery is more risky than the original surgery. make sure you consult someone who is experienced with REVISIONAL surgery

My surgeon has told me that he going to be placing me on blood thinner injections for 2-3 weeks after surgery is this normal? Or should I be worried that they suspect me more prone to DVT/PE?

many surgeons treat their patients in this manner. the truth is, all individuals whose BMI is more than 35 are more prone to DVT and PE

5 months out, what do you suggest to help with hair loss?

get your protein each day. some vitamins such as Biotin, coenzyme Q10, flaxseed oil, primrose oil, and zinc can help minimize the hair loss.

Dr. Cirangle...Is there a pre-op diet that we should follow?

Amy will be calling you tonight about this (funny you should ask). I only require liquids the day before surgery and 3 tablespoons of milk of magnesia the morning before.

Doctor, aside from the obvious reduction in the amount of food I will be able to consume, what types of modifications should I expect to make after my surgery. Are there any types of foods I will need to avoid all together?

avoid simple carbohydrates such as bread, rice, potatoes, and pasta. Eat slowly and chew well. Always focus on foods high in protein such as eggs, meat, etc.

Can a 60 yr. old woman who is 2 1/2yrs post op from gastric bypass surgery undergo a colonscopy clean out?

yes

I just heard the other day on the website that some surgeons are doing revisions of the RNY by using a lap band above it. Have you heard of that or it's effectiveness of the surgery.

I have heard of this - it would not be my personal choice.

I am 7 weeks post op from Lap RNY. I understand why no drinking during or after meals, but why not before meals?? If the fluid leaves quickly, wouldn't that keep you out of harm?? Thanks

I tell my patients that it is fine to drink up to 15 mins before you eat.

How do surgeons decide how much to bypass?

based on your weight and what the insurance company has approved

what are the risks/ benefits of lap gastric bypass as opposed to open gastric bypass?

in my opinion, there are only benefits. Less pain, quicker recovery, and in my experience better results (greater weight loss).

Hi doctor, I am now 15 mths post op from having lap rny, I was wondering have you had any patients who are longer post ops than who have had any problems with gaining there weight back?, and what is the success rate for keeping the weight off in the long term? thank you for you time e

i believe that patients are the determinants of their own destiny. The gastric bypass is a tool, not a cure. During the first year or two after surgery, a successful patient will develop new dietary habits, eat less, and participate in a regular exercise program. If these are not held as long term behaviors, patients will regain some or all of their weight back. Generally the regain begins 3-6 years after their surgery. In my practice, very few patients have this problem because we have regular follow-up for 2 years.

With the lapband surgery...what is the average time between fills?

it is very variable. I have some patients who have only had 1 or 2 fills over the course of 1-2 years, and others who have a fill every 6-8 weeks. I try to personalize it to the patient and their weight loss pattern

i have really bad lungs and weigh 400lbs with breathing problems can i lap surgery

it is possible - in order to say for sure I would need to delve a little further

what is your opinion about taking a pill to "prevent gallstones"--I'm not sure what it is called--is it beneficial?--thankyou.

actigall - yes, I believe all patients who lose more than 8-10 pounds per month should take it. it reduces the incidence of gallstones from 30-35% to 2-3%

I am worried about the recovery process - I am in relatively good health, can you compare the open RNY to a cesaerean section?

I prefer not to perform the open RNY because of the problems associated with wound complications and post-operative pain. the incision that is made in the open RNY will be more painful than a c-section.

Hi, Dr. Cirangle, thank you for your time. I saw a surgeon re: the lap-band procedure. He told me that the bypass would be dangerous for me and would not suggest it but that I am a prime candidate for the lap-band. What are the extra dangers associated with the laproscopic bypass?

to start, the bypass is a safe and effective procedure. I think that the reason to perform a Lap-Band is because it is the right surgery for you. There are some additional risks with the bypass, but they occur very infrequently (<1-2%). They are associated with "leaks" from one of the staple lines or connections that are made during the procedure. I would need to know more about your situation to give you my opinion on your particular case

How long does it take typically for the incision to completely heal?

at 6-8 weeks the incision is about 60-70% healed (in terms of strength) in an open bypass.

My wls surgeon only requires me to take 1 chewable vitamin 2x per day is this usual?

what operation did you have?

rny

rny patients should be taking the following for the rest of their lives - vit B12, multivitamin with iron and folate, and calcium.

Dr. Cirangle, how much body muscle is usually lost from the surgery?

As long as you initially supplement with a liquid protein (protein shake), very little if any should be lost.

I weighed 285 at surgery and am 5'7, what is my ideal weight?

147 pounds

AND THE LAST QUESTION OF THE EVENING, GOES TO...

How long after surgery can we start aerobics? Weight training? Crunches?

after a laparoscopic surgery, I tell my patients that they can start using a treadmill, riding a bicycle or walking within 1 week. They should wait 4 weeks after surgery to lift weights or perform strenuous exercise. 4 weeks for the crunches as well.

Best of luck to all in their quest for health and a better lifestyle!!

DR. CIRANGLE, THANK YOU SO MUCH FOR JOINING US THIS EVENING. WE HOPE TO HAVE YOU BACK WITH US AGAIN SOON!!!

you are welcome, definitely

THANK YOU MEMBERS FOR BEING WITH US THIS EVENING. THIS CHAT TRANSCRIPT WILL BE AVAILABLE ON DR. CIRANGLE'S WEBSITE AS WELL. WE HOPE THAT EACH OF YOU HAVE A WONDERFUL EVENING. GOOD NIGHT :-)

Contact our office to speak directly with a weight-loss specialist at 808-561-5511 or toll free at (866) WLS DOCS.