Chat with Bariatric Surgeon, Dr. Cirangle, 10 May 2004
<**MODERATOR**> I want to welcome all our member to the surgeon chat this
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What surgery would be the most beneficial for a person who is 5'4
and weighs about 340, lap band or rny?
That depends on your eating habits and exercise practices.
Actually neither may be the best - the Duodenal Switch may be a better option.
I had RNY 6 mos ago. My surgeon never prescribed vitamins for me
and never said what to take. He is now GONE....and I am unsure what I need to
be taking. Or what labs I should have my pcp do, can you help me?
Was your surgery done in HI?
You should be taking the following: Multivitamin with folate
and iron (twice the adult dose per day), Vitamin B12 500 micrograms per day,
Calcium 1500 mg per day. You should have nutritional labs drawn at the one year
When do you normally get a fill if you have the lap band, 1 mo, 2mo,
That varies from patient to patient. The first fill is generally
not done until at least 5-6 weeks after the initial surgery. After that, it
is based on your weight loss and sense of "restriction".
I have a question...How will I take my heart medications after
The same as you take them now.
I have a colostomy and was turned down for the RNY procedure. Have
you heard of anyone having it done with an ostomy ?
Why do you have a colostomy?
diverticulitis and anal stenosis
It is still possible to have a gastric bypass in your situation
- you should get a second opinion.
please tell me how long the surgery takes
Gastric bypass about 2 hours, lap band about 1 hour.
I am concerned about being on a respirator when I come out of surgery,
can you tell me the percentage of patients who require this?
It is very rare - less than 5%. Generally these are patients
who are in excess of 500 pounds and have significant underlying medical problems.
What are the typical tubes that a person is hooked up to after surgery?
Ng tube etc?
The only tube that I use is a foley catheter and only in the
RNY gastric bypass. Lap Band patients do not have any tubes. I never use an
I have surgery in 4 days. What is the best advice you can give
to someone who is feeling like backing out of surgery?
If you are not sure that surgery is for you - Do not have it.
I am having a hard time finding a doctor who does the DS Surgery
that accepts Blue Shield PPO. Do you know why this is so hard? Are other people
find this as difficult as me?
I am one of only about 30 or 40 surgeons in the country that
performs the DS, so there are not many out there. Most Blue Shield programs
will not authorize the DS. Most bariatric surgeons are not contracted with insurance
companies unless they are at a university or are new to the field (ie have little
I had a proximal rny... was wondering if you have a harder
time absorbing meds (capsules) after surgery... (ex: I'm on fluoxetine 20mg...
after surgery I switched to liquid... about 3months post surg I switched back
to pills... felt like I was going through withdrawals so went back to liquid)
am I just not absorbing it the same way?
A proximal RNY should not significantly affect the absorption
of your medication. If the liquid seems to work better, than it is best to stay
on this for about a year and then try again with the pills.
after I have surgery, will I have a drain?
That depends on your surgeon, I do not use drains routinely.
i had a gastric bypass 2 years ago. I HAD A SECOND Operation for a fistula.
The surgeon could not find the fistula. The next day i had a another surgery
for a perforated ulcer. The fistula leaked for 10 months. IT opened again after
6 months. and it is open now after being closed for 5months. AM i in any danger?
do you think this will keep happening for the rest of my life?
It sounds like you should see another surgeon for a second
I've had a hysterectomy, and I already have to up my calcium. I know
I'll need even more post-op.What's the best way to get necessary calcium?
All forms of calcium are pretty equal. The most important is
to find one that you will take and to take it with a food that is rich in protein.
what are some things you can do to prepare your body for surgery?
Start exercising regularly and lose 5-10 pounds before your
surgery. This will minimize your chances of having problems. It also helps to
find a good protein supplement (liquid) that you like before your surgery.
I weigh 342 whats the most weight that I could lose?
That depends on your height. You can lose 100% of your excess
weight if you follow a good program and have your surgery done by an experienced
I have done alot of research and feel the DS surgery is best for
me. Can you tell me what would be the deciding factor as to the surgery being
Open or Laproscopic?
I always perform it laparoscopically.
DO YOU DO GASTRIC BYPASS ON A 14 YR OLD?
I would prefer to perform a Lap-Band procedure in someone that
I had rny surgery about 4 yrs ago. I lost about 100 lbs and have
stopped. My surgeon says he did not bypass enough and now wants to go back in
and bypass more. What risks am I looking at? More risks, less risks? Is Death
one of them?
Death is always one of them (even the first time around). The
risks are always higher the second time - at least double. Make sure your surgeon
has experience with revisions procedures.
I'm concerned about hair loss with lapbanding. How common is it and
how well does the hair grow back??
The hair always grows back. It is less common with the Lap-band
than with the gastric bypass. There are things that you can do to minimize this
problem if it occurs.
What is a stricture?
A stricture is a narrowing of one of the connections that are
made at the time of surgery. The most common location is where the stomach attaches
to the small intestine.
is there a way to decrease sagging skin before and after surgery
The best way to minimize this is to make sure you exercise
at least 4-5 days per week. Much of this is determined by your age and your
What do you recommend for your patients when it comes to protein?
real food or shakes/drinks?
Initially shakes are necessary, however once they have advanced
to a regular diet (3-5 weeks after surgery), foods such as eggs, fish, turkey
and shellfish are best.
I have talked to a few people who have had weight loss surgeries
and want to begin the process, I know my insurance will cover it, how/where
do I begin?
Where do you live??
Santa Barbara, CA
The most important is to obtain a consultation from an experienced
bariatric surgeon in your area. He should be able to discuss the pros and cons
of each of the procedures with you and get your insurance company to authorize
the one which is best for you. if you would like to come to San Francisco, I
would be happy to help We also see patients in San Luis Obisbo.
are fistulas common and should they last 2 years?
Fistulas are the result of unresolved leaks and generally do
not last that long.
My mom is thinking about surgery but i am a little worried. she is
58 and has a lot of health problems. one being heart disease. is it wise for
someone with that to consider surgery?
There is no way for me to advise you specifically in this forum,
however I have operated on 58 year olds and they have done well. The most important
thing is to make sure before surgery, your mom gets a thorough evaluation to
determine if she would be able to tolerate surgery.
I have herniated disks in my neck and now my chiropractor thinks
I have herniated one or more in my low back. How much success have your patients
had in relieving back pain or fixing back problems such as herniated disks by
Weight loss helps, however it is not a cure for this problem.
Most herniated discs will resolve with time and anti-inflamatory medication.
Perhaps the wisest thing I could suggest to you is to see a spine surgeon and
not a chiropractor about this problem.
What are some of the most important questions to ask your surgeon
on your initial consult?
How many procedures have you done and what is your complication
rate? Which types of surgery do you do? Do you do them laparoscopically?
Hello Dr. I have heard about the lab band but my surgeon insists on
open rny why would this be preferred?
Because he is not up to date. Please see another surgeon -
be very wary of any doctor who tells you that open surgery is better than laparoscopic
surgery or who doesn't offer you a choice in procedures.
I would like to learn more info about the lap band. I am so undecided
about which surgery is best for me, but I think I like the fact that the lap
band is less evasive. What are the pros and cons of the lap band?
This is a complicated topic, certainly not one that can be
thoroughly discussed in a forum such as this. The simple answer is this PRO
- reversible, adjustable, and lower incidence of serious complications CON -
less weight loss on average, patients must be motivated to succeed.
What would you recommend for post op patients to take of headaches
and or body aches with flu symptoms?
Tylenol and plenty of fluids. If it is not better within 24
hours call your doctor.
Which procedure is best if your bmi is 55? thanks
That depends on many things. It would be impossible to tell
you what is best for you without sitting down and talking with you for an hour
I had RNY surgery about 3 yrs ago and I have a hernia. I have these
muscle spasms at times that take my breath away. Like the wind is knocked outta
me. Is this my hernia or my old stomach having spasms?
Hernia generally cause a dull ache, not intense pain as you
describe. You should see your doctor and have your hernia repaired.
Hi dr I had my surgery 7 weeks ago and feeling great? when if at all
is it ok to drink diet coke?
I do not recommend drinking any carbonated beverages. At this
point you should be focused on making sure that you eat enough protein and drink
enough water throughout the day. Diet coke offers absolutely no nutritional
What affects will surgery have on pregnancy?
You should never become pregnant sooner than 2 years after
your gastric bypass as it can be very dangerous for your baby. As far as after
that, there should not be any additional issues that other mothers do not experience.
After lapband surgery - are you ever able to take medication like
I do not recommend it as it can cause ulcers.
do you normally go to ICU after the RNY or only if there is a problem
with the surg.
I do not send my patients to the ICU routinely.
I drink a two liter of diet coke a day. Why can you not drink while
you eat and just how much soda if any is ok after surgery
You drink entirely too much Diet Coke - please see the above
comment. You should not drink while you eat because it will increase the amount
of calories you consume and also may increase the incidence of food getting
stuck in the connection between your stomach and your intestine.
<**MODERATOR**> LAST QUESTION OF THE EVENING, GOES TO.....
I have had gall bladder surgery 10 years ago - will that affect my
ability to have my surgery done laproscopically?
I do laparoscopic surgery on patients who have had their gallbladder
out all the time - it should not be a problem.
<**MODERATOR**> TO LEARN MORE ABOUT DR. CIRANGLE AND THE PROCEDURES HE PERFORMS,
PLEASE VISIT http://www.hawaiiweightloss.com or http://www.lapsf.com/ TO SCHEDULE
A CONSULT, PLEASE CALL 808-561-5511
I would like to remind any of the patients from Hawaii that
I will be presenting an educational seminar to anyone interested in weight loss
surgery tomorrow at 6 pm it will be at the Outrigger Waikiki hotel on 2335 Kalakaua.
<**MODERATOR**> THANK YOU FOR JOINING US, DR. CIRANGLE.
Thanks to everyone who participated and good luck in your quest
for better health.
Contact our office to speak directly
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