Beyond doubts the gastric sleeve surgery is a comparatively safer surgery than the lap band. The band has shown to have many complications like erosion, slippage, obstruction, perforation and all these are surgical emergencies and require surgery to tackle them.
Not every patient needs to go on a liquid diet before Gastric Sleeve surgery. There are many factors that decide which patients need to go on a liquid diet and also the duration for which they need to go on a diet. These are super obesity, severe breathlessness associated with OSA (obstructive sleep apnea), fatty liver etc. By going on a liquid diet , one loses few Kilos of weight, liver becomes a little pliable and shrinks a bit in size and this makes surgery easier technically. The weight loss with the liquid diet before surgery also has a very good impact on the breathing capacity, decreases breathlessness and thus makes anaesthesia safe.
To start with, it all depends on the degree of obesity(morbid obesity, super obesity) and also the degree of gynaecomastia and type of gynaecomastia (only fat or whether there is a lot of associated glandular tissue). Presence or absence of sagging also a deciding factor. Secondly it also depends on what is the desired outcome i.e how much reduction will satisfy oneself. If gynaecomastia is mild and does not have glandular element, then better to wait and watch if the gynaecomastia settle down with weight loss. You may not require treatment for it. If the gynaecomastia is moderate then doing it at the same time saves you another anaesthesia, another surgery, another hospital admission. If gynaecomastia is already large and associated with sagging, then it is better to wait until desired weight loss takes place. By this time, the fat from the breast also shrinks and you get an exact idea of the increase in sag of breast. Thus in a single sitting one can remove the remaining fat along with excision of the sagging breast tissue if required.
In both sleeve gastrectomy (SG) and gastric bypass surgery one has weight loss, but the Gastric Bypass Surgery scores over the Sleeve Gastrectomy in many ways. Firstly, if obesity is associated with diabetes, then gastric bypass is capable of giving a complete resolution from diabetes along with weight loss. Secondly if a person has GERD then sleeve gastrectomy is the preferred surgery in order to relieve the GERD. A patient of mine, after undergoing gastric bypass surgery a year ago has lost 40 kgs and is no longer a diabetic. The patient was suffering from diabetes( type 2) since 5 years. After surgery, in a week’s time, all diabetes medicines were stopped.
Yes, it is possible to have another bypass. But, strict evaluation is required — whether weight loss was incomplete, or there was weight regain, noncompliance in terms of physical activity. Based on the history, endoscopic findings and CT gastrograffin findings, then surgery is decided. It could be reshaping of the gastric pouch either correcting the widened anastomosis to creating a distal gastric bypass.
Bariatric surgery (either sleeve or gastric bypass) on the whole in indicated patients will only help them to lose weight and to have a better quality of life not only physically (good health), but also socially. Excessive weight gain makes them shy away from social gatherings, where as after weight loss they are more confident and have high self esteem. Young girls who are not getting their periods regularly or have excessive facial hair growth, after weight loss surgery get their periods regularly and facial hair growth is decreased. Obesity is a cause of both male and female infertility. Weight loss helps reverse infertility in the young. Cons: The only con is the myth that people are still not yet overcome — that after bariatric surgery one cannot conceive or the baby will not get sufficient nutrition. Both of which is NOT true.
I have had many patients come to me and ask this question. How soon can I lose weight after surgery? Their very next question is what are the pros and cons of this surgery? Gastric bypass is the standard surgery for weight loss in the morbidly obese and has stood the test of time. It not only helps one to lose excess weight but also helps one to get rid of long-standing problems like diabetes, high blood pressure, high cholesterol, knee joint pain, sleep apnea, and infertility. The con which people refer to is the necessity to take supplements for a lifetime, which is not an issue at all. It is better to take two supplements rather than suffer from obesity and the plethora of problems associated with it. How soon can you lose weight? : Weight loss starts within the first week after surgery and is completed within 6 to 9 months in 90 percent of the patients. However one must take into consideration the BMI (super obese) and the associated problems like knee joint pains, associated polio, etc. In these cases, weight loss takes about a year.
Metabolic surgery / Diabetes surgery is done for remission of Diabetes. It is effective to the extent that Diabetics can maintain normal blood sugar levels even after stopping their regular diabetes medication . A word of caution here- Only Type II diabetics can benefit from this metabolic surgery. Keep reading . More information to follow …..