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Michigan Medicine Adult Bariatric Surgery Program: Online Information Session

March 9, 2020

– [Instructor] Welcome to
the University of Michigan Adult Bariatric Surgery Program. We offer a comprehensive and personalized weight
loss surgery program designed to help you reach your goals. Success starts by learning
more about obesity, understanding the risks
and benefits of surgery and committing to lifelong habits to improve your overall health. Let’s start with the facts. Obesity is really common
in the United States and about 1/3 of people in Michigan are living with obesity today. As a result, many people are suffering from diseases related to being obese. These include diabetes, heart
disease, high cholesterol, sleep apnea, arthritis,
fatty liver disease, infertility, and even certain cancers. It’s clear that when you lose weight, you can improve your overall health, reduce your dependence on
expensive prescription medication, and even extend your life. In fact, the National Institutes of Health recognizes that bariatric surgery is the most effective
treatment for morbid obesity. We perform two bariatric procedures at the University of Michigan, a gastric bypass and
the sleeve gastrectomy. Gastric bypass is also known
as the Roux-en-Y gastric bypass and the sleeve gastrectomy is also known as the
vertical sleeve gastrectomy. Both of these procedures are
performed laparoscopically, which means we make small
incisions along the abdominal wall and use the camera and instruments
to perform the operation. It is very similar to gallbladder surgery and removing your appendix. Using these advanced techniques results in shorter
hospitalizations, quicker recovery and less complications
when compared to procedures that were performed with a large incision. If you’ve had previous
surgery, like a C-section, hysterectomy, or gallbladder removal, it’s important to know that in many cases, bariatric surgery can still
be performed laparoscopically. So let’s discuss each operation
in a little bit more detail. The first type of bariatric
procedure we perform is the sleeve gastrectomy. In this operation we use
special surgical staplers to divide 80 to 85% of the
stomach and remove it completely. The operation is done
under general anesthesia and usually takes about one to two hours. The hospitalization is two
to three days typically, and most people lose about 55 to 65% of their excess body weight. Depending on how much you weigh, this is usually around 60 to 100 pounds. It’s important to know that
weight loss is maximized at one year after the
procedure is performed. Overall complications are low and similar to that of
gallbladder surgery. Major complications such as leak or bleeding along the area
that is stapled is also low. Remember that this
operation is not reversible since the stomach is removed
completely from the abdomen. It is also important to
know that in some patients, this operation can result in heartburn. This animated video will
provide you with an opportunity to see how the procedure is performed and how food will travel
through the stomach after a portion of it is removed. The second type of bariatric
procedure we perform is the gastric bypass. This operation is more involved but it’s still performed laparoscopically. With this procedure,
the stomach is divided using surgical staplers and separated from the remaining stomach, thus creating a small gastric pouch. This is about the size of an egg. Next, the small intestine is divided midway down the intestinal tract and then connected to the stomach. So when you eat food, it goes straight into the small intestine and this bypasses the stomach and first part of your intestinal tract. Bile, pancreatic and gastric juices are still being made and
they continue to pass through intestinal tract as before. This operation is also performed
under general anesthesia. But the operation is longer, usually about two to three hours. Most people lose about 65% to 75% of their excess body weight
or about 100 to 150 pounds depending on how much
they weigh before surgery. As with the sleeve gastrectomy, maximum weight loss happens at one year. When compared to sleeve gastrectomy, gastric bypass has a
higher complication rate, but overall major
complications are still low. One important difference to remember is that after gastric bypass surgery, some people can develop an ulcer at the connection between the stomach and the small intestine. The risk is usually low, less than 5%. But it’s most common in people who decide to smoke after surgery or those who take nonsteroidal
anti-inflammatory medication like Motrin, Advil, aspirin or ibuprofen. So after gastric bypass, you can never take
these medications again. Other issues that are unique
to gastric bypass surgery is dumping syndrome, which
results in sweating, diarrhea, and gastrointestinal discomfort as a result of eating certain foods that are high in sugar or fat. This often improves with a change in diet. Finally, in rare instances, some people can develop an
internal hernia after surgery that causes a serious
blockage of the intestine. This usually requires surgery to correct. Together with diet and exercise, bariatric surgery is extremely effective in achieving weight loss. However, it is not exactly
clear why it works much better than diet and exercise alone. With a smaller stomach,
many people do eat less and there may be some decreased
absorption of some food. But recent research shows
that these operations fundamentally change
your body’s regulation for gaining and losing weight. In many cases, surgery changes tastes and cravings for certain foods, and even changes how
you process these foods. For some, the operation can cure diabetes even before the weight loss is achieved. However, in a small number of people, bariatric surgery does not
result in successful weight loss, and in other cases, some experience significant weight regain. It is difficult to know
why this happens exactly. But it often has to do
with our food choices, our exercise tolerance, as well as our genetics, gender and age. For others, taking certain medications or being ill for other reasons may prevent the body from
achieving maximal weight loss. After surgery, most people
stay in the hospital for two to three days and
are then discharged to home. Main restriction is to
avoid heavy lifting. However, you can resume many
of your usual activities. Since the incisions are
closed with absorbable suture and covered with a waterproof
dressing, you may shower. You can also walk up steps and stairs and we encourage you to walk at least 30 to 45 minutes
a day after surgery. Driving is restricted so long as you’re taking
narcotic medications. The first follow up visit
is two weeks after surgery. During that visit, your
surgeon and your dietitian will see you in clinic. You will follow up in clinic two months after surgery as well and again be seen by your
surgeon and dietitian. We usually get lab tests
during that visit as well. At the six month and yearly visit, you will be seen by our physicians in the Metabolic and Endocrine
Clinic at Domino’s Farms. Using our multidisciplinary approach, these doctors will work with you to make sure you achieve your
long-term weight loss goals. The diet after bariatric
surgery is very specific and one of the most important
parts to being successful. Before surgery, you will need to be on a calorie restricted high protein diet for two or four weeks, after surgery your diet will progress from liquids, to purees, to soft foods and ultimately to solid foods. Our goal is for you to eat
70 grams of protein each day as well as drink 64 fluid ounces. This is not a simple task and after surgery, sweets
and carbonated beverages are not tolerated at all. It is also important to know
that after bariatric surgery, vitamins are not absorbed in the same way, so it’s important to take supplements. As you can see the vitamin supplementation includes a multivitamin,
vitamin B12, and calcium. If you have a gastric bypass, you will need to take more supplements. So what is the best procedure for you? Well, in trying to answer this question, you must always balance the risks of complications with surgery with the benefits of weight loss. In order to help with this decision, we use a special calculator that give you the results of surgery in other people who are just like you. So each person that
goes through our program will get a personalized
risk benefit profile that gives us the best guide for which surgery is the
safest and most beneficial. So before considering bariatric surgery, it is important to think about your goals. In many cases, the amount of
weight loss is not as important as the reduction of comorbid conditions, improved mobility and cutting
out prescription medication. Regardless of procedure,
undergoing bariatric surgery is a life changing experience that requires a careful
consideration of your overall health as well as understanding of
the non-surgical alternatives. If you’re struggling to lose weight after multiple attempts,
are over the age of 18 and are willing to make lifelong
commitment to your health, bariatric surgery may be for you. In order to be a candidate for surgery, you’ll need to first calculate
your body mass index or BMI. This can be done from
our website calculator. You’re a candidate for
surgery if your BMI is over 40 or if your BMI is over 35 and you have certain
weight-related illnesses like diabetes or high blood pressure. You will also need to be able to tolerate general anesthesia, you must be able to walk
to your clinic visits and also commit to a
daily exercise program. Finally, you’ll also need to commit to lifelong dietary changes and stop using any form of tobacco product as we are a substance free program. The road to surgery is not always simple, but we’re here to help. It starts with watching this video, as it gives you the necessary
information to proceed. After careful consideration, the next step is to schedule a medical
and dietary evaluation. Once these are complete, you’ll need to schedule a
psychological evaluation next. Since we wanna provide a
comprehensive approach to your care each one of these
evaluations is mandatory. After these initial evaluations, our multidisciplinary review committee will assess your candidacy for surgery, and we may require additional
task for you to complete. These often include cardiac
clearance, labs, endoscopy, or other imaging studies. You will receive a personalized letter that will include your
risk benefit profile, detailing your estimated weight
at one year after surgery, as well as your risk for complications. Finally, this letter will also include additional requirements
and some recommendations that will be presented
in a checklist format. We will also ask you two attend
to support group meetings so that you can meet other people that have undergone surgery. This is really important
to fully understand the lifestyle changes
necessary after surgery. For some people, your insurance carrier may also require that you
undergo three, six or 12 months of medically supervised
weight loss documentation before undergoing surgery. Once all these requirements
have been completed, you will undergo a
separate nutrition class that will detail the pre
and postoperative diet. You’ll also meet with
your surgeon in clinic so that you may ask them specific
questions about your care. Finally, you will undergo
a pre-operative history and physical exam in
which our anesthesiologist will make important recommendations about which medications you will need the night before surgery. Insurance coverage for
bariatric surgery varies, so it is important that you
contact your own provider to get the specific details. In order to help, we’ve provided
a list of questions online that you can use when you
contact your insurance carrier. It is also important to document medically supervised
weight loss appropriately. So we’ve provided a sample form online in order to help you do this. Ultimately, we want you to succeed. And in order to ensure your success, we offer a comprehensive approach with a multidisciplinary team of experts. Our experienced surgeons are trained in bariatric procedures, and are always available for emergencies, providing coverage 24 hours
a day and seven days a week. We also offer a secure online site with resources at your fingertips, as well as a weight loss
conditioning program that is designed for your needs in mind. Finally, we also offer a
specialized nutrition program that explores core reasons for overeating and emotional eating. Our clinic is located at Domino’s Farms and surgery is performed
at the university hospital. If you’re interested in
taking the next steps towards undergoing bariatric surgery, please answer the quiz questions below and provide us with contact information so that we may schedule
your first evaluation. If you’d like to learn more, you may attend an informational meeting. This is a two hour group session that allows you to meet
one of the surgeons as well as dietitians. You’ll be given the opportunity
to ask general questions about surgery as well as our program. Thanks for listening and we look forward to helping you lose weight
and improve your health.

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