MENU
PREVBypass or Lap-band weight loss surgery - which surgeon and surgery?
All the major weight loss surgeries work and all of them have advantages and disadvantages. If you select a surgeon first, then you will have the type of surgery that he is qualified to perform. If your community has several bariatric surgeons who do different types of surgeries, then you have a great choice. However, not having a choice isn't a bad thing either. Select a surgeon you can relate to, someone you have confidence in, and someone that can be your bariatric doctor for some time. Finding a surgeon is not like finding someone to work on your car. If, like most people, you have an uncomplicated surgery and recovery, then you may have little interaction with your surgeon. God forbid you should have a leak or some other problem, but if this happens you may have to stay in the hospital for weeks, then you may have to go to a Rehabilitation center afterwards. If something goes wrong, then you want a doctor who is attentive, kind, and will help you through this process.
Don’t insist on some type of surgery that the surgeon is not familiar with. If your surgeon’s specialty is Vertical Banded Gastroplasty, but you read that a Roux en Y might have better results, don't ask your surgeon to change the type of surgery he does because of what you read. People are not all alike and you may not mesh with your surgeon—he or she doesn’t have to be your best friend, but if you cannot tolerate All of the modern surgeries have fantastic success stories, as well as horrific complications. your surgeon, then find another one. With some types of surgery, you may just want the doctor to do the work and forget about you. Bariatric surgery is not like that.
All of the modern bariatric approaches have their advocates and their detractors. All of the modern surgeries have fantastic success stories, as well as horrific complications. All surgeons have their complications—and if they have not had complications, well—they are better than this author. There is an old saying in surgery. If you have not had complications, you have not done enough surgery. Of course, a high rate of complications is not good.
Why do weight loss surgeons all do bypass or Lap-band surgery differently?
Using the Internet to get advice:
Often patients go to the Internet to find out what they should do. Our advice is simple: follow your surgeon’s program. This is major surgery. Trust the experts. Your doctor knows you and he knows what he is doing—or he wouldn’t be doing surgery very long. Using the internet to get a bit of advice is not only silly, it can be dangerous. There are a few things surgeons do differently. Here is a list of them, along with some of their reasons:
- Abdominal binders for patients. There is no evidence that a binder will prevent a hernia, but it will take the pressure off the incision until it heals better. Some surgeons worry that a binder will discourage patients from taking a deep breath, and thus contribute to lung problems. Some patients love their binder. It gives them a bit of security in the first post operative weeks. Other patients find them cumbersome and don’t like them at all. In either case, if your surgeon wants you to wear them, then do so.
- Use of drains and feeding tubes. Some surgeons use these as a matter of routine, and some do not. If you need to have a feeding tube, it is easy to put in during the surgery. After surgery it is harder to put in. The same can be said for a drain. Those who don’t use them say the odds of needing them
are small, and they can be placed later. There is no right or wrong answer here, so do not ask your surgeon to change his way of doing things. - Leak tests. Some use them before allowing patients to eat, some wait until there seems to be a problem. As mentioned previously—you not have a leak one day, and the next day you may have one. Some surgeons feel very comfortable never ordering this test, and some surgeons order this test as a matter of routine before a patient leaves the hospital. Go with your surgeon’s routine.
- Use of various amounts of calcium and vitamins. There are set values that can, and should, be followed. In the appendix of this book we have a list of tests and what should be ordered and why. Often times it is the internist, or primary care physician, who will do your test and follow these laboratory values. Too much can be quite harmful and can be as bad as too little.
- Post operative diets. Some surgeons like their patients on clear or full liquids for weeks. Liquids are much easier on a post operative stomach than solids. Some surgeons advance the diet as quickly as the patient can tolerate it. Again, take your surgeon’s advice.
- Laparoscopic versus open procedures. More and more surgeons are doing weight loss surgery through the laparoscope. This means smaller incisions, less adhesions following surgery (scar tissue) and less pain. However, some patients are not candidates for a laparoscopic procedure. Open procedures leave a larger scar, and have less of a leak rate than laparoscopic. If your surgeon is comfortable doing laparoscopic procedures, and feels you are a candidate, great. If they don’t feel you are a candidate—or if they start a surgery through the laparoscope and change it to an open procedure, trust your surgeon's judgment.
The use of non-steroidal anti-inflammatory drugs, such as aspirin, Motrin®, and ibuprofen are okay to use with the duodenal switch. If an ulcer develops, a gastroenterologist can use an endoscope and possibly treat the ulcer. Some surgeons do not like their patients using these drugs.- The common channel length is debated in the literature. Most have found that 100 cm for a common channel is appropriate. At 75 cm there are a number of patients (5 percent) who will need revision because of protein malnutrition.
- The ideal length of the enteric channel is also debated. Some surgeons will make it 40 per cent of the usual 600 cm of the small bowel, and others will make it 200 cm. There is no right or wrong answer, just a lot of speculation.
Before you select a bypass or Lap-band surgeon, ask some questions
How many surgeries has this weight loss surgeon done? Are you their first, their 1000th? Practice usually makes perfect, but not always. Some very busy weight loss surgeons claim that, because they do hundreds of these a year, they are good and careful surgeons and therefore you should trust them. There is something to numbers—the more you do something the better are at doing it—most of the time.
However, this is not always the case. I was asked to evaluate this very nice surgeon because he was in a bit of trouble with the medical board. He had a lot of experience doing a certain type of surgery, but it seemed like he always was getting in trouble. When I observed him performing surgery, I noticed he was a bit reckless and a bit rough, and I could see where he had a problem. I worked on a few things, made some suggestions, and his results improved afterwards. By the way, he is now happily retired, which is probably best. The thing is, he had done far more surgeries than I ever had but practice had not improved his Technology often changes how we do surgery. technique; practice had ingrained bad habits.
Some surgeons learn more with every surgery they perform. They try things a little different here and there; try a new instrument or a new suture, or a new technique. They are always looking to improve what they are doing. When they find something that works, they stick with it. They are not afraid to try something new, but not afraid to do it the same way every time if it works for them.
Another measure is speed. How fast do they do the surgery? Well, speed can kill. I have seen a lot of fast surgeons, and when it comes to my body, I want someone who will take an extra bit of time and do it right. This isn’t a race.
Before you choose a surgeon check with medical boards, check with nurses, see if the surgeon belongs to American Society for Bariatric Surgery or if they are in the American College of Surgeons. The real issue is, do you like them? Do you get along with them; do they have a program that you can feel good about? Do their programs make sense? So, how do you choose your surgeon? After you check several of them out, go with your gut feelings.
Here is a checklist:
- Fellow of the American College of Surgeons
- Member of the American Society for Bariatric Surgery
- Staff is friendly and professional – the staff often mirror the surgeon
- Surgeon and staff communicate with you
