Bariatric surgery is the area of surgery that focuses on operations to reduce weight and treat obesity. The name comes from the Greek words baros, meaning weight, and iatrike, meaning treatment.
Weight Loss Surgery is a major surgery involving the gastrointestinal tract. The stomach and intestines are modified so that less food can be consumed or absorbed, which leads to a substantial loss of weight that can be maintained for years. Liposuction is a form of cosmetic surgery in which areas of the body are reshaped or resculpted by removing excess amounts of fat in those areas. The purpose of liposuction is not to produce weight loss.
The Bariatric Surgical Team at Weight Loss Team in Puerto Vallarta Mexico advises that you must have clinically severe obesity, also known as morbid obesity. This means your BMI must be higher than 35, or you must be at least 100 lbs above your ideal body weight. You may be a candidate if you’re less than 100 pounds overweight, if you also have significant health problems due to your weight, such as Type 2 diabetes. Most people with clinically severe obesity are good candidates for surgical treatment-as long as you understand the procedure, don’t have a severe, pathological eating disorder and are willing to come back for follow-ups.
It stands for Body Mass Index and it determines someone’s health risk related to their weight. A BMI greater than 40 or greater than 35 with associated medical problems means you have clinically severe obesity which is associated with diabetes, heart disease, high blood pressure, high cholesterol, heartburn, gallstones, arthritis, urinary stress incontinence, infertility, and some types of cancer.
Yes. Morbid obesity is an independent risk factor for premature death, with the risk rising as the BMI increases. People with a BMI of 30 have a relative risk of dying early that is 1.3 times greater than normal weight individuals. By the time the BMI is 40, the risk is close to 3 times as great.
No, obesity tends to run in families. Identification of several genes and their corresponding hormones (leptin) have been found to be at least partially responsible for obesity. Therefore, there is evidence that obesity is at least partially biological, helping to reduce the misconception that it is a behavioral or psychological disorder. I consider obesity a disease which needs a cure, rather than a moral failing which is the fault of the individual.
Because it works! Surgical treatment for obesity is the ONLY treatment that reliably produces significant and sustained weight loss. People with clinically severe obesity are at great risk for developing many associated medical conditions. Research has shown that surgical treatment results in significant weight loss and improvement in most problems associated with obesity. Surgical treatment for clinically severe obesity has been endorsed by the National Institutes of Health, the World Health Organization, Shape-Up America, the American Heart Association, the American Dietetic Association, and the American Obesity Association.
If you can lose the necessary amount of weight (and keep it off) through diet and exercise - more power to you! Ninety-five percent of the people considering WLS have tried (sometimes numerous times) and failed.
Drug treatment and injections like Ozempic and other drugs does produce limited success (usually weight loss of about 35 to 40 pounds). However, concerns about the safety of long-term treatment have limited the drugs available and the length of time people can take them. This, in turn, limits their effectiveness because, as with any chronic disease, such as diabetes or high blood pressure, the drug is only effective as long as it is taken. Weight Loss surgery is a permanent solution that typically ends up costing less than injections over the long run.
Operations for the treatment of obesity usually induce weight loss by limiting the amount of food consumed, altering the normal absorption of nutrients, and/or altering the way the body utilizes energy. A Gastric Sleeve Surgery or Gastric bypass does all three. They actually boost your metabolism for the first 18 months, which is one reason patients lose weight so quickly.
Laparoscopic surgery is a good choice for most people. People who have had previous bariatric surgery or surgery on the stomach are probably better candidates for the open approach. People with BMI > 60 (more than 200-250 pounds overweight) may be better candidates for open surgery.
You and your friends should be aware that there is no easy way out. Surgery makes the discipline of exercise and dietary control effective when it would not otherwise be effective. Obviously, surgery also entails risk and the courage to take that risk.
The Bariatric Surgical Team at Weight Loss Team in Puerto Vallarta Mexico likes to answer this question by asking another question: “Is it healthy to be 100 pounds overweight?” The rapid weight loss experienced after WLS is extremely gratifying psychologically and physically. If you eat properly, making sure you get enough protein, there should be no ill effects from it.
No. Successfully operations have been done on patients who weighed 750lbs., who had a BMI of 100. The operative risks are higher the more you weigh, but they still don’t approach the risk of remaining at such a high weight. The Bariatric Surgical Team at Weight Loss Team in Puerto Vallarta Mexico personally has operated on patients weighing well over 500 pounds with great success, yes the risks are higher, but so are these patients health risks without surgery.
Yes. Much happier. Most patients say they would do it again “in a heartbeat.” Studies show that this kind of patient satisfaction is a true test of the surgery.
Regular, follow-ups are needed to monitor weight loss, provide dietary counseling, and to monitor for the occurrence of nutritional deficiencies or complications. We recommend visiting your local doctor once a year for a checkup and get a full blood panel drawn to make sure there are no deficiencies.
Yes. People can be too young. You need to have stopped growing and you need to have a mature bone age. In addition, you must understand the surgery and want it. You can’t have an operation because your friends or your parents want you to. You need to be able to give “informed consent”, which means you make an educated decision and then give your permission for the procedure. It is also necessary that your parents are supportive of your decision and understand the role they will need to play in your care and recovery.
Age is one factor that needs to be considered together with all other aspects of a person’s health. I would not give an arbitrary or absolute cut off. Surgeries have been done on several patients in their late 60s and early 70s, with excellent results.
If you are overweight with associated problems due to obesity, you are not too sick to have this operation! You are too sick NOT to have it. The only chance you have for improvement in your medical conditions is through weight loss surgery.
Not guaranteed, but it is a common experience.
Yes you will need to be careful after surgery because pregnancy is common after weight loss so use precaution.
The depends on your eating habits. If you are a sweet eater, then maybe you are a Bypass Candidate, if you are a large quantity and non-sweet eater, the Sleeve is perfect. ALso based on BMI there is now a choice between RNY, SASI Bypass, SADI Bypass and VSG surgery.
The Bariatric Surgical Team at Weight Loss Team in Puerto Vallarta Mexico provides support and experience. Weight Loss Team and its Bariatric Surgical team including the anesthesiologist specialize in Bariatrics and have years of experience working in the medical tourism industry for the last 19+ years. Weight Loss Team at the CMQ Family of Hospitals provides top quality care and service to the patients both before and after surgery. The team is available to you both preop as well as postop. The service you get, the attention you receive and the fact that we do not charge anything extra for the care we provide make having surgery with us a simple decision. You will not pay extra by having surgery with us, in fact we offer bariatric surgery in Puerto Vallarta for thousands of dollars less than other doctors offices in the USA. Puerto Vallarta is also much safer than Tijuana for weight loss surgery. There is a lot of drug violence at the Tijuana border and the insecurities of flying into San Diego and then having someone you dont really know transport you across the border in an unsecured vehicle can be dangerous. In Puerto Vallarta you will fly directly into the city and dont have to deal with the US border and the hourlong delays. Plus Puerto Vallarta is family friendly and safe. In Puerto Vallarta you can actually make a vacation out of your surgery and dont have to worry about the dangers of travelling to Tijuana.
POST-OP QUESTIONS
Each diet is designed by a team of bariatric nutritionists and The Bariatric Surgical Team at Weight Loss Team in Puerto Vallarta Mexico, and it is important to follow the preop diet so that you reduce your chances of having complications during the surgery. A sample preop diet may consist of: Unlimited Lean Protein, Unlimited Green Vegetables, and Unlimited Salad with Lite salad dressing. No Carbs and no sugars. You should drink 3 liters of water per day and do this diet for a minimum of 2 weeks or longer depending on what the Team tells you based on your BMI.
Most medication can be stopped the day prior to surgery but any anti clotting meds and some anti-inflammatory medications make bleeding more of a problem and if they can be discontinued without too much discomfort a week or two preoperatively it is desirable. Please consult a doctor for exact guidance.
Some surgeons believe that a ‘bowel prep’ decreases constipation after surgery and makes managing a colon injury safer. In our experience colon injury is extremely rare and constipation is not a post-surgical problem. Therefore the doctors do not recommend cleaning out the bowel prior to surgery.
Yes we can remove the gallbladder during the surgery the cost is an extra $1000usd.
Yes we must repair all Hiatal Hernias during surgery for a cost of $500us we also do standalone Hernia repair surgery and the cost is $4460usd.
Laparoscopic surgery is a good choice for most people. People who have had previous bariatric surgery or surgery on the stomach are probably better candidates for the open approach. People with BMI > 60 (more than 200-250 pounds overweight) may be better candidates for open surgery.
PRE-OP QUESTIONS
Infections virtually always come from bacteria present in the wound at the time of closure. Wounds seal to the outside within hours after surgery so it is safe to bathe or shower the next day. Similarly, iv and drain sites can be cleansed and redressed with minimal likelihood of infection
So long as discomfort does not prevent you from rapidly hitting the brake or steering effectively and you are not taking medications that impair your reflexes or judgment, it is safe to drive after surgery.
The only change that appears to be of clinical significance is a marked decrease in the production of ghrellin and a consequent marked decrease in hunger sensations.
As a generality weight loss increases fertility and improves the likelihood of a normal delivery. However, getting pregnant while rapid weight loss is occurring may not be safe and commonly results in less final weight loss.
If you have had laparoscopic surgery there are no limitations on your activity except the presence of a drain and your general energy level. Most people are quite ready to return to work once they arrive home from surgery. When circumstances permit some people choose not to return to work until they feel completely ‘on top of their game’ again and they may take considerably more time off work than a week or two. Following open or incision surgery, heavy lifting must be avoided for eight weeks, Otherwise the timing of a return to work is as for the laparoscopic patients.
It is not recommended you drink alcohol after weight loss surgery. The amount of alcohol absorbed before gastric bypass is limited to about 50% by the presence of an enzyme in the stomach which breaks down the alcohol before absorption. After a gastric bypass this enzyme does not come into contact with ingested alcohol and more is absorbed, so it is easier to get drunk. Also alcohol is a significant source of calories: 7 calories per gram as compared to 5 with carbohydrates or protein. After the gastric sleeve surgery, alcohol is digested the same as before surgery but is a major factor in weight regain.
There is no evidence that carbonated drinks expand the pouch or otherwise impair the surgical result but it is recommended to avoid carbonation post weight loss surgery anyway.
Yes. There is a general tendency for weight loss to occur from the head and neck first and thereafter from the upper body and abdomen but people differ and where you lost weight before is likely where you will experience the most weight loss again.
Yes, but it would take another operation. No one, in my experience, has asked to have the surgery reversed.
Food preferences change for many patients after surgery; others have to make do with discipline. The reasons for changes in food preferences are unknown but most likely hormonal.
Irritable bowel syndrome is neither improved nor worsened by surgery.
Not guaranteed, but it is a common experience.
Yes, with a few exceptions. Small tablets, the size of the end of a pencil or smaller, will pass readily through the pouch into the intestine and are not a concern. Examples include thyroid medication, BDP’s, and other hormone tablets. Many larger tablets may stop in the pouch and sit in one spot, will slowly dissolve. As some are quite caustic, they will burn an ulcer, and cause pain that will last for days, until the ulcer is healed. It is therefore important to crush them prior to swallowing.
The shakes ensure adequate protein and calorie intake after surgery which is important for healing and other reasons. A liquid diet ensures that the pouch and opening will not be stretched early on when that is more easily accomplished. The shakes also interpose a significant change between the way you have eaten and the way we hope that you will eat in the future. Because the shakes are somewhat monotonous when you switch to a low fat more healthy diet it is ‘tasty’ by comparison and therefore more likely to be preferred in the long run.
Four weeks; and it is a good test of your willingness to make some dietary changes. Taking the shakes for a week or two before surgery will shrink the liver and make surgery easier and safer. This is advised in some very heavy patients.
A daily multivitamin is probably a good idea for everyone to take to prevent the fairly common and widely varied deficiencies seen as people get older.. The iron, B12, and calcium supplements should be taken for life, if you have had a gastric bypass.
The gastric pouch although initially very small has a hole in the bottom so that a reasonable amount of food can be eaten if taken slowly. As time passes the pouch enlarges and where initially only one or two bites could be taken without a sense of fullness, later a small adult meal can be consumed. As it becomes possible to eat more food it becomes also more important to have developed good habits with regards to food choices.
Except for the tiny hormone replacement pills most tablets should be crushed after surgery. Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating, flushing, weakness, fatigue and sometimes abdominal cramps and diarrhea – a phenomenon called "dumping."
Don’t eat after you feel full.
The Bariatric Surgeons at Weight Loss Team advocates walking and light weight lifting immediately after surgery. If you’ve had laparoscopic surgery you can lift weights immediately. If you’ve had open surgery, do not lift more than 10lbs for the first six weeks. After that, you can increase to 30 lbs. for 2 weeks and no limit after 8 weeks. This is because hernias almost never occur after laparoscopic surgery, but are quite common after open surgery with an incision. It is unlikely that effort that does not cause abdominal pain will affect the likelihood of hernia. Similarly, if you can hit the brake hard without discomfort and are not taking painkillers then it is ok to drive a car. The discomfort standard should be applied to sex as well: if it doesn’t hurt, go for it.
It depends on what you mean by normal. Many overweight people eat more and make higher calorie food choices than the rest of the population. So it is possible that you were not eating ‘normally’ to begin with. After surgery although you can eat small amounts of anything, we hope that you will choose low fat foods for the most part. Also you will in general consume fewer calories than someone your size who was not previously overweight. Your could eat frequent small amounts of high calorie foods and gain your weight back.
We advocate increasing two kinds of exercise as part of a post surgical lifestyle change: 1) Increase the difficulty of unscheduled everyday activities. For example, try to walk farther – a pedometer is helpful in this regard – climb the stairs instead of taking the elevator; volunteer for small tasks that you might not otherwise choose. 2) Schedule workouts two or three or four times a week simply for the purpose of exercising. Although any activity is helpful, weightlifting is the most efficient for extra weight loss.
Most patients lose between 50 and 80% of their excess body weight over about 1-1 ½ years. Some reach their ideal weight, but some don’t, surgery is only a tool and you must be willing to work with it for success.
Except for using steroid injections to stop keloiding I have heard of no tested way to diminish scarring, but lots of remedies are tried and perhaps some work. In any case it seems harmless to try.
Whether plastic surgery is desirable depends on how old you are (skin is less elastic with age) how much weight you lose (the more the more skin) and individual differences in elasticity. Loose skin bothers some more than others, but there is nothing shameful about wanting to look your best and we will try to help anyway that we can. Getting rid of loose skin requires plastic surgery, some types of which we do ourselves.
Exercise is wonderful for many things but unfortunately does very little for loose skin.
Most often it is forgetting that weight control is a lifelong project. But obviously the genetic pressure to gain is greater in some than others and although we cannot currently recognize it the surgery may be better for certain types of obesity than it is for others.
Ideally, pregnancy should be delayed until weight loss is maximal, usually around 12 to 18 months after surgery. Weight loss makes women more fertile and decreases the likelihood of complications related to pregnancy. It is safest to get pregnant after weight loss is complete as there is some theoretical risk to the fetus with rapid weight loss.
Enough to account for the baby, the placenta, and some amniotic fluid – about 35 lbs. Ask your obstetrician.
Excess weight is hard to lose. It is best to gain only the amount necessary for a normal baby and pregnancy.
The tests to do are Ferritin, B12, PTH (parathyroid hormone), Calcium and cbc. It is recommended to do tests 3,6,9 and 12 months after surgery for the 1st year and and repeat every 6 months every year thereafter.
POSSIBLE COMPLICATION QUESTIONS
The first weight loss procedure was an intestinal bypass and it commonly caused diarrhea. Diarrhea is not normally a consequence of proximal gastric bypass or the gastric sleeve. Some increase in the frequency of bowel movements may occur after distal gastric bypass. And every so often a patient may experience diarrhea after weight loss surgery.
Weight loss and the breakdown of fats cause the formation of ketones which are volatile and are partially exhaled. The odor however is not unpleasant and has been likened to that of Juicy Fruit chewing gum. It is important however to maintain normal dental hygiene and to brush your teeth even when taking only a liquid diet; otherwise, bacteria accumulate on the tongue and between the teeth and can cause bad breath.
The amount of loose skin after surgery depends on the amount of weight loss, your age – younger skin is more elastic than older skin – and individual differences. When weight loss is rapid, skin tightening may continue to occur after weight loss has stopped. In general, if you have lost a lot of weight you are likely to have some loose skin and may want some plastic surgery to correct it.
Hernias occur where the abdominal wall is weaker and from increased intraabdominal pressure. It is somewhat speculative but most incisional hernias probably occur with straining and coughing while the patient is waking up from anesthesia. Patients waking from anesthesia are pain free so when they strain their effort is not restrained. Sudden severe straining after surgery which happens more quickly than can be modified by reaction to discomfort is another likely cause for hernias. Examples include straining from falling, coughing, or vomiting. A sudden response to an unexpected weight (child jumps into your lap) can also cause hernias. A smaller contribution to the development of hernias can come from ordinary efforts that rely on abdominal musculature such as lifting and other forms of exercise. Standard advice is that following open surgical procedures with abdominal incisions, one should not lift a weight greater than 10 lbs for the first month and not greater than 30 lbs for the second month. Risk of hernia after laparoscopy is so low that full activity can be resumed almost immediately.
Constipation after weight loss surgery is a common complaint. It is caused by decreased food and water intake and, in some people, supplemental iron, or narcotic pain killers, tranquilizers, and antidepressants. It is often aggravated by weak abdominal muscles or busy schedules wherein people defer having a bowel movement when the urge exists. Our approach is to provide the following advice: Do exercises that strengthen the abdominal muscles and assist in bearing down. Most people experience the need for a bowel movement after breakfast and that is the natural and easiest time to have a bowel movement and should not be ignored. Increase water intake. An increased intake of any vitamin except B12 and vitamin A tends to produce diarrhea and has not significant other side effects and is helpful in eliminating constipation. Especially useful in this regard is Vitamin C or ascorbic acid since in addition to preventing constipation it enhances the absorption of iron in Trinsicon or other forms. Next add fiber to the diet: Eat high fiber breakfast (bran-based cereals, oatmeal) add vegetables to other meals. Miller’s unprocessed bran found in the cereal section of the grocery store can be taken with juice, or sprinkled into salad, meatloaf, cereal, etc. The same thing can be done with Metamucil, or psyllium seed. These are more expensive forms of non-digestible cellulose or fiber. The water content of stool can also be increased with a stool softener, docusate sodium, marketed as Colace, or Peri-Colace or P-Col-Rite. If the above measures are still not correcting the problem the electrolyte laxatives such as Fleet Phospho-Soda, Magnesium citrate, Milk of Magnesia, or Colyte, to name a few, should be tried. Avoid laxatives that directly stimulate the bowel smooth muscle eg. Senecot, as tolerance develops and more and more is required over time.
Excessive air swallowing is probably the commonest cause and may result from deliberately belching to relieve a sense of fullness or from swallowing frequently as sometimes occurs with anxiety and nervousness. A deliberate change in behavior is usually effective. Simethicone, marketed as Gas X, helps reduce large bubbles of gas to small ones and may relieve the cramping sensations. Nullo which is a chlorophyll derivative also may be helpful. After gastric bypass, excessive dietary intake of fat increases intestinal transit time and delivers undigested food to the colon. Food in the colon is broken down by resident bacteria and results in a very malodorous gas. A restriction of dietary fat intake may be sufficient to eliminate the problem. Bismuth subgallactate marketed as Devrom is also helpful. If the problem occurs soon after a distal gastric bypass, Pancrease – a pancreatic enzyme supplement – taken with meals may be useful. Milk sugar called lactose is digested by an enzyme called lactase the production of which declines with age and following gastrointestinal surgery. Lactase tablets, drops and milk products with pre-added lactase are available. Beans, cauliflower, onions, broccoli and other vegetables contain complex carbohydrates (oligosaccharides) which are broken down in the colon to form gas. Beano contains a-galactosidase which helps to convert the oligosaccharides to simple sugars which can be absorbed and gas is thereby prevented. An alteration in intestinal flora usually caused by antibiotics may produce gas. Ultraflora – a bacterial preparation – may be given to repopulate in intestinal tract normally. When the cause is fungal overgrowth, Diflucan (fluconazole) may be effective. Flagyl is sometimes tried to suppress anaerobic bacterial growth in bypassed portions of the intestine. Other causes are gallstones, diverticulosis, irritable bowel syndrome, and parasites, and, rarely, cancer of the ovary or bowel.
Hair loss is commonly assumed to be due to lack of adequate dietary protein but a clear cause and effect relationship is lacking. Nevertheless, one should measure the prealbumin, and if it is low, increase protein intake. Ephedrine is said to be effective in restricting protein weight loss and enhancing fat weight loss. Hair loss due to dietary restriction is nearly always temporary. Rogaine and Nexium shampoo have both been reported to be effective and should be tried if the loss is excessive.
Put simply the main risks are death and complications. Mortality risk reported across the US is 0.5% or 1 patient in every 200. By recent count our mortality risk is less than one patient in every 500 gastric bypasses. The commonest causes for death are pulmonary emboli and infections. The commonest complications are wound infections, strictures, and hernias. The risks after adjustable band surgery and after gastric bypass are different (see Information Seminar). The major problems that occur with any frequency after gastric bypass are 1) leakage from the bowel connection to the pouch, 2) pulmonary emboli, 3) bowel obstruction or kinking, 4) bleeding, 5) stricture. The major problems after an adjustable band are 1) erosion, 2) slippage or herniation of the stomach up through the band, 3) pulmonary emboli, 4) esophageal dilatation.
The symptoms can vary from sudden severe abdominal pain, weakness, chills, and abnormal drainage to no symptoms and unusual looking material coming from the drain site. The treatment depends on the severity of the leak but varies from no treatment, to hospitalization and iv’s, to re-operation.
Shortness of breath and pain on breathing. Treatment involves giving ‘blood thinners,’ anti-coagulants, and hospitalization.
Waves of abdominal pain, nausea and vomiting sometimes preceded by a loose bowel movement. Treatment involves surgery, usually laparoscopic, and correction of the kink or obstruction.
A stricture or too much narrowing at the connection of the pouch to the intestine is usually experienced as progressive difficulty with swallowing: first solid foods, then soft foods, finally liquids won’t pass through. The treatment is endoscopy and balloon enlargement of the opening.
Bleeding usually occurs in the first day or two after surgery and is recognized by a fast heart rate, weakness, paleness, and abnormal blood tests.
Typically the patient can eat more amounts of food as the esophagus turns into part of the stomach and holds food when enlarged.
Any abdominal operation sets the stage for a possible bowel obstruction the lifetime frequency of which is approximately 8%. Vitamin and mineral deficiencies can occur if calcium, B12, and iron supplements are not taken as prescribed. Less commonly protein deficiency can occur.
Less than 1% after laparoscopic surgery and about 10% after the open procedure.
Pretty small. We see one about every year or two. That said you need to avoid NSAIDS to prevent ulcers and take pantoprazole to protect your stomach when you do.
In patients who do not have gallstones at the time of surgery only 4% subsequently develop stones. We therefore only remove the gallbladder in patients who have stones diagnosed before or during surgery. In general we do not remove the gallbladder unless it is diseased or there is a strong family history or gallstones and gallbladder removal.
Yes, ursodiol is given to prevent gallstones in high risk patients. Because it is expensive, we do not prescribe it for every patient.
Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating, flushing, weakness, fatigue, and sometimes abdominal cramps and diarrhea – a phenomenon called ‘dumping.’ This is not usually a problem after gastric sleeve surgery.
After gastric bypass but not after gastric sleeve surgery, absorption of iron, B12, and calcium is impaired and extra amounts need to be taken. Trinsicon is an iron, B12, folate and intrinsic factor combination which is simply a convenient way to get iron and B12 which certainly can be taken separately and are available over the counter. Calcium should not be taken at the same time as iron since they compete for absorption. Iron absorption is enhanced if taken with vitamin C (ascorbic acid).
Wound infections occur because bacteria inevitably get into the wound during surgery . Some types of bacteria may be difficult for the body to eliminate. Also, local factors like variations in tissue blood supply, small amounts of blood, sutures, and other things beyond the surgeon or patient’s control, influence the likelihood of wound infection. Antibiotics are routinely given and used to irrigate wounds. Wound infections occur about one time in ten after open gastric bypass. They are quite unusual after laparoscopic bypass because the wounds are much smaller.
Vomiting may sometimes cause a tear and a leak, but usually does not. After about three weeks it is nearly impossible to rupture the staples. We create a double buttress to prevent this exact problem
Generally speaking with the gastric sleeve surgery, not, but with certain medications it may be wise to check blood levels after surgery. Also patients who have Gastric Bypass surgery may need to seek redose of medications with their local family doctor.
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