AUAA… Episode 56 – Bariatric Surgery – Penn State Health St. Joseph Medical Center

>>From Penn State Health St. Joseph, this
is Ask Us Anything about Bariatric Surgery. I’m Scott Gilbert. Well, for some people, bariatric surgery can
be a life-saving choice. It’s not just about the weight. It can also help to improve conditions like
diabetes, heart disease, and even sleep apnea. Undergoing bariatric surgery, though, does
require a lifelong commitment to diet and exercise to keep the pounds off. We’re going to learn about all that today
with Dr. Allison Barrett. She’s a bariatric surgeon here at Penn State
Health St. Joseph. Dr. Barrett, appreciate your time today. Let’s start by talking about how people may
know whether they could be eligible for bariatric surgery. Say someone says, “I’m a little overweight,
perhaps even obese,” how do they go down that path to find that out?>>So most of the patients we see for bariatric
surgery have been overweight for a number of years and have tried and failed a lot of
times at other diets and exercise plans. We know specifically that people are good
candidates for bariatric surgery if they have a body mass index, or BMI, above 40. If you don’t know what your BMI is, it’s easy
to calculate it on the internet. A BMI above 40 automatically qualifies you
for bariatric surgery. If it’s between 35 and 40, you may also be
a good candidate as long as you other — have other medical problems like diabetes and sleep
apnea as well.>>Conditions that truly can affect somebody’s
life and life expectancy.>>That’s right, absolutely, so people who
have extra weight, who are obese and overweight do have a shorter life expectancy, and we
know that with bariatric surgery, or weight loss surgery, their life expectancy improves
along with a lot of their medical problems like their blood sugar, their sleep apnea,
high blood pressure, heart disease, etc.>>Those things can improve. I’ve heard that it can even cure things like
diabetes. Is that an overstatement or true?>>That’s actually true. People who have type 2 diabetes for less than
five years stand a very good chance of being cured of their diabetes just by losing weight
from weight loss surgery alone. People who have been diabetic for a bit longer,
5 or 10 years or even longer, it’s harder to say that we cure diabetes with a weight
loss surgery, but we certainly see significant improvements, especially with respect to how
much medication they’re using for their diabetes.>>You’re watching Ask Us Anything about Bariatric
Surgery from Penn State Health St. Joseph. We welcome your questions for Dr. Allison
Barrett. Whether you’re watching this video live or
if you’re watching it on playback, you can put those questions in the comment field below
this Facebook post and we’ll make sure we get you some answers from Dr. Barrett. So I’m curious about the screening process. I know it is a rather rigorous screening process
people go through to determine whether or not they are a good fit for bariatric surgery. What does that involve?>>That’s right. It does take upwards of three to six months
to get a patient ready for bariatric surgery, and the reason for that is largely to make
sure that they’re medically ready for an operation but also that they’re psychologically ready
for an operation. Bariatric surgery is a very large change to
how somebody lives their day-to-day life, how they eat, how they interact socially with
their friends and colleagues, so it’s something that people need a lot of time to get ready
for.>>Okay, and we’ll talk more about the preparation
for it as well, but we’re talking about bariatric surgery a bit in the abstract, so I’d like
to get specific and talk about the most common types of bariatric surgery, especially those
done here at Penn State Health St. Joseph.>>There are several main kinds of bariatric
surgery. The most common operation right now performed
is a sleeve gastrectomy. We also perform a gastric bypass operation,
which has been around for a number of years, and then sometimes patients need revision
on surgery, specifically patients who have had lap bands in the past and may have some
issues with those.>>So walk us through each of those. Let’s start with a sleeve gastrectomy. What’s going on with that?>>A sleeve gastrectomy involves removing
about two-thirds of the stomach by using a surgical stapler. It’s called a “sleeve gastrectomy” because
it looks like the sleeve on your coat. It’s long and narrow like a sleeve. That operation takes about an hour and it
involves staying in the hospital just one night after surgery.>>Gastric bypass, I think “gastric” means
“stomach.” Does this literally mean we’re bypassing the
stomach in some regard?>>That’s right, gastric bypass operation
has been around for many years. That does involve making the stomach much
smaller by stapling it into a small configuration about the size of an egg and then attaching
it directly into the intestines. So somebody who has had a gastric bypass is
going to eat much less food and then their body won’t absorb all of the food either.>>And I imagine part of that screening process
is determining which of those procedures is most appropriate for the individual.>>That’s right. Not every patient is a good fit for every
operation, and part of the consultation visit with me and going through our preoperative
process is making sure we’re picking the right operation for the right patient.>>So let’s say that screening determines
that someone is indeed a good fit for some sort of bariatric surgery, what are those
next steps in terms of preparing for surgery? I understand one of those steps is a diet
people need to go on.>>That’s absolutely right. So we do expect patients to change their diet
leading up to surgery, and losing some weight is a part of that process. During the three to six months of preparation
for surgery, they’re going to be meeting with and communicating regularly with Luis Diaz
who is our Bariatric Nurse Coordinator. He will help walk the patients through the
entire process, including helping make appointments with a nutritionist, the pulmonary or lung
doctors, if needed, getting their blood work done, endoscopy, etc. It is a lot of work for the patients to do,
but we’re lucky to have Luis help coordinating that process for them.>>Right, I mean, it’s important to note,
I mean, there are some surgical procedures where you go, you have the procedure done,
you’re off and on your way, you never probably talk to the patient again unless there’s a
complication. This is different. This sounds like more of a holistic approach.>>Bariatric surgery is a field that’s very
unique in the surgery world because we really expect these patients to be invested in their
care, not just from the surgery standpoint, but for the rest of their lives, and we are
a big part of that process on the surgery team end, so patients don’t have a surgery
and then just disappear. They stay with us for life. We do know that patients who are more likely
to be seen in the office and patients who follow up with their nutritionist will absolutely
have better results with their weight loss than patients who don’t follow up with us
afterwards.>>All right, but patients obviously do have
a very important role to play themselves, as you’re saying. You’re watching Ask Us Anything about Bariatric
Surgery from Penn State Health St. Joseph. I’m Scott Gilbert alongside Dr. Allison Barrett. She’s a bariatric surgeon here and she welcomes
your questions, so just put them in the comment field below this Facebook post and we’ll make
sure we get you some answers. One question I imagine some folks have is
how long the hospital stay would be after a procedure like this.>>Most patients are able to go home one to
two days after surgery, and part of the reason we can do that is by using enhanced recovery
after-surgery programs. These programs specifically target early functional
return for patients, early back-to-work time for patients, and the way we do that is by
limiting the amount of narcotics and opiate drugs they get as well as encouraging them
to really be up and — up and walking as soon as they can after the operation.>>And probably a lot more of these they’re
doing laparoscopically, that is, with a small incision than many years ago.>>Right, most bariatric surgery operations
are done with minimally invasive techniques. That usually means laparoscopic surgery which
involves using small incisions. I also do a large number of my operations
robotically, which is using similar small incisions and also using the advanced techniques
of a robot to do the operation.>>What kind of pain can people expect after
the surgery?>>Most patients will need pain medications
for three or four days after surgery, but we do a very good job of controlling that
pain with other techniques and other medications to try to limit the amount of pain medication
they need when they go home. So most patients who are working at an office
job will be comfortable enough to go back to work within 7 to 10 days of surgery.>>Wow, that’s great, just about a week or
so. And how fast can people expect to lose weight
after the surgery? I’m sure it’s not as simple as you wake up
and you’re 40 pounds lighter, but, I mean, what’s the reasonable expectation there?>>Most patients do start losing weight within
the first few weeks after an operation. The patients who undergo weight loss surgery
are on a liquid diet for two weeks after surgery, so by the time I see them in the office for
their first post-operative visit, patients are often 5 or 10 or 15 pounds lighter already,
and that weight loss is very quick the first six months after an operation.>>Now let’s get into some of those lifestyle
changes people need to employ, because like you say, the surgery itself doesn’t do everything. People have to commit to some lifestyle changes,
dietary changes, maybe exercise. Can you talk about those various components
and how they factor in?>>Sure. There are a lot of issues that people need
to address with the way that they eat food before they undergo an operation. We as Americans tend to eat very, very large
portion sizes that are unusually large, and one of the largest adjustments for patients
who undergo weight loss surgery is making their eyes match their stomach and reducing
those portion sizes back down to what they should be. So that’s one of the biggest adjustments patients
need to make. On top of that, we do expect them to be picking
healthy foods to eat and trying to avoid greasy or fatty foods.>>You’re watching Ask Us Anything about Bariatric
Surgery from Penn State Health St. Joseph. Just add your questions or comments for Dr.
Allison Barrett in the comment field below this post and we’ll make sure we get some
answers for you. And also, if you enjoy this information, you
find it useful, as we hope you do, we hope that you’ll share this on your Facebook page. Let’s talk a bit about complications. Any type of surgery comes with a possible
risk of complications. What are the kind of things that you as a
physician look out for post-surgery?>>Specifically for patients who are overweight
and undergoing surgery, we always do worry a bit more about blood clots in the legs. We do recommend that the patients get up and
walking as soon as they can after surgery, which can be within six hours. Doing so will help lower their risk of having
blood clots, on top of which we do make sure that they get blood thinners around the time
of the operation. Other common complications people have after
bariatric surgery is really dehydration. It’s hard to drink enough after your stomach’s
been stapled, so the first few weeks can be a little difficult for patients, and we’re
aggressive about taking care of people if they do have a problem with that.>>And how about if people have had things
like abdominal surgery or if they have a hernia, are there factors like that that could limit
their ability to have laparoscopic surgery, that small incision we’re talking about?>>Those are great questions that we always
review with the patients at the time that they first see me for the consult. As we talked about before, not every operation
is the right choice for every patient. Some people who have had a lot of abdominal
surgery may have more difficulty with a complicated operation like a gastric bypass, so something
a little similar like — simpler like a sleeve gastrectomy may be the right choice, but those
kind of things are what we would discuss with them at the time of their initial visit and
make sure we’re doing what safest and right for the patient.>>And this field has evolved greatly, right? Because if we were having this conversation
10 years ago or so, there may be other procedures on the table that really have fallen out of
favor today, right?>>Right. Ten years ago, the landscape of bariatric
surgery was largely based around open gastric bypass operations with a large incision or
laparoscopic gastric band operations. The lap band operation has really fallen out
of favor because it’s proven to be somewhat less effective than the others and prone to
complications, so not many people are doing lap bands lately. Nowadays most operations are done laparoscopically
or robotically with very small incisions, which, again, allows the patient to be back
to their regular life pretty quickly after a major operation.>>And we’re talking a bit about surgery risk. What if someone has type 2 diabetes? They might say, “Does that make it more risky
for me to have the surgery?”>>Only a little. We do worry about people’s blood sugars around
the time of any operation and, of course, we pay attention to that when somebody’s having
a bariatric operation, but we know from a lot of good medical literature that some of
the patients who benefit the most from bariatric surgery are those who have type 2 diabetes
and stand to benefit greatly from doing an operation.>>Now, how about somebody who’s hoping to
get pregnant in the near future? How soon after bariatric surgery might it
be safe for them to do so?>>That’s a great question. So I see — I do see a lot of young women
who are overweight and maybe they haven’t been successful in getting pregnant because
of their obesity. Having a bariatric operation gives them that
fertility back, that ability to get pregnant that maybe they couldn’t before. Generally, I recommend that patients who are
trying to get pregnant wait at least a year to 18 months after their weight loss surgery
to have a pregnancy, but some of my favorite patients have been the ones who have come
back after a weight loss operation with a baby in their arms.>>That must be very rewarding for you to
see as a practitioner. So long term, what are ultimately the factors
that determine whether the weight stays off and whether someone is successful 5, 10, 20
years from now in, you know, keeping that weight off?>>We talked a few minutes ago about seeing
patients back in the office regularly. Having patients come back regularly to the
bariatric surgery office to meet with me, our coordinator, and our nutritionist goes
a long way towards making sure that patients are compliant and having good success in the
long term. We always worry about vitamin deficiencies
in this patient population, too, so having regular contact with our team is important
to make sure that none of those complications are developing.>>If somebody loses a lot of weight, is there
a possibility they may need to have plastic surgery after a bariatric surgery?>>Yes, it’s a frequent question that comes
up: Do I need plastic surgery after I have my weight loss surgery? Sometimes the answer is yes. For people who are older, their skin is not
as elastic as people who are younger, so older people who have a lot of weight loss do tend
to have extra skin. How much it bothers them is really up to the
patient individually. Some patients don’t have too much issue with
the extra skin and some do. It’s a very personal decision.>>All right. Do insurance plans tend to cover bariatric
surgery?>>They do. As with anything else, there are certain requirements
to meet to make sure that insurance coverage is provided, but yes, overall they do.>>All right. And if people have questions and they want
to learn more about the program here for bariatric surgery at Penn State Health St. Joseph, we
will put some — we’ll put the contact info for you in the comment field below this Facebook
post, and if you’re thinking, man, Dr. Barrett knows her stuff, she could have written the
book on bariatric surgery, well, she didn’t write it, but she did edit this book on bariatric
surgery. She’s one of four editors on this. This is a book used by medical practitioners
across the country, right?>>Right. This is a book that we published last year
that’s called The Manual of Bariatric Surgery. It’s the second edition of this textbook that’s
meant for other bariatric surgeons in the United States and around the world. What we did, we were able to compile a lot
of information and update everything that’s happened in the last 10 years since the first
edition came out.>>And like you say, 10 years, that’s a long
time when it comes to bariatric surgery. So much has changed, as we talked about before,
so as a physician, I’m sure you’re trying to keep on top of what the next developments
will be.>>Right, and part of the way I do that is
through social media and keeping in touch with my colleagues around the world, but also
making sure that we have access to the medical journals and the medical information we need. I’m also pleased to go to two conferences
every year, including one that I’m presenting at in April, where we learn a lot more from
our colleagues who are out there doing interesting and new things in the bariatric — bariatric
surgery field.>>So the key takeaway of someone who’s overweight
or obese, it’s affecting their health, and if it’s not affecting it drastically now,
it could someday. They should see if this is an option.>>Bariatric surgery is a very good option
for patients who have a good amount of weight to lose, and I think we are askew to think
that the average bariatric surgery patient is 600 or 700 pounds and that’s just not the
case. The average American now is overweight and
obese, and so there are a large number of patients who would benefit from bariatric
surgery.>>All right, Dr. Allison Barrett, thanks
so much for your time today. Dr. Barrett is a bariatric surgeon here at
Penn State Health St. Joseph. Again, contact info in the comment field below
this Facebook post to learn more about the program here. Thank you so much for watching Ask Us Anything
about Bariatric Surgery from Penn State Health St. Joseph.

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