Weight Loss Surgery - Gastric Bypass/Sleeve Gastrectomy: 2 Year Follow-up

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Gastric Bypass Surgery:  Two-Year Anniversary




Speaker:  Dr. T. Karl Byrne – Department of Surgery


Well, congratulations, this is an anniversary of your gastric bypass.  It may be your second, third, fourth, fifth, or even fifteenth anniversary of your gastric bypass, so it’s time, now, to take stock of how far you’ve come and where you are.  Obviously, if you’re two or three years out, the weight loss that you achieved initially, in the first six months, and certainly within the first year, has probably stopped.  Most people, after the second year, will find that they’ve put a little weight back on.  This is not very unusual.  And, in fact, if you look at the statistics for patients who have had gastric bypass out to 15 years, whereas initially, you will have lost maybe 65 to 70 percent of your excess weight.  If you look at everybody at 15 years, the average weight loss is 55 percent of your excess weight at that period of time.


So, if you’ve put a little weight back on, don’t be too discouraged.  Most people go down to their lowest weight and then bounce back up some.  What you don’t want to happen is to continue to put that weight back on.  So, if it’s an anniversary, such as your second, third or fourth, you need to come see us in the clinic.  You certainly need to contact us so we can talk to you.  If you have put some weight back on, then we have methods to nip this in the bud for you.


Firstly, your pouch will have stretched out some, so everybody, after two years, will be able to eat a little bit more than they did initially, certainly, compared to the first six months.  But, there are other things that may be going on in your life apart from that.  If people come back to us and they’ve begun to put the weight back on, we notice that their portion sizes have gotten a little bit bigger, but also, they’ve started to eat the wrong kinds of food again.  They’ve lost sight of what they started off doing after their gastric bypass.  So, you’re now, maybe, eating foods that are higher in carbohydrates and fat, compared to the obsession you had initially with a high protein diet. So, we can put you back on track for that.  If you come back to the clinic, you will have access to our dieticians, Debbie and Nina, as well as Diana and me, and we can see where you’re going wrong, if you are going wrong, and put you back on track. 


The other component of this entire weight loss surgery is the psychological aspect of it.  We have a new arrangement now with our behavioral medicine folks at MUSC where we can refer you onto them if you’re having issues in your life that are causing you to put your weight back on, such as emotional issues, if you’re an emotional eater, if you’re depressed, if you’ve swapped out your food addiction for something like alcohol addiction, or whatever, we can put you in the right direction from that point of view.  So, don’t hesitate to contact us, and don’t hesitate to come back and see us if you think these issues are interfering with your achievement of weight loss and you’ve begun to put some weight back on. 


Likewise, at two years, three years, four years, and so on, out from your surgery, you should have developed some significant lifestyle changes.  And the one singular thing that we look for in patients after weight loss surgery is that they’ve developed an addiction to exercise.  That’s a tremendous addiction to have.  So, we hope that you will have swapped out your food addiction for an addiction to exercise, where you feel that if you don’t exercise so many days a week, you just don’t feel right.  This is tremendous, and any kind of exercise is okay, be it walking, treadmill, elliptical trainer, spinning, cycling, swimming, whatever, or, of course, like many of our patients do, join a gym, go to Curves, whatever.  Anything at all will do, as long as you do something to expend more calories than you take in.  So, again, if you haven’t gotten to the stage of doing something regular like that, we’ll talk to you about how you can do it and how you get onto an exercise kick for yourself where you can maintain your weight. 


At this stage, if you haven’t had any complications following your surgery, it’s unlikely that you’re going to have anything life-threatening, except for a bowel obstruction.  Bowel obstructions are not unusual in patients, particularly two or three, or four years out.  These bowel obstructions are usually due to what we call an internal hernia.  The most common reason for this is that the fat inside your abdomen has now, more or less, melted away with your weight loss, and parts of your intestine, which have been rerouted from the time of your gastric bypass surgery, can go in the wrong place.  If that happens, you would get symptoms such as abdominal pain, a feeling of bloating, sometimes vomiting, sometimes an inability to have a bowel movement, a feeling, generally, of your tummy being very blown up and distended. 


If that’s the case, and you’ve been experiencing these symptoms, you need come to see so we can get a CAT scan and make sure that you don’t have an internal hernia.  If an internal hernia is not addressed, or if you have a significant internal hernia, you can obstruct your intestine, and that is a life-threatening condition.  That’s the main thing that can happen about two or three, or four years out; it can happen for the rest of your life. 


If you have an internal hernia, and we diagnose an internal hernia on a CT scan, this is easily fixed, as long as you don’t have a bowel obstruction that is causing your intestine to twist, or be kinked, or actually lose its blood supply.  The fix for it is a laparoscopy where we turn the intestine back to the position that it was in originally.

This is an operation that takes us, maybe, twenty minutes.  Most of the patients that have come back to us with internal hernias of this nature, that we’ve discovered in the clinic, have come back to us because they’ve had these symptoms.  We’ve taken care of them in half an hour, twenty minutes, and half an hour in the operating room, and they’ve gone home the same day.  However, if you leave it, and you’ve got the symptoms, and you do nothing about it, then one night, or one day, you’re going to wind up in the emergency room with a severe problem which might require an open operation.  So, if you’ve got any symptoms that are suggestive that you’ve got an internal hernia or bowel obstruction, you need to come see us.



The other thing that can happen to you is if you’ve resumed smoking, or if you’re taking medications such as nonsteroidals for arthritis, such as Motrin, Naproxen, and that kind of thing, you can develop an ulcer.  And it’s not unusual to see ulcers even two or three, or four years out, particularly in patients who have started to smoke again.  So, again, if you come back to us, we can help you with that.  There are ways and means of getting you off cigarettes if you’re back on them again.  And, certainly, you will need to be treated with medications for ulcer.


One way or another, we are available to you at all times.  We have, as you know, the MUSC website, which is www.muschealth.com/weightlosssurgery.  You can contact Nina and Debbie at any time.  You can call or email Diana or me at any time if you’re having any problems.  At the anniversary of your weight loss procedure, of your gastric bypass, we really do need to see you, so we would like for you to come see us in the clinic.  If you’re more than two years out, then you’re going to come back and see Diana.  If she thinks there’s and issue that needs to be addressed by one of the surgeons, then we’ll be happy to see you.  Congratulations and keep up the good work.

Your MUSC Bariatric Surgery Team wants you to be successful and stay in touch.  If you need an appointment, call us at (843) 792-7929 or visit us at www.muschealth.com/weightlosssurgery   

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