It is essential for all patients contemplating bariatric surgery to understand that the most important aspect of the journey will be their preparation and follow-up by a very experienced and accredited team, headed up by an endocrinologist.
Although the surgery may be the most momentous part of the treatment, it is by no means the most important. Searching the internet for an experienced surgeon should not be the criteria by which you look for your future bariatric treatment.
It is unlikely that a truly top class surgeon will be performing bariatric surgery in isolation. Before you engage in securing your appointment with a surgeon, first acquire information regarding the endocrinologist heading up the team, his/her level of experience and that of the rest of the team members.
Many a heart-ache, frustration, unhappiness and misperception can be prevented by going through stringent preparation and follow up. Patients who prefer to pursue their own adaptation of the recommendations will end up with difficulties. In such cases, they should return to their team for support. Any Centre of Excellence worthy of accreditation will always strive to keep the complications to the bare minimum. This can only be done successfully if the patient is prepared and followed by an endocrinologist experienced in bariatric medicine and a surgeon with the necessary experience, compassion and expertise. WHAT TO EXPECT FROM YOUR SURGERY
- You will be successful at losing weight
The amount will depend on the procedure that the team decides on. Generally, patients at a BMI above 50 and patients with a significant sweet eating disorder or night eating disorder, should undergo a Bilio-Pancreatic-Diversion with a Duodenal Switch for a favourable long term outcome. Currently two surgeons are accredited to perform this procedure in SA. All attempts should be made by the in-house psychiatrist to control bipolar disease that mostly accompanies night eating disorder.
- You will have fewer co-morbidities
Diabetes resolution or near resolution can be expected within 48 hours two 12 weeks, depending on the degree of severity. The mechanism of resolution is not primarily through weight loss, but through modification of certain gut peptides, notably GLP-1 and GIP. Other co-morbidities will improve in a similar manner.
- You will have a greater sense of satiety
This is as a result of the altered cross talk between the stomach/gut and the pituitary centre in the brain where the appetite centre is located. Not understanding these new signals, and what to avoid or react to, is paramount in how well the patient will perform post-operatively.
- You will have a better quality of life at many levels
How extensive this improvement will be, will depend on how well you understand your new ‘built in tool’. You need to be aware of whether you are using it correctly, or want to abuse in a manner that is inappropriate. It essential that your family and friends work with you in understanding your needs and changed lifestyle. After all, you will not be chasing around two peas in a plate, but be eating correctly (probably for the first time in a long time), and you should take the lead in setting the example to those around you who are still following an unhealthy life style.
- You will have prolonged your life by many years
Obesity is a chronic disease with many consequences such as cancer, heart disease, clots and sleep apnoea. Start off by admitting that you have this disease, and then work with your team in understanding this disease, in a manner similar to what you would have done, if you were diagnosed with for instance, asthma.
- You will experience side effects if you push the boundaries
Your ‘tool’ has been designed to help you lose weight in a healthy, controlled manner. If you experience persistent dumping, diarrhoea or bloating, you are reverting to the old habits you had, instead of carefully listening to your tool and your team. Having a diet that consists of crisps, chocolates and popcorn cannot be good for any stomach, so how would it be good for the newly created pouch?
- You will not be able to abuse alcohol
Alcohol breakdown requires an enzyme called alcoholic dehydrogenase, secreted by your stomach. Your pouch will secrete a far lesser amount of this enzyme, so having an excessive amount to drink is as good as pouring pure alcohol into your blood stream.
- You will have to take vitamin supplements
This should be done in a controlled and scientific manner by your endocrinologist. These supplements are not given to ‘make you feel better’. They are critical to your well-being and in preventing the onset of deficiencies. It is paramount to understand that we replace only those elements and vitamins that would normally have been absorbed from your food by the greater curve of your stomach and the first 80 cm after the gastric outlet. You cannot take yourself of to the chemist and follow your own shotgun approach.
- You will have to exercise restraint
This is true in the beginning when the pouch is still swollen, but it is even more true for when you reach goal weight. It is a misnomer to think that you can “stretch” the pouch. In the beginning the pouch has a smaller volume as it is swollen from the surgery. Gradually it settles down to the required size over three months at which you time you should be able to consume a small plate of the correct food four times a day. It is during this time that you are required to watch your protein intake carefully and to go through the various stages of liquid and soft diets. Very few patients will not be able cope with this period of dietary adjustment if they have been counselled correctly. Overeating beyond this point results from ignoring your own body’s signals of satiety. Food will either be stored back up the oesophagus or the outlet stapling will be stretched. Weight maintenance, once you have reached goal weight is no less a challenge than it would be for any other person, even if they have never been overweight. There is no person in this world that can eat what they want and not gain some weight. The operation is for your weight loss assistance. Weight maintenance will depend on how much effort you are prepared to put into the process. So don’t be deluded into thinking that the tool will continue to deal with an adverse lifestyle for life.
- You will always have to listen to the prophets of doom and those begrudging you your success
This attitude stems mostly from an extreme lack of knowledge, even within the medical community, as well as outdated popularistic views on the old jejeno- ileal bypass, an unaccredited procedure that was finally banned in SA 2 years ago.
- Your self- perception, interaction with other people and levels of confidence may change drastically
Let your psychologist guide you regards this. It is important for your in- house psychologist to get to know you well before the operation in order to give you the needed advice, as your life situations may change afterwards. Many of these changes may be for the better, and may be long overdue. Nevertheless, they may be intimating to deal with, without the needed support.
- If you are at an extreme weight, you almost certainly will have loose skin to remove
You embarked on this road to improve your health and longevity. Removing the excess skin should be seen as the last stretch on a very productive walk to freedom. Don’t feel intimated by the prospect, but make sure you discuss the option of an appropriate plastic surgeon with your endocrinologist, as not all plastic surgeons are experienced in dealing with the kind of surgery you may need.