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Central Valley Bariatrics' Patient Handbook

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Central Valley Bariatrics' Patient Handbook CENTRAL VALLEY BARIATRICS PATIENT HANDBOOK Your Guide to Successful and Healthy Weight Loss surgery: Duodenal Switch Sleeve Gastrectomy Revisional Weight Loss Surgery Ara Keshishian, MD, FACS, FASMBS www.dssurgery.com 818-812-7222 Central Valley Bariatrics – Patient Handbook TABLE OF CONTENTS Introduction ..................................................................................................................................... 2 Normal Anatomy ............................................................................................................................ 3 Weight loss Surgical Options.......................................................................................................... 4 Sleeve Gastrectomy .................................................................................................................... 4 Gastric Reduction Duodenal Switch ........................................................................................... 5 Gastric Bypass- Roux-En Y ........................................................................................................ 6 Adjustable Gastric Banding ........................................................................................................ 6 Comparison Table for Weight Loss Surgical Options ............................................................ 7 Complication Associated With Weight Loss Surgery .................................................................... 8 Out of Town Patient Protocol ......................................................................................................... 9 Pregnancy After Weight Loss Surgery ........................................................................................... 9 Pre-Operative Section ................................................................................................................... 11 6 Weeks Before Surgery ........................................................................................................... 11 2 Weeks Before Surgery ........................................................................................................... 12 10 Days Before Surgery ............................................................................................................ 12 Two Days Before Surgery ........................................................................................................ 13 One Day Before Surgery ........................................................................................................... 13 Morning of Surgery................................................................................................................... 13 Hospital Section ............................................................................................................................ 15 Post-Operative Section.................................................................................................................. 17 Bariatric Diets ............................................................................................................................... 19 Nutrition Section ........................................................................................................................... 20 Sample Vitamin and Protein Schedule ......................................................................................... 22 Vitamin Section ............................................................................................................................ 23 Shopping Guide Suggestions .................................................................................................... 23 Intestinal Issues (Associated with the Duodenal Switch) ............................................................. 24 Hair Loss and Skin Changes ......................................................................................................... 25 Vitamins-Benefits-Deficiency ...................................................................................................... 27 A Lifetime With Your Duodenal Switch ...................................................................................... 28 Weight loss Surgery Quiz ............................................................................................................. 30 Bariatric Surgery Contract ............................................................................................................ 32 Teaching Guidelines ..................................................................................................................... 33 References ..................................................................................................................................... 34 ©2014 Ara Keshishian, MD, FACS, FASMBS 818-812-7222 www.dssurgery.com Page 1 Central Valley Bariatrics – Patient Handbook Introduction: Dear prospective patient, This workbook is provided as an educational tool for an individual considering weight loss surgery for treatment of obesity and its associated illnesses. It is by no means an all-inclusive source of information. It is a supplementary source to your formal consultation that you will have with me in the office. This represents my opinion as supported by published scientific data. It is critical that any patient considering weight loss surgery, to research with due diligence, by investigation the procedures being considered. I also strongly advocate for patients to seek second opinions. The order in which the surgical procedures are discussed is to only facilitate the flow of the information and not based on outcomes. The details of the each procedure and their relative outcomes are discussed in detail. A copy of this is also available on our website at www.dssurgery.com. ©2014 Ara Keshishian, MD, FACS, FASMBS 818-812-7222 www.dssurgery.com Page 2 Central Valley Bariatrics – Patient Handbook Normal Anatomy Digestion begins in the mouth with the chewing of food and the addition of salivary secretions. The esophagus carries the swallowed food to the stomach. In the stomach certain secretions are added to begin the breakdown of the food in the stomach. The role of the stomach is to prepare the food for delivery to the small bowel where almost all the absorption takes place. The Pylorus is the gatekeeper of the stomach, not letting food pass into the small intestines until it has been optimized for absorption, by the added secretions of the stomach. When food enters the small intestines, within a short distance of the pyloric valve, bile and digestive enzymes from the liver and pancreas are added. From this point on, over the entire length of the small bowel all the absorption of the carbohydrates, fat and protein is taking place. The nutrients absorbed are then taken to the liver, where they are converted to either energy to be utilized at that time, or is processed to be stored away for later use. There are a number of very intricate and complex biochemical pathways that dictate what is absorbed at what rate, and how the absorbed is stored. It is also through this process where minerals, vitamins, and micro and macronutrients are absorbed. Vitamins, specifically fat-soluble vitamins, are very closely dependent on fat absorption. In the Colon (large intestines) water is absorbed, bacterial fermentation takes place and feces is formed. ©2014 Ara Keshishian, MD, FACS, FASMBS 818-812-7222 www.dssurgery.com Page 3 Central Valley Bariatrics – Patient Handbook Weight loss Surgical Options Sleeve Gastrectomy With the sleeve gastrectomy (lap. sleeve gastrectomy, vertical sleeve gastrectomy) approximately 75-80% of the outer curvature of the stomach is removed. This results in reducing the size of the stomach, not only restricting the amount of food that may be eaten at each meal, but also reducing the stimulation for hunger, since the a large portion of the cells of the stomach that secrete Ghrelin is also removed. Ghrelin is a hormone primarily produced by the cells lining the fundus of the stomach that stimulate hunger. The pancreas also has a portion of Ghrelin producing. The pylorus is retained and all normal digestive actions in the stomach take place just as in a normal anatomy. There is no change in the arraignment of the bowels. All food, calories and nutrients that are accommodated in the stomach are all fully absorbed. This procedure can be classified as a restrictive procedure, since it only causes restriction of the food volume. The functional end result of the sleeve gastrectomy is a scaled version of the normal stomach. Almost everything that takes place in normal intact stomach, takes place in a sleeve stomach in a smaller scale. Sleeve Gastrectomy can be the first stage of the two-stage duodenal switch operation. ©2014 Ara Keshishian, MD, FACS, FASMBS 818-812-7222 www.dssurgery.com Page 4 Central Valley Bariatrics – Patient Handbook Gastric Reduction Duodenal Switch The outer curvature of the stomach is removed, reducing the size of the stomach, therefore restricting the amount of food that may be eaten at each meal. The pylorus is retained and all normal digestive actions in the stomach take place just as in a normal anatomy. This segment of the operation is identical to the sleeve gastrectomy described previously. The small bowel has three segments: Duodenum, Jejunum and Ileum. First, the Duodenum is divided. One end (Alimentary Limb) carries food down to the Ileum which is connected to it. The other end (Biliopancreatic Limb) carries Liver and Pancreas secretions (“digestive juices”)
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