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Weight Loss Surgery Information Meeting Weight Loss Surgery Information Meeting Dieter Pohl, MD, FACS | Aaron Bloomenthal, MD, FACS | Daniel Christian, MD, FACS The Start to Your New Good Life! An affiliate of CharterCARE Health Partners ______________________________________________________________________________ 41 Sanderson Road, Smithfield RI 02917 | (401) 521-6310 | loseweightRI.com Dieter Pohl, MD, FACS | Aaron Bloomenthal, MD, FACS | Daniel Christian, MD, FACS Information Pamphlet Regarding Weight Loss Surgery (401) 521-6310 CCMA Page 1 of 63 TABLE OF CONTENTS Page 2 Who we are (surgeons) Page 3 Weight loss surgery introduction Page 4 Gastric Bypass and Sleeve Gastrectomy Page 5 SADI-S Page 6 Advantages and disadvantages of SADI-S Page 7 Comparison of all weight loss surgeries Page 8 Qualifying and paying surgery Page 9 Outpatient evaluations before surgery Page 10 How surgery helps with weight loss; Necessary changes Page 11 Side effects; Benefits and risks Page 12 How to reduce risks Page 13 What to expect from hospitalization Page 15 Long-range results and expectations. Page 16 Alcohol and pregnancy after surgery Page 17 For family and friends Page 18 Weight loss surgery check-list Page 19 Preoperative Diet, 2 weeks prior to, and morning of surgery Page 20 Medications to stop before surgery Page 21 Hospital experience Page 22 Postoperative instructions Page 23 Intake guidelines Page 24 New way of eating Page 26 Diet following surgery Page 32 Gastric Bypass diet Page 38 Sleeve Gastrectomy and SADI-S diet Page 44 General calorie content of foods Page 45 Basic food groups, serving sizes and recommended foods Page 49 Long-term maintenance for patients 6 months or more after surgery Page 50 Successful long-term weight loss and maintenance Page 54 Exercise guidelines Page 56 Other guidelines Page 57 Sample forms Page 65 Support group form Page 66 Support groups schedule Dieter Pohl, MD, FACS | Aaron Bloomenthal, MD, FACS | Daniel Christian, MD, FACS Information Pamphlet Regarding Weight Loss Surgery (401) 521-6310 CCMA Page 2 of 63 AMERICAN COLLEGE OF SURGEONS AND AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY ACCREDITED COMPREHENSIVE CENTER SINCE 2005 WHO WE ARE: Dieter Pohl, MD, FACS Medical School in Germany Residency in Surgery in Germany and New York City Fellowship in Minimally Invasive Surgery at the University of Washington, Seattle General Surgery Bariatric Surgery, laparoscopic gastric bypass and sleeve gastrectomy. Advanced laparoscopic surgery for gallbladder, groin hernia, abdominal hernia, colon removal, reflux, hiatus hernia, achalasia, spleen, adrenal, and stomach. Cancer Surgery. Aaron Bloomenthal, MD, FACS Boston University School of Medicine, MD, 2001 University of Massachusetts General Surgery Residency Program, 2009 Thomas Jefferson University Fellowship in Minimally Invasive and Hepatopancreaticobiliary Surgery, 2010 General Surgery Bariatric Surgery, laparoscopic gastric bypass, sleeve gastrectomy, and revisional surgery. Advanced laparoscopic surgery for diseases of the esophagus, stomach, small intestine, colon, gallbladder, all types of hernias, etc. Daniel Christian, MD, FACS Florida State University Medical School, MD, 2012 New Hanover Regional Medical Center Carolinas Medical Center General Surgery Bariatric Surgery, laparoscopic gastric bypass, sleeve gastrectomy, and revisional surgery. Advanced laparoscopic surgery for diseases of the esophagus, stomach, small intestine, colon, gallbladder, all types of hernias, etc. Roger Williams Medical Center www.loseweightri.com Dieter Pohl, MD, FACS | Aaron Bloomenthal, MD, FACS | Daniel Christian, MD, FACS Information Pamphlet Regarding Weight Loss Surgery (401) 521-6310 CCMA Page 3 of 63 INTRODUCTION OF THE WEIGHT LOSS SURGERIES You have asked for information about gastric operations for the treatment of obesity. Consequently, your weight must be making it difficult for you to live the kind of lifestyle you desire. Both the medical profession and the general public recognize the fact that the burden of carrying more than twice your normal weight creates numerous health problems that interfere with normal body functions. Being overweight can also cause problems with social and personal relationships, emotional stress, and upheaval. Diets, for many individuals, have not been successful in taking off and keeping off extra weight. This results in continuous, frustrating attempts and a feeling of failure. Because of the frequency of obesity in our culture, and the greater than 95% failure of sustained weight loss through diet, with or without pills, in patients more than 100 pounds over ideal weight, surgeons have developed gastric operations for the treatment of patients extremely overweight. Since 1966, these procedures have helped approximately 80% of the operated patients achieve a healthier body weight. This booklet will provide you with general facts about gastric bypass, sleeve gastrectomy and SADI-S. It is beyond the scope of this booklet to offer great detail or to answer all your questions. On the contrary, it may create some questions in your mind. Please feel free to ask any questions you may have. THE DEVELOPMENT OF GASTRIC BYPASS, SLEEVE GASTRECTOMY,SADI-S AND HOW THEY WORK In 1966, the first gastric bypass operations were performed at the University of Iowa. Since that time, many variations and modifications to this original gastric bypass have been introduced. They include variations in the method of connecting the small intestine to the upper segment, Roux- Y gastric bypass, then the sleeve gastrectomy, which removes a large part of your stomach completely and leaves a small, long stomach pouch while re-routing the intestines. Now the SADI- S, which is a bypass of some of the small intestine with a connection to the duodenum and a sleeve gastrectomy. Dieter Pohl, MD, FACS | Aaron Bloomenthal, MD, FACS | Daniel Christian, MD, FACS Information Pamphlet Regarding Weight Loss Surgery (401) 521-6310 CCMA Page 4 of 63 GASTRIC BYPASS AND SLEEVE GASTRECTOMY Roux-Y Gastric Bypass (figure B) places a 3-foot segment of intestine between the small gastric pouch and the rest of the intestines, leaving approximately 15 feet of intestine available for digestion and absorption. This bypass technique creates a stomach pouch which can hold 15-30 cc (about the size of your thumb) of liquid or food. This operation is usually performed laparoscopically. Figure A: Normal Stomach Figure B:Gastric Bypass This operation bypasses approximately 97 percent of the stomach. In other words, 97 percent will not be used to receive or hold food. The upper 3 percent is used as the food holding pouch. It will hold about two to three tablespoons of solid food. This pouch must have a new opening created between it and the intestine. This new opening is only slightly larger than a pencil or pen (less than 1/2 inch in diameter). The small opening slows the rate at which food leaves the stomach; therefore, a small amount of food fills you quickly and you stay full longer. The gastric bypass works by: 1. decreasing the portion side of a meal. 2. not absorbing some of the calories and nutrients in the top 3 feet of the intestine. 3. changing certain hormones in the body with the effect that hunger is reduced for up to a year, and blood sugar will be improved. Sleeve Gastrectomy (figure C) is a procedure in which the majority of the stomach is stapled off and removed. The patient will have a long small stomach tube going from the esophagus to the intestines. This new stomach looks like a banana. This stomach holds about 3 ounces. This surgery works by reducing the portions of food that can be eaten. There is also a change in hormones in the body that helps to reduce hunger. Figure C: Sleeve Gastrectomy Dieter Pohl, MD, FACS | Aaron Bloomenthal, MD, FACS | Daniel Christian, MD, FACS Information Pamphlet Regarding Weight Loss Surgery (401) 521-6310 CCMA Page 5 of 63 SADI-S The SADI-S abbreviation stands for a medical mouthful of incomprehensible words: Single Anastomosis Duodeno-Ileostomy with Sleeve gastrectomy. We will explain what all this means. The SADI-S is a procedure that was developed in the early 2000s. It consists of a sleeve gastrectomy and a bypass of some of the small intestine with one connection between the duodenum and the small intestine. There are now many reports about the success and safety of the surgery and many thousands of patients had the surgery in the US and worldwide. The surgery was endorsed by the American Society of Metabolic and Bariatric Surgery in October of 2019. The surgery works in three ways. 1. The sleeve gastrectomy part creates a 2-3oz small stomach and as a result, a person cannot eat much. The eating portions are small. 2. The food will move from the new small stomach directly into the lower 10 feet of the small intestine and bypass the first part of the small intestine, which is about half of the small intestine. Normally, the small intestine that is available to absorb calories and nutrients is around 15 to 25 feet long. The result is that less of the calories are absorbed. 3. Certain hormones in the body are changed. The hunger hormone Ghrelin is reduced and most persons after surgery will have no hunger for many months. Several hormones that regulate blood sugar are changed so that blood sugar is much better controlled. The SADI-S is excellent for diabetes treatment. Dieter Pohl, MD, FACS | Aaron Bloomenthal, MD, FACS | Daniel Christian, MD, FACS Information Pamphlet Regarding Weight Loss Surgery (401) 521-6310 CCMA Page 6 of 63 ADVANTAGES OF THE SADI-S OVER THE GASTRIC BYPASS AND SLEEVE GASTRECTOMY ALONE ARE: . Better initial weight loss and better long-term weight loss than sleeve and bypass. Less chance that the weight will come back. Better diabetes treatment than sleeve and bypass. Much more stable blood sugar levels throughout the day than with sleeve and bypass. Less acid reflux than sleeve. Lower risk of internal hernia than gastric bypass.
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