Weight-loss surgery may help people with obesity better manage high blood pressure
People with obesity who had weight-loss surgery were able to better manage their high blood pressure in the long term than those using medications and lifestyle changes, a new analysis finds.
The research, being presented Friday at the American Heart Association’s Hypertension Scientific Sessions in Chicago, is considered preliminary until full results are published in a peer-reviewed journal. The results were based on an analysis of data from 18 randomized controlled trials involving more than 1,300 participants.
“Our findings indicate bariatric surgery is a durable solution for obesity-related hypertension since it results in high blood pressure remission, or long-term control, while reducing the dependence on blood pressure medications,” lead researcher Dr. Sneha Annie Sebastian said in a news release. Sebastian is a researcher and a residency candidate from Alberta, Canada.
“Additionally, by improving blood pressure control, bariatric surgery also lowers the risk of cardiovascular disease and enhances overall heart health,” she said.
Bariatric surgery reduces the size of a person’s stomach, helping them feel full after eating less. It also can change the structure of the digestive system so that fewer nutrients and calories are absorbed. The American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders recommend the procedure for anyone with a body mass index of 35 or higher.
In the new analysis, researchers combined data for 1,386 adults with high blood pressure and obesity who took part in 18 studies across several countries from December 2002 to May 2024. Participants in the studies were randomly assigned to undergo bariatric surgery or a nonsurgical, medication or lifestyle intervention. Follow-ups were conducted for up to five years. Several types of weight-loss surgery were used in the studies, but most focused on Roux-en-Y gastric bypass and sleeve gastrectomy.
Compared to people assigned to the control group, those who underwent bariatric surgery were nearly three times more likely to lower their blood pressure to less than 140/90 mmHg without the need for blood pressure-lowering medication. They also were seven times more likely to lower it to less than 130/80 mmHg while substantially reducing their use of blood pressure-lowering medication. The bariatric surgery group lowered their systolic blood pressure – the top number – an average 3.67 mmHg more than those in the control group.
Sebastian said future research should focus on large randomized controlled trials with long-term follow-up, with a specific emphasis on hypertension since many currently focus on diabetes outcomes. “Furthermore, it is essential to evaluate the efficacy and cost-effectiveness of different bariatric procedures for various patient profiles and to identify optimal candidates for each type of surgery,” she said.
The findings underscore the beneficial impact of weight loss on blood pressure control, Dr. Michael E. Hall said in the news release. Hall, who was not involved with the new research, was chair of the writing group for the AHA’s 2021 scientific statement on weight-loss strategies for preventing and treating hypertension. He also is chair of the department of medicine at the University of Mississippi Medical Center in Jackson.
“Bariatric surgery consistently improved blood pressure control in individuals with obesity,” he said about the findings. “Further, given the effectiveness of newer weight loss medications and beneficial effects on cardiometabolic conditions like hypertension, we need randomized clinical studies comparing bariatric surgery to these newer medications to decide which people are better suited for a specific weight-loss strategy.”
Source Credit: https://www.stroke.org/en/news/2024/09/05/weight-loss-surgery-may-help-people-with-obesity-better-manage-high-blood-pressure
Bariatric surgery more effective and durable than new obesity drugs and lifestyle intervention
Systematic reviews of medical literature between 2020 and 2024 show that bariatric surgery, also known as metabolic or weight-loss surgery, produces the greatest and most sustained weight loss compared to GLP-1 receptor agonists and lifestyle interventions. The study was presented today at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting.
Researchers found that lifestyle interventions such as diet and exercise resulted in an average weight loss of 7.4%, but that weight was generally regained within 4.1 years. GLP-1s and metabolic and bariatric surgery proved far superior. Studies included thousands of patients from clinical studies and several randomized clinical trials.
Five months of weekly injections of GLP-1 semaglutide resulted in 10.6% weight loss and nine months of tirzepatide produced 21.1% weight loss. However, once treatment stopped, about half the lost weight returned within a year, despite the drug used. If injections were continued, tirzepatide patients plateaued at 22.5% weight loss at 17–18 months. Patients on semaglutide plateaued at 14.9% during the same time period.
Metabolic and bariatric surgery procedures gastric bypass and sleeve gastrectomy demonstrated total weight loss of 31.9% and 29.5% one year after surgery, respectively. Weight loss of approximately 25% was maintained for up to 10 years after surgery.
“Metabolic and bariatric surgery remains the most effective and durable treatment for severe obesity. Unfortunately, it also remains among the most underutilized,” said study co-author and bariatric surgeon Marina Kurian, MD, NYU Langone Health. “Surgery needs to play a bigger role in obesity treatment and be considered earlier in the disease process. It is no longer a treatment of last resort and should not be withheld until more severe disease develops. There is no medical reason for this.”
“While the new drug treatments show great promise and will lead to more people being successfully treated, particularly if prices come down and insurance coverage improves, we are barely using the best tool we have to fight obesity—metabolic and bariatric surgery, which is safer and more effective than ever before,” said Ann Rogers, MD, ASMBS President-elect and Professor of Surgery at Penn State College of Medicine, who was not involved in the study. “For many people, the risk of death from obesity, diabetes, and heart disease exceeds the risks of surgery.”
The study included a systematic review of studies that examined weight loss through lifestyle modification, GLP-1s (semaglutide or tirzepatide) or metabolic and bariatric surgery. GLP-1 data included four randomized clinical trials conducted between 2021 and 2024 while conclusions on lifestyle modifications were based on a systematic review of eight studies. Metabolic and bariatric surgery (gastric bypass and sleeve gastrectomy) were subject to a review of 35 studies, including two randomized clinical trials. In all, researchers reviewed the weight-loss results of approximately 20,000 patients.
More information: A322: Effectiveness and durability of common weight loss methods
Provided by American Society for Metabolic and Bariatric Surgery
Source Credit: https://medicalxpress.com/news/2024-06-bariatric-surgery-effective-durable-obesity.html
Can You Drink Alcohol After Weight Loss Surgery?
People considering weight-loss surgery often ask if it is possible to safely incorporate alcohol into a healthy diet and lifestyle after surgery. The short answer is “yes,” but gradually and with modifications. Below are reasons why.
Altered metabolism
Research shows that blood alcohol levels peak higher and faster and take longer to return to normal due to altered metabolism after gastric bypass surgery. In addition, many post-surgical patients consume less food when they’re drinking alcohol, which contributes to expedited absorption of alcohol in the blood stream. For many post-surgical patients, all it takes is a single drink to elevate blood alcohol level to the point of legal intoxication. This is important to remember for maintaining a healthy diet and before getting behind the wheel.
Low blood sugar
Rapid weight loss and low carbohydrate intake can lead to reduced sugar or glycogen in your body. Alcohol consumption further depletes glycogen, which causes your blood sugar levels to drop, putting those who have had bariatric surgery at higher risk for developing low blood sugar.
Hypoglycemia, or low blood sugar, is a dangerous condition that can lead to loss of consciousness, brain and nerve damage or even death if left untreated. As a result, it’s important to be on the lookout for symptoms, which include loss of coordination and balance, slurred speech, poor vision and confusion.
If you experience symptoms of hypoglycemia, drink diluted juice or take a glucose tablet immediately to raise your blood sugar level, and then have a snack with complex carbohydrates and protein to sustain it. If hypoglycemic episodes occur frequently even without alcohol consumption, make sure you seek proper medical treatment.
Excess calories
Alcohol is high in calories and low in nutrients, which is why excess calories from alcohol can slow weight loss or even contribute to weight gain.
Addiction transfer
Patients with a history of addiction are at higher risk for developing a new addiction. With the dramatic reduction of food consumption after bariatric surgery, some patients may trade their food addiction for other addictive behaviors, including drugs, shopping, gambling, sex and alcohol.
Guidelines for drinking
Follow these guidelines to re-introduce alcohol without compromising your commitment to a healthy lifestyle after weight-loss surgery:
- Avoid alcohol for the first six months after bariatric surgery.
- When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers.
- Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar.
- Never drink and drive, even after consuming only minimal alcohol.
- Only drink with meals or while eating to help slow absorption of alcohol.
- Be aware of the calorie content of alcohol.
- If you find yourself drinking regularly to cope with emotions or stress, seek help by consulting with your doctor.
Taste Changes Following Bariatric Surgery
Also known as weight loss surgery, bariatric surgery is a procedure carried out to help people who are severely or morbidly obese to lose weight.
Image Credit: Ursula Ferrara / Shutterstock
Types of bariatric surgery
There are three types of bariatric surgery that may be performed:
- Gastric band procedure – During this procedure, the size of the stomach is reduced using a band that is placed around the stomach. This reduces the amount of food a person needs to eat in order to feel full.
- Gastric bypass – This procedure involves dividing the stomach into a smaller upper section and a larger lower section. The smaller section is then connected to the duodenum, which is the beginning portion of the small intestine. Food only passes into the small stomach and this part of the small intestine, thereby allowing it to bypass the remaining stomach and bowel. This reduces the number of calories absorbed when food is passed through the digestive system, while also decreasing the amount of food a person needs to eat in order to feel full.
- Sleeve gastrectomy – A sleeve gastrectomy procedure will involve the removal of a part of the stomach to reduce its size and limit the amount of food intake required for a person to feel full.
Sensory changes following surgery
Change in the taste, smell, or tolerance of food following bariatric surgery is a common phenomenon. In fact, one study has found that as many as 97% of patients experience at least one such change following these surgeries.
Fortunately, the sensory changes experienced by individuals post-bariatric surgery often benefit patients, with research showing that they help people to lose more weight as compared to those who do not experience these changes.
According to a study conducted by researchers from the University Hospitals of Leicester, which included 103 patients who underwent gastric bypass, 73% reported changes in the taste of food and almost 50% reported changes in smell. The most commonly reported taste changes were heightened sensitivity to sweet food, sour food, and fast food.
In this same study, some patients also developed an oversensitivity to sweetness in protein shakes, which can be a problem should patients need to follow a liquid-only diet after their operation. If this happens, a patient should talk to their doctor to ensure their dietary requirements are being met.
Eating behaviors may also change following bariatric surgery. Patients may be less likely to find that emotional eating is a problem, thereby reducing the impact that eating cues might have on an individual.
Evidence also suggests that the mood-altering effect of sweet foods may be reduced, with patients less likely to experience a “sugar high” after a bariatric procedure. The tendency to eat purely as a matter of habit may also fade.
Causes
The exact cause of these sensory changes following bariatric surgery is not yet clear; however, many researchers suspect that fluctuating gut hormones and their physiological effects on the nervous system may play a role.
The central nervous system (CNS) relays hunger, craving, and satiety messages between the brain and gastrointestinal tract. The nerves that carry these messages are affected when a part of the stomach is removed, which impacts a person’s sense of taste, smell, and satiety.
Ghrelin is a hormone that plays an important role in hunger. A reduced calorie intake and weight loss leads to increased ghrelin production, which makes people feel hungry. In contrast, weight loss as a result of bariatric surgery leads to decreased ghrelin production, which therefore reduces hunger and food intake following the procedure.
Another important hormone that is involved in satiety is leptin. The primary function of this hormone is to relay messages between the gut and brain about how full a person is and determine whether calories are burned or stored as fat.
Losing weight is believed to increase a person’s sensitivity to these messages, resulting in a person feeling full more easily after eating only small amounts of food.
Source Credit: https://www.news-medical.net/health/Taste-Changes-Following-Bariatric-Surgery.aspx
Bariatric surgery more effective and durable than new obesity drugs and lifestyle intervention
By American Society for Metabolic and Bariatric Surgery
Systematic reviews of medical literature between 2020 and 2024 show that bariatric surgery, also known as metabolic or weight-loss surgery, produces the greatest and most sustained weight loss compared to GLP-1 receptor agonists and lifestyle interventions. The study was presented today at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting.
Researchers found that lifestyle interventions such as diet and exercise resulted in an average weight loss of 7.4%, but that weight was generally regained within 4.1 years. GLP-1s and metabolic and bariatric surgery proved far superior. Studies included thousands of patients from clinical studies and several randomized clinical trials.
Five months of weekly injections of GLP-1 semaglutide resulted in 10.6% weight loss and nine months of tirzepatide produced 21.1% weight loss. However, once treatment stopped, about half the lost weight returned within a year, despite the drug used. If injections were continued, tirzepatide patients plateaued at 22.5% weight loss at 17–18 months. Patients on semaglutide plateaued at 14.9% during the same time period.
Metabolic and bariatric surgery procedures gastric bypass and sleeve gastrectomy demonstrated total weight loss of 31.9% and 29.5% one year after surgery, respectively. Weight loss of approximately 25% was maintained for up to 10 years after surgery.
“Metabolic and bariatric surgery remains the most effective and durable treatment for severe obesity. Unfortunately, it also remains among the most underutilized,” said study co-author and bariatric surgeon Marina Kurian, MD, NYU Langone Health. “Surgery needs to play a bigger role in obesity treatment and be considered earlier in the disease process. It is no longer a treatment of last resort and should not be withheld until more severe disease develops. There is no medical reason for this.”
“While the new drug treatments show great promise and will lead to more people being successfully treated, particularly if prices come down and insurance coverage improves, we are barely using the best tool we have to fight obesity—metabolic and bariatric surgery, which is safer and more effective than ever before,” said Ann Rogers, MD, ASMBS President-elect and Professor of Surgery at Penn State College of Medicine, who was not involved in the study. “For many people, the risk of death from obesity, diabetes, and heart disease exceeds the risks of surgery.”
The study included a systematic review of studies that examined weight loss through lifestyle modification, GLP-1s (semaglutide or tirzepatide) or metabolic and bariatric surgery. GLP-1 data included four randomized clinical trials conducted between 2021 and 2024 while conclusions on lifestyle modifications were based on a systematic review of eight studies. Metabolic and bariatric surgery (gastric bypass and sleeve gastrectomy) were subject to a review of 35 studies, including two randomized clinical trials. In all, researchers reviewed the weight-loss results of approximately 20,000 patients.
Source Credit: https://medicalxpress.com/news/2024-06-bariatric-surgery-effective-durable-obesity.html
Dumping Syndrome Symptoms and Causes
Dumping syndrome is a known problem for persons who have undergone gastric, esophageal or bariatric surgeries. It is believed to as a direct consequence of the rapid transit of large osmotically active food particles into the lumen of the small intestine. It is estimated that up to 1 in 5 people who have had parts of their stomach surgically removed develop the condition.
Depending on the timing of the occurrence of symptoms after a meal, dumping syndrome may be classified as early dumping syndrome (EDS) or late dumping syndrome (LDS), which both are due to the rapid transit of food in the body, but are proposed to have slightly different underlying pathophysiological mechanisms. Despite some overlap, they each have different symptoms. The majority of people will tend to present with EDS symptoms while approximately 25% will present with LDS clinical manifestations.
Early Dumping Syndrome
EDS tends to occur 30 to 60 minutes after a meal and is due to the hyperosmolarity produced by the largely undigested particles in the small bowel lumen. This leads to fluid shifting from the intravascular compartment to the lumen and this is the main cause of the symptoms associated with EDS. These symptoms include, but are not limited to:
- Abdominal distension
- Abdominal pain
- Bloating
- Nausea
- Urges to lie down following a meal
- Sweating
- Facial flushing
- Tachycardia (fast heart rate) and palpitations
- Diarrhea
The signs and symptoms of EDS have been tested by several studies which demonstrate that the depletion of intravascular volume and fluid shifts leads to the cardiovascular and gastrointestinal manifestations observed. Dumping experimentally induced in dogs by transfusing them with portal vein blood, has led some to propose that humoral factors may be significant players in the pathogenesis of EDS. There is evidence that suggest a hyperosmolar small intestinal lumen causes the release of serotonin which mediates the vasodilation of the mesenteric and peripheral vessels thereby causing fluid shifts and hypotension.
Other studies have demonstrated that postprandial release of gut hormones such as glucagon-like peptide-1 (GLP-1) may also be implicated in the symptoms of EDS by its activation of sympathetic outflow. GLP-1 tries to slow proximal gut motility and reduce acid secretion. It thereby attempts to delay the proximal transit time as a response to the rapid delivery of large food particles to the distal parts of the small intestines.
Late Dumping Syndrome
LDS is believed to be due to an overwhelming increase in insulin that leads to reactive hypoglycemia (i.e. low blood sugar level). It occurs anywhere between 1 to 3 hours after eating. The hypoglycemia associated with LDS causes symptoms such as:
- Tremors
- Sweating
- Hunger
- Palpitations
- Sweating
- Fatigue
- Fainting
- Confusion
- Aggression
LDS-reactive hypoglycemia occurs due to a rapid absorption of glucose from the small intestine and a responsive hyper-secretion of insulin that stays elevated for a period longer than usual. GLP-1 is thought to play a crucial role in LDS as it is a potent anti-hyperglycemic hormone. It is often found to have an elevated response in patients who have had operations that speed up gastric emptying and causes increased insulin secretion, further compounding hypoglycemia.
References
- https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2015/11/UklejaArticle-Feb-06.pdf
- https://www.niddk.nih.gov/health-information/digestive-diseases/dumping-syndrome
- http://www.ncbi.nlm.nih.gov/pubmed/19724252
- https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=107
Source Credit: https://www.news-medical.net/health/Dumping-Syndrome-Symptoms-and-Causes.aspx
Poor muscle health common in people living with obesity increases early mortality risk
Poor muscle health is associated with a higher risk of an early death in people living with obesity and individuals with adverse muscle composition were up to three times more likely to die during the course of the study than those with healthy muscles, a Swedish study of people in the UK concluded.
“We found that just by looking at muscle composition we can predict which individuals with obesity are most likely to die during the next few years,” said lead researcher, Dr Jennifer Linge, of AMRA Medical, a health informatics company in Linköping, Sweden, who presented the findings at the European Congress on Obesity (ECO) in Venice, Italy.
Weight loss is increasingly recommended in the management of chronic conditions such as type 2 diabetes and cardiovascular disease and weight loss drugs are allowing people to lose larger amounts of weight than in the past.
However, with drugs now achieving weight loss close to the magnitudes seen with surgery, the concern for potential adverse effects on muscle health, such as significant loss of muscle mass and reduced mobility, is growing.
“Research has shown that although individuals with obesity have more muscle mass, their muscles are, in general, relatively weaker,” she added. “They also have lower muscle quality, as well as reduced mobility and function. Accurate assessment of muscle composition, assessing both quantity and quality of the muscles during evaluation these treatments will teach us whether significant and rapid weight loss is safe – especially for the more vulnerable patients, such as those with sarcopenic obesity or of older age.”
Previous research using magnetic resonance imaging (MRI) has linked poor muscle health with poor functional performance (lower grip strength, slower walking pace, more difficulty in climbing stairs and more prone to falls), ill health and death from any cause in individuals with non-alcoholic fatty liver disease (NAFLD) and in the general population. But there is a lack of such data in individuals who are living with obesity.
To find out more, Linge and colleagues used AMRA Researcher (software that provides body composition measurements from MRI scans) to analyse scans from 56,109 participants in the UK Biobank study.
Muscle volume (muscle quantity) and muscle fat (indicating muscle quality) were quantified and a personalized muscle volume z-score (an indication of how their muscle volume compares to the average for their sex and body size) was calculated.
Participants were partitioned into four groups according to whether they had normal muscle composition, high muscle fat only, low muscle volume z-score only or adverse muscle composition (both high muscle fat and low muscle volume z-score).
A total of 9,840 participants (50% men, average age 64.4 years and BMI 33.5 kg/m2) were living with obesity and had data available on sex, age, BMI, and muscle composition. Of these. 2,001 (20.3%) had adverse muscle composition.
The participants were followed-up for an average of 3.9 years, during which time 174 died. The most common causes of death were ischemic disease (coronary heart disease) and hypertensive disease (primary hypertension, hypertensive heart disease and hypertensive renal disease).
While having low muscle volume z-score or high muscle fat alone was not significantly associated with a higher risk from death from any cause, adverse muscle composition (having both low muscle volume z-score and high muscle fat) was. This underlines the importance of assessing the amount of fat in muscle, as well as muscle volume, when evaluating muscle health, say the researchers.
Participants with adverse muscle composition were three times were more likely to die during follow-up than those with normal muscle composition.
The association between poor muscle health and all-cause mortality was still significant when strength (hand grip), other diseases (cancer, type 2 diabetes and coronary heart disease) and lifestyle factors (smoking, alcohol consumption, and physical activity) were taken into account. In this fully adjusted model, adverse muscle composition was associated with a 70% higher risk of early death. Sex, age, type 2 diabetes and smoking were also associated with a higher risk of an early death.
The researchers concluded that adverse muscle composition was common in individuals living with obesity and significantly associated with all-cause mortality.
“The results indicate that maintaining muscle health is of paramount importance for people with obesity,” Linge concluded. “Determining whether drugs achieving significant or rapid weight loss are causing excessive loss of muscle or worsen muscle quality will lead to safer treatment of obesity, both in general and in more vulnerable patients.”
Source Credit: https://www.bariatricnews.net/post/poor-muscle-health-common-in-people-living-with-obesity-increases-early-mortality-risk
Understanding both metabolic and bariatric surgery
Written by: MR SANJAY AGRAWAL
Published: 28/02/2020 | Updated: 03/03/2020Edited by: LAURA BURGESS
What is metabolic surgery?
Metabolic syndrome is the name given to a cluster of conditions that occur together, which thereby increase the risk of developing heart disease, stroke and type 2 diabetes mellitus. These conditions include high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
In contrast to bariatric (weight loss) surgery for those with morbid obesity, metabolic surgery is an effective option for patients with type 2 diabetes mellitus.
Why is it needed?
Losing weight, exercise and dietary changes can help prevent or reverse metabolic syndrome. However, if this fails then metabolic surgery is the next and only option to reverse metabolic syndrome, mostly with type 2 diabetes mellitus.
Is metabolic surgery the same as bariatric surgery?
Bariatric surgery encompasses metabolic surgery. Bariatric surgery is for all patients with a very high weight who need weight loss surgery. Metabolic surgery is used with the specific intent to address diabetes and metabolic dysfunctions that have failed to respond to lifestyle and medication changes as opposed to obesity per se.
Is there a difference in BMIs that metabolic and bariatric surgery can be performed on?
Metabolic surgery can be performed on any patient with a Body Mass Index (BMI) of 30 in the presence of type 2 diabetes mellitus. Bariatric surgery can only be performed on someone who has a BMI over 35 and obesity-associated comorbidities, or on a patient who has a BMI of 40 without any co-existing health conditions.
What techniques are used for metabolic and bariatric surgery?
The operations are the same and there are three surgical options that can be used depending on the individual case. These are either gastric band, gastric bypass or the sleeve gastrectomy.
What are the expected outcomes of metabolic surgery?
The outcomes in metabolic surgery depend on the associated conditions in the metabolic syndrome. For example, the best outcome is expected in patients with newly diagnosed, or small duration of type 2 diabetes mellitus.
Source Credit: https://www.topdoctors.co.uk/medical-articles/understanding-both-metabolic-and-bariatric-surgery
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Overview
A biliopancreatic diversion with duodenal switch (BPD/DS) is a less-common weight-loss procedure that entails two major steps.
The first step is sleeve gastrectomy in which about 80 percent of the stomach is removed, leaving a smaller tube-shaped stomach, similar to a banana. However, the valve that releases food to the small intestine (the pyloric valve) remains, along with a limited portion of the small intestine that normally connects to the stomach (duodenum).
The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS both limits how much you can eat and reduces the absorption of nutrients, including proteins and fats.
BPD/DS is generally performed as a single procedure; however, in select circumstances, the procedure may be performed as two separate operations — sleeve gastrectomy followed by intestinal bypass once weight loss has begun.
While a BPD/DS is very effective, it has more risks, including malnutrition and vitamin deficiencies. This procedure is generally recommended for people with a body mass index (BMI) greater than 50.
Why it’s done
A BPD/DS is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:
- Heart disease
- High blood pressure
- High cholesterol
- Severe sleep apnea
- Type 2 diabetes
- Stroke
- Infertility
A BPD/DS is typically done only after you’ve tried to lose weight by improving your diet and exercise habits.
But a BPD/DS isn’t for everyone who is severely overweight. You likely will have an extensive screening process to see if you qualify.
You must also be willing to make permanent changes to lead a healthier lifestyle both before and after surgery. This may include long-term follow-up plans that involve monitoring your nutrition, your lifestyle and behavior, and your medical conditions.
Check with your health insurance plan or your regional Medicare or Medicaid office to find out if your policy covers weight-loss surgery.
Risks
As with any major surgery, a BPD/DS poses potential health risks, both in the short term and long term.
Risks associated with BPD/DS are similar to any abdominal surgery and can include:
- Excessive bleeding
- Infection
- Adverse reactions to anesthesia
- Blood clots
- Lung or breathing problems
- Leaks in your gastrointestinal system
Longer term risks and complications of a BPD/DS may include:
- Bowel obstruction
- Dumping syndrome, causing diarrhea, nausea or vomiting
- Gallstones
- Hernias
- Low blood sugar (hypoglycemia)
- Malnutrition
- Stomach perforation
- Ulcers
- Vomiting
Rarely, complications of a BPD/DS can be fatal.
How you prepare
If you qualify for a BPD/DS, your health care team gives you instructions on how to prepare for surgery. You may need to have various lab tests and exams before surgery.
Food and medications
Before your surgery, give your surgeon and any other health care providers a list of all medicines, vitamins, minerals, and herbal or dietary supplements you take. You may have restrictions on eating and drinking and which medications you can take.
If you take blood-thinning medications, talk with your doctor before your surgery. Because these medications affect clotting and bleeding, your blood-thinning medication routine may need to be changed.
If you have diabetes, talk with the doctor who manages your insulin or other diabetes medications for specific instructions on taking or adjusting them after surgery.
Other precautions
You may be required to start a physical activity program and to stop any tobacco use.
You may also need to prepare by planning ahead for your recovery after surgery. For instance, arrange for help at home if you think you’ll need it.
What you can expect
BPD/DS is done in the hospital. The length of your hospital stay will depend on your recovery and which procedure you’re having done. When performed laparoscopically, your hospital stay may last around two days.
Before the procedure
Before you go to the operating room, you will change into a gown and will be asked several questions by both doctors and nurses. In the operating room, you are given general anesthesia before your surgery begins. Anesthesia is medicine that keeps you asleep and comfortable during surgery.
During the procedure
The specifics of your surgery depend on your individual situation and your doctor’s practices. Some surgeries are done with traditional large, or open, incisions in your abdomen, while some may be performed laparoscopically, which involves inserting instruments through multiple small incisions in your abdomen.
- The first step of a BPD/DS. The first step in a BPD/DS involves removing a portion of the stomach. After making the incisions with the open or laparoscopic technique, your surgeon removes a large portion of the stomach and forms the remaining portion into a narrow sleeve. Your surgeon leaves intact the valve that releases food to the small intestine (the pyloric valve), along with a limited portion of the small intestine that normally connects to the stomach (duodenum).
- The second step of a BPD/DS. During the second step, your surgeon makes one cut through the part of the small intestine just below the duodenum, and a second cut farther down, near the lower end of the small intestine. Then your surgeon brings the cut end near the bottom of the small intestine up to the other cut end, just below the duodenum. The effect is to bypass a large segment of the small intestine.
Each part of the surgery usually takes a few hours. After surgery, you awaken in a recovery room, where medical staff monitors you for any complications.
After the procedure
Immediately after a BPD/DS procedure, you may have liquids but no solid food as your stomach and intestines begin to heal. You’ll then follow a special diet plan that changes slowly from liquids to pureed foods. After that, you can eat soft foods, then move on to firmer foods as your body is able to tolerate them.
Your diet after surgery may continue to be quite restricted, with specified limits on how much and what you can eat and drink. Your doctor will recommend that you take vitamin and mineral supplements after surgery, including a multivitamin, calcium and vitamin B12. These are vital to prevent micronutrient deficiency.
You’ll also have frequent medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, bloodwork and various exams.
You may experience changes as your body reacts to the rapid weight loss in the first three to six months after a BPD/DS, including:
- Body aches
- Feeling tired, as if you have the flu
- Feeling cold
- Dry skin
- Hair thinning and hair loss
- Mood changes
Video: Biliopancreatic diversion with duodenal switch
Results
After a BPD/DS, it may be possible to lose 70 to 80 percent of your excess weight within two years. However, the amount of weight you lose also depends on your change in lifestyle habits.
In addition to weight loss, a BPD/DS may improve or resolve conditions often related to being overweight, including:
- Gastroesophageal reflux disease
- Heart disease
- High blood pressure
- High cholesterol
- Obstructive sleep apnea
- Type 2 diabetes
- Stroke
- Infertility
A BPD/DS can also improve your ability to perform routine daily activities, which could help improve your quality of life.
When weight-loss surgery doesn’t work
It’s possible to not lose enough weight or to regain weight after weight-loss surgery. This weight gain can happen if you don’t follow the recommended lifestyle changes. If you frequently snack on high-calorie foods, for instance, you may have inadequate weight loss. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.
It’s important to keep all of your scheduled follow-up appointments after weight-loss surgery so your doctor can monitor your progress. If you notice that you aren’t losing weight or you develop complications after your surgery, see your doctor immediately.
Source Credit: https://www.mayoclinic.org/tests-procedures/biliopancreatic-diversion-with-duodenal-switch/about/pac-20385180
Surgery for colorectal cancer
This page was reviewed under our medical and editorial policy by Chukwuemeka Obiora, MD, Surgical Oncologist
THIS PAGE WAS REVIEWED ON APRIL 7, 2023.
Surgery is the most common treatment for colorectal cancer and may range from minimally invasive, such as removing a polyp during a colonoscopy, to, in rare cases, removing the entire colon. Many surgeries for colorectal cancer involve removing tumours, the section of the colon in which the tumours was found, surrounding normal tissue and nearby lymph nodes.
Patients may receive chemotherapy and/or radiation therapy before and/or after surgery for colorectal cancer. These adjuvant therapies may help shrink tumors before they are surgically removed and are intended to target cancer cells that may remain after surgery.
The colon must be clean and empty for colorectal surgery. You’ll need to do “bowel prep” beforehand, whether you’re having a polyp removed during a colonoscopy, or the surgeon is removing part of your tumor and colon and/or rectum in order to help treat cancer. Several methods are available to ensure you have a clean colon before surgery, including:
- Pills
- Drinks
- Enemas
These can all be used as laxatives to flush out your colon, and your care team can tell you what to do and expect. Prepare to spend time in the bathroom the day or night before surgery.
The type of colorectal surgery you have depends, in part, on the cancer stage. Early-stage cancers may be treated through a local procedure in which the surgeon doesn’t need to cut through the abdomen. Advanced-stage cancers may require more complex surgery in which a surgeon removes all or part of the colon and/or rectum. If the cancer has spread to other parts of the body, such as the liver, colorectal cancer treatment may involve surgery to remove tumors in those distant areas as well.
Local excision, polypectomy and endoscopic mucosal resection: If colorectal cancer is found early—at stage 0 or 1—your care team may be able to remove the cancer through procedures used during a colonoscopy. These procedures don’t require cutting through the abdomen, because the doctor is able to access the colon or rectum through the anus with a colonoscope and an attached cutting tool or snare that removes the polyps or abnormal cells. If a polyp or area of abnormal cells cannot be removed during these procedures, then laparoscopic or open surgery may be required.
- Polypectomy: If the excision involves the removal of a colorectal polyp, the procedure is called a polypectomy.
- Local excision: If the excision involves removing cancerous cells and some surrounding tissue through a colonoscope, it’s called a local excision. This surgery is a bit more complex than a polypectomy, and it may require more time to recover.
- Endoscopic mucosal resection: The removal of a stage 1 or stage 2 colorectal cancer with a colonoscope is called endoscopic mucosal resection (EMR). Your doctor may perform a polypectomy or EMR if polyps are found during a colonoscopy or sigmoidoscopy.
Colectomy: A colectomy is the removal of all or part of the colon. The resection may be performed as a less invasive laparoscopic colectomy. If open surgery is needed, a long incision in the abdomen may be required. With open surgery, patients may need to stay in the hospital for a week or more and face a longer period of recovery.
- Removing part of the colon: The surgeon will remove the cancerous cells as well as some healthy tissue on either side of the tumor. During the surgery, the new ends of the colon will be reattached so there are no gaps. This is called a hemicolectomy, partial colectomy or segmental resection. Your surgeon may also remove some nearby lymph nodes.
- Removing all of the colon: More rarely, the surgeon may need to remove all of the colon, called a total colectomy. This is typically only necessary when there are other problems in the colon besides cancer, such as inflammatory bowel disease or hundreds of polyps.
When possible, a surgical oncologist will perform a laparoscopic colectomy to remove the cancerous portion of the colon and nearby lymph nodes, and then reattach the healthy ends of the colon. A laparoscopic colectomy may result in less pain, a shorter stay in the hospital and a speedier recovery.
With a laparoscopic colectomy, approximately four to five small incisions are made around the abdomen. The surgical oncologist then inserts a laparoscope, a thin tube equipped with a tiny video camera that projects images of the inside of the abdomen on a nearby monitor. The surgical oncologist then inserts instruments through the incisions to perform the surgery.
How long colorectal surgery takes depends both on your surgeon’s goals and what’s found during the procedure. In general, colorectal surgery may take 1.5 to 3 hours to complete, but you should ask your care team what to expect based on the specifics of your cancer treatment.
Colostomy: A colostomy may be necessary, depending on the type and extent of the colorectal surgery performed. During this procedure, the colon is connected to a hole in the abdomen (called a stoma) to divert stool away from a damaged or surgically repaired part of the colon or rectum. Some colostomies may be reversed once the repaired tissue heals. Other colostomies are permanent, and the stoma is attached to a colostomy bag that collects waste.
You should ask your care team to discuss your specific recovery and expectations with you.
Proctectomy: A proctectomy is performed to remove all or part of the rectum.
- A low-anterior resection (LAR) involves the surgical removal of cancer located in the upper part of the rectum, which is closest to the S-shaped sigmoid colon. Some adjacent healthy rectal tissue may also be removed, along with nearby lymph nodes and fatty tissue. A pathologist may examine the lymph nodes to determine if cancer cells are present. This will help doctors determine the stage of the disease and whether additional colorectal cancer treatment is needed. After the cancerous portion of the rectum is removed, the surgical oncologist connects the sigmoid colon with the remaining healthy tissue located in the lower part of the rectum. This allows waste to pass normally out of the body through the anus.
- Abdominoperineal resection is used to treat cancer in the lower rectum. Because this procedure requires surgical removal of the cancerous portion of the lower rectum nearest the anus, some or all of the anal sphincter is also removed. The sphincter is a muscle that keeps the anus closed and prevents stool leakage. Because the sphincter is responsible for bowel control, the surgical oncologist also performs a colostomy to enable the body to excrete waste.
- Anastomosis is a procedure that removes the entire rectum but connects the colon to the anus so you can pass stool normally. Your surgeon may create a pouch where your rectum would be to make room to store stool.
- Pelvic exenteration is a complex operation to remove the rectum and other organs that the cancer has spread to, such as the bladder. Recovering from this surgery can take months and depends on which organs are removed. You typically need a colostomy after this surgery.
HIPEC: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery.
Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC may deliver chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment.
HIPEC may be particularly helpful for colorectal cancer patients with abdominal tumors that have spread to the inside of the abdomen but have not spread to organs such as the liver or lungs, or to lymph nodes outside the abdominal cavity.
Robotic surgery: The da Vinci® Surgical System may be used to perform a colectomy and/or a low anterior proctectomy. The surgeon may use an EndoWrist® Stapler during surgery to remove the malignant portion of the colon using the da Vinci system. The surgeon may also use Firefly™ Fluorescence Imaging to find blood vessels with good blood supply, which normally would not be seen under white light. Using this imaging system may allow the surgeon to help ensure there is good blood supply when reconnecting the colon and rectum.
Compared with traditional open surgery for colorectal cancer, the da Vinci system may require smaller incisions. Many colorectal cancer patients may also experience faster recovery time and speedier return of bowel function.
Possible complications from colorectal cancer surgery
Your experience after colorectal cancer surgery depends on which type of procedure you had and how it was done. Speak with your cancer care team about what to expect in your case.
As with all surgeries, colorectal cancer surgery involves risk. After the procedure, you may have a higher chance of bleeding. You also may develop blood clots or an infection. Sometimes, if your care team has reattached parts in your colon, rectum or anus, these may begin to leak. Your care team should monitor you closely for signs of this happening, such as fever or lack of appetite. They’ll also keep an eye out for signs of any adhesions (places where scar tissue from the surgery is affecting how your organs function) even after you leave the hospital.
After surgery, you’ll likely experience some pain. Your care team can help you manage with pain medications as you recover. It may take a few days to resume eating and drinking normally as your digestive tract heals.
Depending on which type of surgery you had, some people need a colostomy or ileostomy after surgery. These collect waste outside of your body—whether directly from the small intestine (ileostomy) or directly from the colon (colostomy)—that you would normally pass as stool through your anus. Sometimes this is a temporary part of your recovery, but it can often be permanent.
What to eat after colorectal surgery
Following surgery, it’s important to consume the right nutrients and give the body time to recover. Your care team typically provides clear liquids when you’re ready for them after surgery. You may be eating and drinking normally within a couple weeks.
Learn more about what to eat after colorectal surgery
In the weeks following surgery, eat several small meals a day, avoiding high-fiber foods and hard-to-digest foods such as:
- Nuts
- Seeds
- Corn
In general, aim to stay hydrated by drinking enough water each day. If you have other health issues, be sure to ask your doctor how much liquid you should be aiming for—some people with kidney or heart issues may need to limit their fluids.
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