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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.

Source Credit: https://www.cancercenter.com/cancer-types/colorectal-cancer/treatments/surgery#:~:text=Early%2Dstage%20cancers%20may%20be,the%20colon%20and%2For%20rectum.

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.

Safety and Effectiveness of Different Weight Loss Surgeries

While all surgeries have some amount of risk, there are many noninvasive options available for weight loss surgery.

Weight loss surgery, also called bariatric surgery, is a type of surgery that helps people with obesity lower and manage their weight. In 2018, more than 250,000 peopleTrusted Source in the United States underwent weight loss surgery, according to statistics from the National Institute of Diabetes and Digestive and Kidney Diseases.

While most weight loss surgeries are generally considered safe, there are risks and benefits for each type of surgery. For example, research has shown that gastric band surgery has a lower risk of side effects than other bariatric surgeries. But it’s also not as effective for weight loss as gastric bypass surgery or gastric sleeve surgery.

Below, we’ll explore more about the safety and effectiveness of the most common types of weight loss surgery — including which weight loss surgery is the safest and most effective.

What are the most common types of weight loss surgery?

In the United States, the three most common types of weight loss surgery include:

• Gastric bypass: Also called Roux-en-Y gastric bypass, this is a procedure in which a doctor connects a smaller pouch of your upper stomach to a different part of your small intestine. The “bypassed” part of your stomach and segment of your small intestine no longer store food but still contribute stomach acids and enzymes to digested food.
• Gastric sleeve: Also known as vertical sleeve gastrectomy, this is a procedure in which a doctor removes a significant portion of your stomach and sews the remainder of your stomach into a small pouch or sleeve.
• Gastric band: Also called adjustable gastric band, this is a procedure in which a doctor places a band around the top portion of your stomach that can be adjusted to modify the volume of your stomach.

Even though each surgical procedure is different, all three of these surgeries help with weight loss by directly changing the way that you eat and absorb your food.

Which weight loss surgery has the highest success rate?

In the same large studyTrusted Source mentioned above from 2018, gastric bypass surgery was associated with the highest average total weight loss percentage after 1 year. Results of the study found that gastric bypass resulted in more than 31% total weight loss after a year, with gastric sleeve and gastric band at 25.2% and 13.7% respective weight loss after a year.

Gastric sleeve and gastric bypass are also effective for non-weight loss outcomes, too. In one large analysis, researchers found that both surgeries had comparable benefits for type 2 diabetes resolution. Gastric bypass resulted in improvements in dyslipidemia, high blood pressure, and gastroesophageal reflux disease (GERD).

Which weight loss surgery has the highest failure rate?

Research studies suggest that gastric banding tends to have the lowest impact on weight loss. In one early study from 2014, researchers found that gastric band surgery was associated with a high percentage of failure, with roughly 31% of people not experiencing clinical weight loss and another 13% undergoing band removal.

All surgeries have risk

Whether you’re undergoing a major surgical procedure like bariatric surgery or a simple procedure like a tooth extraction, all surgeries come with the risk of complications. These complications can happen both during the surgery and during recovery.

If you’ve decided to undergo weight loss surgery, it’s because you and a doctor have decided that the benefits outweigh the risks. If you have any questions or concerns about the risks associated with your weight loss surgery, consider reaching out to a doctor to discuss them.

Which weight loss surgery has the fewest complications?

In one major study from 2021Trusted Source, researchers explored the safety of both gastric sleeve and gastric bypass in more than 95,000 people with obesity up to 5 years after surgery. According to the study results, gastric sleeve had a lower risk of complications, mortality, and surgical revisions.

But the authors also noted that gastric sleeve surgery was associated with a higher risk of surgical revision. Surgical revision was defined as any changes to the original procedure, such as changing from gastric sleeve to gastric bypass.

All surgeries have the potential for complications, but here are some of the frequently noted complications of bariatric surgery:

• bleeding
• blood clots
• infection
• obstruction
• stomach leakage
• GERD
• stricture
• stenosis
• stomach twists or kinks
• hernia
• stomach ulcer
• nutritional deficiencies
• hypoglycemia
• peripheral neuropathy
• osteoporosis
• complication with gastric banding, band slippage, or band erosion

Takeaway

Weight loss surgery can be an effective way for people living with obesity to lower and manage their weight. Most weight loss surgeries are generally regarded as safe. But of all three major surgeries, gastric sleeve surgery has a lower risk of complications and a higher effectiveness for weight loss.

If you or a loved one has been considering weight loss surgery, reach out to a doctor to discuss the options available to you. Together, you can find an option that’s both safe and effective for your own personal health journey.

Source Credit: https://www.healthline.com/health/weight-loss/safest-weight-loss-surgery#takeaway

Definition & Facts of Weight-loss Surgery

What is weight-loss surgery?

Weight-loss surgery encompasses a group of operations that help you lose weight by making changes to your digestive system. It is also known as bariatric surgery (“bariatric” means “related to treatment for heavy weight”).

Some types of weight-loss operations make your stomach smaller, limiting how much you can eat and drink at one time, so you feel full sooner. Other weight-loss operations change your small intestine—the part of your digestive system that absorbs energy and nutrients from foods and beverages. This operation reduces the number of calories the body can absorb. Weight-loss surgery also can affect hormones or bacteria in the gastrointestinal tract in ways that may reduce appetite and hunger and improve how the body metabolizes fat and makes use of insulin.

Who are good candidates for weight-loss surgery?

You may be a good candidate for weight-loss surgery if you are an adult who has obesity and you have not been able to lose your excess weight, or you keep gaining back weight you have lost using other methods such as eating plans, exercise, or medications.

Body Mass Index (BMI) is a measure of obesity used to determine who are good candidates for weight-loss surgery. BMI measures body fat based on weight in relation to height. For people with a BMI of 35 or higher, obesity can be hard to treat with diet and exercise alone, so health care professionals may recommend weight-loss surgery. For people with a BMI of 30-35 who have type 2 diabetes that is difficult to control with medications and lifestyle changes, weight-loss surgery may be considered as a treatment option.

Calculate your BMI NIH external link to learn whether you have obesity.

The BMI scale measures body fat based on weight in relation to height.

Weight-loss surgery also may be an option to consider if you have serious health problems related to obesity, such as type 2 diabetes or sleep apnea. Weight-loss surgery can improve many of the medical conditions linked to obesity, especially type 2 diabetes.^1,2

Does weight-loss surgery always work?

Studies show that many people who have weight-loss surgery lose on average 15 to 30 percent of their starting weight, depending on the type of surgery they have.³ However, no method, including surgery, is sure to produce and maintain weight loss. Some people who have weight-loss surgery may not lose as much as they hoped. Over time, some people regain a portion of the weight they lost. The amount of weight people regain may vary. Factors that affect weight regain may include a person’s weight before surgery, the type of operation, and adherence to changes in exercise and eating.

Weight-loss surgery can make it easier for you to eat fewer calories and be more physically active. Choosing healthy foods and beverages before and after the surgery may help you lose more weight and keep it off over the long term. Regular physical activity after surgery also helps keep the weight off. To improve your health, you must commit to a lifetime of healthy lifestyle habits and follow the advice of your health care professionals.

How much does weight-loss surgery cost?

Weight-loss surgery can cost between $15,000 and $25,000 or even more, depending on what type of surgery you have and whether you have surgery-related complications.⁴ Costs may be higher or lower depending on where you live. The amount your medical insurance will pay varies by state and insurance provider.

Medicare and some Medicaid programs may cover the major types of weight-loss surgery if you have a health care professional’s recommendation and you meet certain criteria (for example, if you have a BMI of 35 or greater and obesity-related health problems). Some insurance plans may require you to use approved surgeons and facilities. Some insurers also require you to show that you were unable to lose weight by completing a nonsurgical weight-loss program or that you meet other requirements.

Your health insurance company or your regional Medicare or Medicaid office will have more information about weight-loss surgery coverage, options, and requirements.

Source Credit: https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/definition-facts

Recovering from Bariatric Surgery

Recovery in the hospital

Patients generally spend one to two days in the hospital following minimally invasive bariatric surgery.

In the early days and weeks after surgery, it’s normal to experience fatigue, nausea and vomiting, difficulty sleeping, postsurgical pain, weakness, light-headedness, loss of appetite, flatulence and gas pain, loose stools, and emotional ups and downs. Patients experience these to varying degrees, so discuss any particular concerns you have with your bariatric surgery team.

Pain control

You may feel pain at the incision site or as a result of how your body was positioned during surgery. Some patients also experience neck and shoulder pain, which occurs when the body reabsorbs the gas used during surgery.

Notify your care team if your pain prevents you from moving. Pain is addressed with oral medications, which work best when used regularly. Don’t wait for your pain to become intolerable before asking for another dose; maintaining a steady level of the medication in the bloodstream keeps pain manageable.

To reduce the need for opioids, the pain management plan involves multiple treatment modes. In cases where oral opioids are prescribed, it will be only for the first few days after surgery.

Exercises to speed recovery

The single most effective way to shorten recovery time is to get active right away. Simply walking short distances and even changing positions in bed promotes circulation. Good blood flow enhances healing and discourages the formation of blood clots.

Perform the following exercises at least once every hour after surgery. It’s also a good idea to practice these movements before surgery to promote lung function and agility.

• Beginning the first night after surgery, sit up and dangle your feet, then stand at your bedside with the help of your nurse or physical therapist. This may hurt but will become easier each time. Your strength will return and your pain will lessen every day.
• The day after surgery, you’ll be asked to get out of bed and walk. After that, walk at least three times per day and perform leg and breathing exercises hourly. You may not feel well enough to go for a walk, but try to do as much as possible.
• Your nurse will teach you how to cough and breathe deeply, and you’ll be shown how to use an incentive spirometer to help expand your lungs. Coughing and deep breathing loosen secretions that may accumulate in your throat or lungs and can help prevent pneumonia. Deep breathing also increases circulation and helps your body eliminate the anesthetics that were used for surgery.

How to breathe deeply:

1. Inhale as deeply as you can, letting your belly – not just your chest – expand.
2. Hold your breath for two seconds.
3. Exhale completely.
4. Repeat three times.

How to cough:

1. Inhale deeply.
2. Cough from your abdomen, not your throat. Hold a pillow against your abdomen for support.

How to exercise your feet and legs:

1. While lying on your back in bed, push your toes toward the end of the bed, as if you’re pressing a gas pedal.
2. Pull your toes toward the head of your bed, then relax.
3. Circle each ankle to the right, then to the left.
4. Repeat three times.

Recovery at home

Leaving the hospital

Your surgeon will decide when you’re ready to go home, based on your progress. Prior to discharge, you’ll receive specific dietary and activity instructions, along with precautions and information on issues that warrant contacting your surgeon. If you have concerns about returning home, discuss them with your nurse or discharge coordinator.

When you return home, take it easy for a while. Your body is healing from major surgery and the weight loss that occurred during the initial recovery period.

Follow-up appointments

We care about your progress. Stay in communication with your bariatric surgery team, so we can do our best to help your recovery go smoothly.

We schedule an initial follow-up video visit for two to three weeks after surgery. Your discharge instructions will include information about this visit. After that, you’ll see your care team regularly – usually three, six, nine and 12 months after surgery. Then you’ll have an annual appointment.

It’s also important to keep your primary care provider informed of your progress.

Activities to avoid

For three to six weeks post-op, strenuous activity is not recommended. Avoid lifting anything heavier than 15 to 20 pounds for the first six weeks.

Recommended activities

During the first few weeks after surgery, you may feel weak and tire easily. However, frequent nonstrenuous activity, such as short walks, is recommended. Gradually increase the distance of your walks. The more physically active you are, the better for your recovery. Following these recommendations will help you get back to your baseline energy level more quickly.

Continue walking at least four times a day, so that you’re walking 30 to 45 minutes per day by the sixth week. If you have specific problems with your weight bearing joints (such as the ankles, knees and hips), you can perform water exercises once your abdominal incisions have healed, typically three to four weeks post-op.

Staying hydrated

You may be nauseated or experience vomiting the first weeks after surgery. To control these side effects, maintain your fluid intake by taking small, frequent sips of water. Drinking 1.5 to 2 liters of water daily is recommended.

Travel

You can resume traveling short distances as soon as you feel strong enough. Don’t drive a motor vehicle until you’re no longer taking prescription pain medication, which is usually about one week after surgery. If your planned trip involves a long flight, wait at least four weeks after surgery.

Personal hygiene

During the first several days after discharge, most patients like to have someone at home with them for moral and physical support. You may shower upon returning home.

Wound care

Your incisions will have sutures (stitches) deep in the skin and surgical glue on top. The sutures dissolve over time, and the glue begins to peel one to two weeks after surgery.

It’s safe to let the incisions get wet during a shower, but don’t submerge them in water until they’re completely healed. As the glue peels off, apply Vaseline or Aquaphor to the incisions to keep the skin moisturized. This prevents scabbing and speeds healing.

A small amount of yellow, pink or clear fluid draining from the incision is normal. If an infection develops at the wound site, it usually occurs three to 10 days after surgery. Watch for symptoms of infection, which include:

• Increased redness or foul-smelling fluid coming from the incision
• Severe pain at the incision site
• A fever of greater than 101.5 degrees Fahrenheit

Contact your bariatric surgery team if you experience any of these symptoms.

Symptoms of concern

Serious problems are not common after this surgery. However, if you experience any of the symptoms below, contact your surgeon immediately:

• Fever of 101.5 degrees F or higher
• Redness, swelling, increased pain or pus-like drainage from your wound
• Chest pain or shortness of breath
• Nausea or vomiting that lasts more than 12 hours
• Pain, redness or swelling in your legs
• Inability to urinate lasting eight hours
• Pain that persists after taking pain medication

Normal side effects

You may experience some of the following postsurgical issues, which are considered normal:

• Moderate swelling and bruising. Notify your surgeon if you experience severe swelling and bruising, as these may indicate infection or internal bleeding.
• Mild to moderate discomfort or pain. Notify your surgeon if your pain becomes severe or persists after your pain medication should have taken effect.
• Temporary numbness. This is caused by the cutting of small sensory nerves near the surface of the skin during surgery. Sensation usually returns as the nerve endings heal, typically within six months. Be careful not to burn your skin when using heating pads on areas of the body that may be temporarily numb.
• Shooting electrical sensations within the skin, which often occur as nerve endings heal. This is common during the recovery period, especially with activity. Wearing an abdominal binder can help minimize this symptom.
• Red, dark pink or purple scars in the first weeks to months after surgery. Scars take about a year to fade. It’s important to protect your surgery scars from the sun for a full year, even when covered by a bathing suit, as sunlight can still reach the skin and cause damage. Apply a sunscreen with a sun protection factor (SPF) of at least 30 before any sun exposure.

Nausea

Nausea may occur as a result of insufficient chewing, stomach fullness, sensitivity to odors, pain medication, going without food for too long, postnasal drip or dehydration. During the first days after surgery, nausea usually can be treated with medications called antiemetics. Take your nausea medication only as prescribed by your surgeon.

Rarely, nausea becomes so severe that it prevents a person from drinking adequate amounts of liquid. If this happens, you’ll need to receive intravenous (IV) fluids at the hospital. Persistent vomiting may lead to dehydration and electrolyte imbalance.

Odors can sometimes be overwhelming after surgery. If you experience dry heaving, try sniffing a few drops of peppermint essential oil on a handkerchief. Avoid perfumes and scented lotions. If food odors bother you, try having someone else prepare your meals or stick to bland foods.

Learn to recognize when you are full. This will not happen immediately, but by eating very slowly, it will become easier.

If you have difficulty drinking due to nausea, try peppermint tea, fennel tea, decaffeinated green tea, or hot or cold water with lemon. Sucking on a cinnamon stick may also alleviate nausea.

If you believe your pain medication is causing nausea, call your surgeon’s office to discuss a prescription change.

Vomiting

Vomiting is often caused by eating inappropriately. Initially, it can be difficult to adjust to your new anatomy. One to two tablespoons may be all you can eat at one time.

Possible causes of vomiting include:

• Eating too fast
• Not chewing food thoroughly
• Eating food that’s too dry
• Eating too much food at once
• Eating solid foods too soon after surgery
• Drinking liquids with meals or right after meals
• Drinking with a straw
• Lying down after a meal
• Eating foods that don’t agree with you

To prevent vomiting:

• Chew food well.
• Keep food moist.
• Measure portions. Eat small amounts every one to two hours in the early postoperative period.
• Follow the “Dietary Guidelines After Bariatric Surgery” education guide recommendations for diet progression.

If you experience prolonged vomiting, stop eating solid foods and instead sip liquids, such as protein shakes and water. If you have difficulty swallowing food or keeping food down, call your bariatric surgery team.

Vomiting may indicate that food isn’t passing successfully through your stomach. If vomiting continues for more than 24 hours, contact your bariatric surgery team. Also, be aware that vomiting can cause severe dehydration, which requires treatment.

Dehydration

Dehydration occurs when you don’t drink enough fluids. Symptoms include fatigue, dark colored urine, fainting, nausea, low back pain (a constant dull ache across the back) and a whitish coating on the tongue. If you experience these symptoms, blood tests will be needed to establish the severity of your dehydration. Dehydration also increases the risk of bladder and kidney infections.

Contact your bariatric surgery team if you’re concerned about dehydration. You may need IV fluids.

To prevent dehydration:

• Buy a reusable bottle, bring it everywhere, and sip water all day.
• Drink at least 1.5 to 2 liters of fluids per day. Increase this amount if you’re sweating a lot.
• Avoid caffeinated beverages because they act as diuretics – increasing the amount of water expelled from your body. Unsweetened herbal tea – hot or iced – is fine.
• If nausea is making it difficult to drink water, suck on ice chips.

Bowel habits

Bowel movements vary greatly after bariatric surgery. Stools may be foul smelling, associated with flatulence, or a different color than normal. Taking iron supplements, for example, will make your stools dark or black. Until you’re eating more solid food, your stools will be soft. Most of these changes resolve as the body heals and adapts to changes. Please call your bariatric surgery team if you have persistent diarrhea.

After bariatric surgery, you’ll consume much less food and fiber. As a result, you may have bowel movements less frequently and experience constipation. If constipation persists, try adding a powdered fiber supplement to your daily routine.

To keep bowel movements regular:

• Avoid cow’s milk products, such as milk and cheese, if you become sensitive to lactose after surgery. Yogurt should still be OK. Lactose intolerance and consumption of high-fat foods can cause loose stools and diarrhea.
• Use a food journal to figure out which foods may be causing irregular bowel movements.
• Add Miralax to your regimen to speed up bowel motility (movement). If your stools continue to resemble rocks (instead of soft logs) after making these changes, contact your bariatric surgery team.

Flatulence

Everyone has gas in the digestive tract. Gas comes from two main sources: swallowed air and the normal breakdown of certain foods by harmless bacteria that live in the large intestine. After gastric bypass surgery, patients have a shortened bowel, which can result in more odorous gas or more forceful expulsion of gas from the body.

In particular, high-carbohydrate foods cause gas, while foods high in fat and protein cause very little. Foods especially known to cause gas include beans, vegetables, some fruits, soft drinks, whole grains, wheat, bran, cow’s milk and cow’s milk products, and foods containing sorbitol or dietetic products.

To lessen flatulence:

• Eat meals slowly and chew food thoroughly.
• Discontinue eating all cow’s milk products. Lactose intolerance is generally the culprit for gas. Yogurt is OK.
• Avoid chewing gum and hard candy; both can contribute to the problem.
• Avoid drinking with a straw, which can also be a contributing factor.
• Try remedies for flatulence, such as Lactobacillus acidophilus supplements (a probiotic or type of beneficial bacteria that aids digestion), natural chlorophyll and simethicone.

Anemia

Bariatric surgery reduces stomach size, which puts recovering patients at risk for decreased iron absorption and iron deficiency anemia. Signs of iron deficiency anemia include paleness, fatigue, weakness, difficulty maintaining body temperature, dizziness and shortness of breath. To prevent this problem, you will take a daily bariatric-specific multivitamin, which has added iron.

Iron deficiency may also be caused by low vitamin A levels. Vitamin A helps mobilize iron from its storage sites, so a vitamin A deficiency limits the body’s ability to use stored iron. This results in what appears to be an iron deficiency because hemoglobin levels are low, even though the body can maintain an adequate amount of stored iron.

Temporary hair loss and skin changes

Hair shedding is one of the body’s natural stress responses to rapid weight loss. This typically improves six to 12 months after surgery. Although the problem is temporary, patients may find it upsetting.

To minimize hair loss, take multivitamins daily and consume at least 60 to 80 grams of protein per day. A bariatric multivitamin includes the components of a hair, skin and nails supplement, so you don’t need to add another supplement to your routine.

Avoid hair treatments, such as permanents, that stress your hair from the outside.

Your skin’s texture and appearance may change after bariatric surgery. Some patients develop acne or dry skin, since protein, vitamins and water intake are important for healthy skin. This is another reason to carefully follow the diet and hydration guidelines.

Sexuality and pregnancy

You may resume sexual activity when you feel physically and emotionally stable.

It is strongly recommended that sexually active women use a reliable form of birth control, such as IUD, after bariatric surgery, as fertility may increase with rapid weight loss.

It is imperative to avoid pregnancy during the first 12 to 18 months after bariatric surgery. Body weight and micronutrient levels rapidly change during this postoperative period, which is not optimal for supporting a healthy pregnancy.

If you do become pregnant, please contact the bariatric surgery office, and your care team will work with your obstetrician to ensure the best possible prenatal care.

A lifelong commitment

Surgery gives you a physical tool for weight loss, but you must commit to making the mental and emotional changes necessary for long-term weight loss and maintenance.

After surgery, you need to take vitamins and supplements regularly, ingest high-quality nutrients, attend follow-up appointments with your bariatric surgery team, exercise, and participate in support groups. Your emotional and physical well-being depends on your dedication to this multifaceted plan.

Common causes of regaining weight after surgery include lack of exercise, poorly balanced meals, constant grazing, and eating processed carbohydrates and sugars. You must manage your food intake and exercise regularly for the rest of your life.

Support Groups

Support groups are an integral part of the healing process, physically and emotionally. All patients are encouraged to incorporate a support group session into their monthly schedule. UCSF offers a support group that meets over Zoom on the third Wednesday of each month. Please visit our Bariatric Surgery Support Group webpage for more information and to join our email list.

Exercise

In a reduced-calorie state, the body naturally tends to use muscle for immediate energy needs. That means following a consistent fitness program after surgery is essential. Exercising at least three times a week conserves lean muscle mass, burns fat and increases your potential for long-term success.

Supplements

Because bariatric surgery changes the digestive process, you’ll take vitamins and other nutritional supplements for the rest of your life. Vitamin deficiencies are preventable and detectable, so take your supplements and see your bariatric surgery team for regular follow-up visits and lab work.

Source: https://www.ucsfhealth.org/education/recovering-from-bariatric-surgery