Why consider SCALES for weight loss surgery?
- Providing unparalleled experience in minimally invasive surgery and laparoscopic weight loss surgery for the Greater San Fernando Valley, Conejo Valley and surrounding regions.
- We perform Laparoscopic Gastric Bypass and Laparoscopic Adjustable Gastric Banding.
- SCALES has established an Operating Room team dedicated to advanced minimally invasive surgical techniques.
- We are unique in our extensive work with the staff and administration to establish clinical pathways designed to provide optimal and efficient bariatric patient care.
- Dr. Waldrep has completed the American Society for Bariatric Surgery (ASBS) Masters course as well as the Advanced Laparoscopic bariatric surgery courses at the University of Pittsburgh Medical Center and Stanford University. Dr. Waldrep was one the first of two surgeons to successfully complete the Surgical Preceptorship sponsored by the American Society for Bariatric Surgery under the direction of former president of the International Federation for the Surgery of Obesity as well as the American Society for Bariatric Surgery, Dr. George Cowan of the University of Tennessee.
- We have an established bariatric support group, Western Obesity and Wellness (WOW)
- Our office staff includes members of the American Society for Bariatric Surgery and American Society of Bariatric Physicians.
Dr. Waldrep is a:
- Diplomate of the American Board of Surgery
- Member of the American Society for Bariatric Surgery [ASBS]
- Member of the American Society of Bariatric Physicians [ASBP]
- Fellow of the American College of Surgeons
- Member of the Society of American Gastrointestinal Endoscopic Surgeons [SAGES]
- Member of the Society of Laparoendoscopic Surgeons
- Member of the Society for Minimally Invasive Therapy
- Member of the American Society of General Surgeons
Weight Loss Surgery
Weight loss surgery is major surgery. Its growing use to treat morbid obesity is the result of three factors:
- Our current knowledge of the significant health risks of morbid obesity
- The relatively low risk and complications of surgery compared to the increasing risks of not having surgery
- The ineffectiveness of current non-surgical approaches to produce sustained weight loss
Surgery should be viewed first and foremost as a method for alleviating debilitating, chronic disease. In most cases, the minimum qualification for consideration as a candidate for the procedure is 100 lbs. above ideal body weight or those with a Body Mass Index of 40 or higher. Patients with a BMI of 35 to 39 should have obesity-related health conditions have resulted in a medical need for weight reduction. In many cases, patients are required to show proof that their attempts at dietary weight loss have been ineffective before surgery will be approved. More important, however, is the commitment on the part of the patient to required, long-term follow-up care. Most surgeons require patients to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of their lives after having weight loss surgery.
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Roux-en-Y Gastric Bypass
(Combined Restrictive & Malabsorptive Procedure)
In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.
According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the most effective method of weight loss and weight maintenance of all surgical and medical techniques available. It is the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased or decreased to produce lower or higher levels of malabsorption.
Advantages
The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
Patients generally lose 60 to 75 percent of their excess weight within the first 6 to 9 months after surgery. After surgery, weight loss averages: a pound-a-day in the first month or two, about 10 lbs per month during the honeymoon period (a period lasting from the second month until anywhere from month 10 to 18), and 2.5 lbs lost per month up to “2 YEARS” or “more” after surgery.
You should know that weight loss among a large patient population is highly variable and is due to many reasons aside from the surgery alone.
There is a 75%-98% improvement of obesity-related conditions such as joint pains including back pain, diabetes, high blood pressure, urinary leakage, and sleep apnea, heartburn, and high cholesterol according to a 2000 study of 500 patients in the journal Obesity Surgery.
Risks
Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar, fat, or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.
The LAP-BAND® was recently approved by the FDA and is an option for patients who need to lose a significant amount of weight but want a less invasive -- although still permanent -- procedure, other than gastric bypass surgery.
The LAP-BAND® is an adjustable silicon band with a balloon at the end. Surgeons wrap the LAP-BAND® around the top part of the stomach and fill the balloon with saline solution that will help make the patient feel full more quickly. The operation can be tailored to the individual patient's symptoms and weight loss. By adding saline to the band, the person will feel full and lose weight faster. If they aren't eating enough or have problems with nausea and vomiting, the band can be deflated.
Because the entire procedure is performed laparoscopically, using only a few, very small incisions, the patient's recovery from surgery is quicker than traditional surgery. The procedure is usually less than an hour and requires an overnight stay.
One group of patients that might benefit from the LAP-BAND® are those female patients who wish to become pregnant. Pregnancy, although possible after gastric bypass surgery, requires strict nutritional counseling. The process is a lot easier and perhaps safer with the LAP-BAND® procedure. Because it's adjustable, the lap band can be deflated for a patient's pregnancy, and the patient is able to ingest the appropriate amount of food daily to sustain a normal pregnancy.
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