AboutKarla K. Expertise I'm very familiar with the four main types of bariatric surgery: Lap-Band/Adjustable Gastric Band, Vertical Sleeve Gastrectomy, Roux-en-Y, and Duodenal Switch. I'm familiar with the Mini-Gastric Bypass and Revisions as well. I'm also beginning my seventh year post-op as a successful bariatric patient--so I can answer questions regarding pre-op, post-op honeymoon, and maintenance phases. I'm less familiar with the nuances of plastic surgery following bariatric surgery--but I do know a bit.
Experience Have been an avid researcher of the science of obesity and bariatric surgery for over ten years now. My professional career used to involve medical device research.
Education/Credentials Master's in Business Administration.
Question QUESTION: I am trying to do some research about the mini gastric bypass vs. the Roux-en-Y gastric bypass procedures, trying to find out which procedure would be best for me. In your opinion, which is the best procedure and why? What would be the after surgery recovery/maintenance for both and how do they compare.
Thank yo for your time.
Tisha
ANSWER: Hi Tisha:
I think in many ways you should be happy with your decision either way. I first learned about the MGB and got in touch with MGB patients back in 1999. Although I did not have an MGB myself, I have stayed in touch with many MGBers. I have to say that I have seen less revisions five years out among the MGB crowd than the RNY.
As I'm sure you know, Dr. Rutledge has published in a peer-reviewed journal some very impressive six year stats regarding the MGB with 95% of his patients maintaining their weight loss with no more than a 22 lb gain. (Initial weight loss was 80% EWL). http://clos.net/Excellent%20Results%20with%20the%20Mini-Gastric%20Bypass%202005....
There are other surgeons (Lee and Noun) who have also reported quite favorable results.
As for long-term RNY results, they tend to be in the 60-70% EWL which is quite good as well.
There are a few studies out there that compare quality of life of people who have an RNY vs. a Billroth I or II as a treatment for gastric cancer. All of the studies I've read seem to favor the RNY as more favorable QOL. (Billroth I/II is a similar one-anastomosis operation to the MGB.) http://www.ncbi.nlm.nih.gov/sites/entrez
Assuming you have your RNY lap, recovery should be the same as for the MGB. Post-op vitamin and medications should be similar as well... including the requirement for Life-long blood testing for vitamin deficiencies as well as life-long vitamins.
It's really tough for me to tell you which surgery is best for you. I think the best thing to do is to join some post-op groups for both surgeries on YahooGroups and just lurk for a bit.. and ask questions. Insurance coverage may play a role in your choosing surgery. Dr. Rutledge does not accept insurance, but does offer a pretty reasonable self-pay price of about $17000.00. If your insurance does cover bariatric surgery, there's a very good chance that they will cover the RNY assuming you meet the requirements for bariatric surgery (BMI of 40+ or 35+ with comorbidities (sleep apnea, diabetes, etc.)).
If it were me, at this stage of my life, insurance coverage would play a part...so I'd be looking at either an RNY, VSG, or Duodenal Switch. Seven years ago when I was a self-pay, I would have leaned towards the MGB.
Hope this helps and good luck on your journey!
Karla
---------- FOLLOW-UP ----------
QUESTION: Does hypothyroidism play a positive or negative role in the gastric bypass surgery? Can it add additional complications to the surgery or recovery? It has played a large role in my inability to lose weight.
-Tisha
Answer Hi Tisha:
As long as your hypothyroidism is being well managed by your primary care physician, surgeon, or endocrinologist, it should have no negative impact on your weight loss results with bariatric surgery. I would work with your physician to determine the right dosage of levothyroxine (commonly known as synthroid) for you prior to surgery. I know of one short-term study that showed no difference between weight loss outcomes of patients with hypothyroidism vs. those with normal thyroid function. (Szomstein et al. "Laparoscopic gastric bypass in patients on thyroid replacement therapy for subnormal thyroid function - prevalence and short-term outcome." Obes Surg. 2004 Jan;14(1):95-7. http://www.ncbi.nlm.nih.gov/pubmed/14980041?ordinalpos=1&itool=EntrezSystem2.PEn...
Post-op, I would hope that your regular bloodwork would detect any deficiencies that need to be treated. Hypothyroidism can be linked to high cholesterol, anemia, and osteoporosis/osteopenia... so those are areas I would be especially concerned about post-op. As I'm sure you know, anemia (due to both iron absorption and B12 deficiency) as well as osteoporosis are two complications that bypass patients need to be aware of.
" Surg Obes Relat Dis. 2007 Nov-Dec;3(6):631-5; discussion 635-6.Links
Influence of obesity and surgical weight loss on thyroid hormone levels.
Chikunguwo S, Brethauer S, Nirujogi V, Pitt T, Udomsawaengsup S, Chand B, Schauer P.
Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
BACKGROUND: The pathophysiologic relationship between morbid obesity and thyroid hormones is not well understood. The goal of this study was to evaluate the influence of obesity and weight reduction after bariatric surgery on thyroid hormone levels. METHODS: Patients who underwent gastric bypass or adjustable gastric banding at our institution, had no previous diagnosis of thyroid disorder, were not taking medication that could affect the thyroid function evaluation, and who were nonsmokers were included in this retrospective evaluation. The association between the thyroid-stimulating hormone (TSH) and free thyroxine (T(4)) levels and body mass index (BMI), and the influence of weight loss after bariatric surgery on these hormones were investigated at different points (preoperatively and 6 and 12 months after bariatric surgery). RESULTS: A total of 86 patients met the study criteria. The TSH levels correlated positively with BMI (P <.001, r = .91) within the BMI range of 30-67 kg/m(2). The mean BMI change from 49 to 32 kg/m(2) after bariatric surgery was associated with a mean reduction in the TSH level from 4.5 to 1.9 microU/mL. Free T(4) showed no association with BMI and was not significantly influenced by weight loss. Before bariatric surgery, 10.5% of the subjects had laboratory values consistent with subclinical hypothyroidism. After bariatric surgery, 100% of these patients experienced significant weight reduction with simultaneous resolution of their subclinical hypothyroidism. CONCLUSION: The results of our study have demonstrated a statistically significant positive association between serum TSH within the normal range and BMI. No association was found between BMI and free T(4) serum levels. The prevalence of subclinical hypothyroidism in study group was 10.5%. Weight loss after bariatric surgery improved or normalized thyroid hormone levels."
From everything I have read, your hypothyroidism should not lead to a negative outcome in bariatric surgery... in fact, bariatric surgery may help you improve your hypothyroidism.
