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Bariatric Surgery


Weight loss surgery

Reduces the size of the stomach with a device or by removing portion of the stomach or by resecting and re-routing the small intestine to a small stomach pouch


US National Institutes of Health (NIH) recommends this surgery

For people who have a body mass index (BMI) of at least 40

BMI of 35 and other serious co-existing medical conditions

BMI of 30-35 with significant comorbities


Surgical procedure types

  1. Malabsorptive procedures
    • Biliopancreatic diversion
      • replaced by modification known as duodenal switch
      • part of stomach is resected and distal part of small intestine is connected to the pouch, bypassing duodenum and jejunum.
      • no restrictive diet
      • must take vitamin and dietary minerals above and beyond recommended daily allow
      • risk of serious illness, if this is not done
    • Jejunoilial bypass
      • procedure is no longer performed due to multiple complications
    • Endoluminal Sleeve
      • weight loss surgery without incisions or scarring
      • can be used before gastric bypass surgery or can be used as the only weight loss method
      • strict guidelines must be followed
        1. rigorous exercise program
        2. healthy diet
        3. behavior modification to change lifestyle habits
  2. Restrictive procedures
    • Vertical banded gastroplasty
      • replaced by modification known as duodenal switch
      • essentially stomach stapling
      • part of stomach is permanently stapled to create a smaller stomach
    • Adjustable gastric band (lap band)
      • performed laproscopically
      • stomach is restricted by using a band that can be adjusted with saline
      • considered one of safest procedures performed today
    • Sleeve gastrectomy (gastric sleeve)
      • performed laproscopically
      • not reversible
      • stomach is reduced to about 15% of its normal size
      • most food items can be eaten in small amounts
      • very effective as first stage procedure for high BMI patients
      • limited results for patients with BMI 35-45.
      • appealing option for people with existing anemia, IBS, Chron's disease
    • Intragastric balloon (gastric balloon)
      • not yet approved by FDA for use in the United States
      • deflated balloon is placed in the stomach and can be filled to decrease the space of the stomach
      • balloon can only be left in for six months
      • can be used prior to another bariatric surgery
      • can be used on multiple occasions, if necessary
    • Gastric Plication (gastric imbrication or laproscopic greater curvature plication)
      • version of gastric sleeve or gastrectomy
      • a sleeve is created by suturing stomach tissue
      • preserves the natural nutrient absorption capabilities
      • reduces the volume of a patient's stomach
  3. Mixed Procedures
    • Gastric bypass surgery
      • Roux-en-Y is the common form
      • considered the "gold standard" in the United States
    • Sleeve gastrectomy with duodenal switch
      • variation of biliopancreatic diversion
      • part of the stomach along the greater curve is resected
      • volume of stomach is reduced, restricting food intact
      • anatomically and functionally irreversible
    • Implantable gastric stimulation
      • currently being studied in the United States
      • device similar to a heart pacemaker is implanted
      • trying to determine electrical stimulation can modify the enteric nervous system of the stomach, which is interpreted by the brain to give a sense of being full
      • early evidence suggest that this is less effective than other forms of weight loss surgery
  4. Revision surgery
    • surgical procedure performed on patients who have already had a type of bariatric surgery
    • performed due to failure or dysfunctional previous surgery
    • can be done laparoscopically or if there is extensive scarring, through an open surgery


Postsurgical diet

  • clear liquid diet immediately after surgery
  • continued until the gastrointestinal tract has recovered from surgery


Blended or pureed sugar-free diet for at least two weeks

  • skimmed milk, cream of wheat, small amount of margarine, protein drinks, pureed fruit and mashed potatoes with gravy


Diet restrictions after recovery from surgery depend on the procedure performed

  • daily multivitamin for life to compensate for reduced absorption or essential
  • Nutrients
  • high protein diet
  • low fat diet
  • low alcohol intake


Common problems after surgery

Gastric dumping syndrome (rapid gastric emptying)

  • Foods bypass the stomach too rapidly and go into small intestine undigested
  • Symptoms of early dumping can include:  nausea, vomiting, bloating, cramping, diarrhea, dizziness, fatigue
  • Symptoms of late dumping can include:  weakness, sweating and dizziness
  • May also suffer from hypoglycemia (low blood sugar) due to release of excessive amounts of insulin
  • reatment:
    • avoid foods that cause it
    • have a balanced diet
    • eat several small meals a day low in carbohydrates
    • avoid simple sugars
    • drink liquids between meals
    • add fiber to diet as this slows gastric emptying and reduces insulin peaks
    • medications can be prescribed in severe cases
    • surgical intervention may be necessary



Metobolic bone disease

  • osteopenia
  • secondary hyperparathyroidism
  • due to decreased calcium absorption
  • occurs because duodenum has been bypassed and this is where the highest concentration of calcium transporters is located


Kidney problems

  • hyperoxaluria – excessive urinary excretion of oxalate
    • can lead to kidney stones
    • can lead to kidney failure
  • rhabdomyolysis –  breakdown of skeletal muscle fibers, that leads to release of muscle fiber contents into the bloodstream
    • can lead to acute kidney injury and 

Nutritional derangements

  • due to deficiencies of iron, vitamin B12, fat soluble vitamins, thiamine and folate


  • have been reported due to inappropriate insulin secretion secondary to islet cell hyperplasia

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Posture and Neck Pain

Chronic neck pain is a miserable experience. Although some cases of neck pain are caused by an injury, many are simply due to poor posture. Poor posture stresses the muscles of the neck and can cause muscle spasms, stiffness and pain. Over time, the stresses of poor posture on the neck can cause degenerative diseases to develop in the discs and bones of the neck. Forward head A very commonly seen posture that puts a lot of strain on the neck is the forward head. The individual habitually thrusts the head forward, carrying it out in front of the shoulders. In this position, the weight of the head is constantly pulling on the spine and the shoulders. Sitting for hours hunched over a desk or a computer is a common cause of forward head. Many people with this habitual forward head carriage suffer from sore shoulders as well as a sore neck. Over time, the vertebrae at the base of the neck (C5 and C6) can develop painful degenerative conditions due to the constant weight of the head pulling on them in the forward head posture. Correct posture A correct posture is one that keeps the spine in alignment. Some people call it a neutral or balanced posture. One exercise to encourage a neutral posture is to focus on opening the chest wide as you try to squeeze your shoulder blades together. Once your chest is open, bring your head into alignment. Think of a string pulling up the top of your head and lengthening the neck. When you do this, your chin will tuck in and your head will naturally shift into proper alignment with your spine. Do the open chest/ string exercise multiple times a day. Other exercises to build better posture are head nods and chin tucks. To do a head nod, slowly nod your head slightly up and down without moving your neck. To do chin tucks, tip your nose down toward the ground and move the top of your head backwards. Repeat head nods and chin tucks several times a day. These exercises strengthen the muscles on the front of the neck. Individuals with habitual forward head posture usually have very weak muscles in the front of the neck. If you've worked hard at correcting your posture and you are still suffering from neck pain, why not give us a call?

Note: The information on this Web site is provided as general health guidelines and may not be applicable to your particular health condition. Your individual health status and any required medical treatments can only be properly addressed by a professional healthcare provider of your choice. Remember: There is no adequate substitution for a personal consultation with your physician. Neither BPF Specialty Hospital, or any of their affiliates, nor any contributors shall have any liability for the content or any errors or omissions in the information provided by this Web site.