Options for a failed gastric sleeve surgery

Options for a failed gastric sleeve surgery

Hi everyone, I’m Nina and welcome to Mexicali Bariatric Center. On our last video we were discussing a failed gastric surgery, and on today’s video I would like to talk to you about the options we have for somebody that has had a failed gastric sleeve due to the construction of the sleeve itself. This has nothing to do with habits or anything else that might cause you to fail.

The first option is resleeving, we can go in and completely redo your sleeve. This is a good option when we see that patients either have a very large sleeve, so large that we can go in and remove i.e 50% of the stomach and make it so much smaller that someone can lose, let’s say, another 100 pounds. Or someone might have a very large fundus and of course it will stretch, so, again, removing the fundus will give the patient very good results.

But if you need to lose, let’s say, 100 pounds, and the sleeve is a little bit on the larger side but not very big, then the doctors would not recommend that. It will not give you the restrictions you need to get to your weight goal. In those cases we recommend something else: go to a DS surgery or the SADI-S. You have the option of making the sleeve smaller and doing the malabsorptive part. In certain cases that is what we recommend, if it’s a little bit larger we say make it smaller, it will give you the immediate effect of the restriction plus the malabsorption, so you’ll have better results. There are some patients that want to keep their sleeve as it is and only want the second part, but just know that if the sleeve is on the larger side the weight loss would be much slower. You’ll get there, but it will take longer. So that is something to consider.

Now, you have the option of having the traditional DS or the SADI-S. The SADI-S is the single anastomosis which offers some benefits. It’s a little bit less malabsorptive and less risk of some complications. We have some information on our website. We are finding that patients contacting us about the SADI-S are usually patients that have a very small sleeve and they just want to lose the last 50 pounds or so, so they go for the SADI-S to lose that amount of weight and keep it off long term. We have also have some patients that don’t need to lose that much weight but their sleeve is larger so they want to make it smaller, and then they don’t need that much malabsorption of the traditional DS so they go for the SADI-S. It’s up to you. We do make recommendations and each case is different. Each revision surgery is different, but ultimately you decide.

Lastly, the option we recommend for patients with a failed sleeve is the gastric bypass. The natural progression with the sleeve is the DS. You already have the first part done. But there are some situations that for medical reasons the doctors will recommend the gastric bypass. The most obvious example is when you have a very severe acid reflux and you’re having trouble controlling it with medication, then the doctors will recommend a gastric bypass done. The bypass will help you take care of the excess weight you still have and also it takes care of the reflux. So that would be a good options.

If you have any questions, if you want to send us x-rays, if you want our doctors’ opinion on whether your sleeve is effective or is there something to do with its construction, send them over and feel free to call us, we’ll be very happy to give you our opinion with the years of experience that our doctors have.

I hope this helps, I hope to see you soon. If you have any questions remember to visit mexicalibariatric.com or call us toll free at 888-344-3916.

Reasons for a failed Gastric Sleeve Surgery

Hi every one, I'm Nina and welcome to Mexicali Bariatric Center. Today I would like to talk to you about reasons why your Gastric Sleeve surgery might have failed. Before we start, I want to identify what somebody what somebody might label as “failed”. Let’s say that you needed to lose 150 pounds and you only lost 30, you might consider that a failure. There are patients that have called us that lost 150 pounds but regained all the weight. That is also considered a failed surgery. Another scenario might be needing to lose 150 pounds and only losing 100 pounds. Personally I wouldn’t consider that a failure, but if your expectations are not met, you may consider that the surgery has failed.

So, what happened? There are several reasons you might have a failed surgery with the sleeve. First (and this doesn’t mean is the most important) we have the construction of the sleeve. You might not have gotten a very good sleeve to start with. Surgery is not the only solution for your weight problem, but if you’re getting weight loss surgery you need a tool to lose that weight and keep it off. Having a good sleeve done by your surgeon is the first step. We find that many of them are not done in the way they should give patients an efficient tool, sometimes we find that sleeves are too big, or sometimes we find some sleeves that have a very large fundus and that, again, holds a lot of food. Third, you will find sleeves that have a very large antrum, which is a lower part… sometimes both of them are wrongly done, so you’ll see sleeves with bulges all over, and that holds a lot of food. What happens is that those sleeves can hold three to four times the amount of food that a tighter -and more efficient- sleeve might hold. Certainly you can lose some weight, but if you’re having a sleeve the better its construction the better your chances of long term success. And that is what you want.

There are things you can do to correct this. If the problem is of construction, it can be fixed through surgery, but we’ll discuss that later. Another reason why the sleeve might have failed is that you didn't change your eating habits. All surgeries are just tools to help you change your eating habits, the DS, the lap-band, the bypass, they are all focused on helping you change the way you eat, so the better the tool you have, the easier to change those habits and help you lose the weight. There’s no way around it: you need to get information from your doctor about protein, carb and water guidelines. Everybody that had surgery should get information on how to use your new tool. Another reason why you might have been failing with your sleeve is exercise. Some patients don’t need to exercise to lose weight lose weight and keep it off… but that’s the minority. Everybody else needs to exercise. And again, it’s not that if you don’t exercise you necessarily won’t succeed, is that you have another strong element in your favor to help you lose weight and keep it off. It doesn’t have to be 3 hours in the gym daily, it doesn’t even have to be 1 hour. It might be 3 times a week, walking 30 minutes a day… and making it part of your lifestyle. Remember, is about changing habits not only in what you eat but also in your physical activity.

Another very interesting situation is that sometimes patients call us that have a very tight sleeve years out of surgery, they are eating small amounts and following the guidelines, and they are doing some exercise. But they are stuck. Usually these patients are in the scenario I mentioned before in where they do lose weight but not what they expected. It’s like the sleeve will not take you any further, that’s where you are. Somebody that has been successful with the sleeve and has lost weight, might say “you haven’t done this or that”. But we mustn't jump to any conclusions. There are some patients that need the metabolic effect, the malabsorption part that maybe the DS or a Gastric Bypass offer; there are some patients that need additional help, but there’s also a solution for this patients. These patients sometimes follow strict dietary guidelines and still won’t lose a pound.

Lastly, about support. You need support from your community, your peers, your family… Talking to patients who have been through a similar situation always helps. Another kind of support is the one from your doctor’s office. It is important to have this type of communication for your doctor to offer solutions by knowing where you are. Calling your doctor and keeping him informed on your situation will always help. Be sure to have good communication with your doctor’s office.

If you are in any of these scenarios doesn’t mean that not having one of them you will necessarily fail, it means that you need to have a more solid foundation for your weight loss. It is like having a table with five legs: it will be more solid. If one of them is missing, it will be a little big harder. If your sleeve wasn’t properly constructed, you will need to rely harder on your eating habits, exercise and support to compensate for that. But you still can do it. Same thing if you don’t exercise. It is when you have everything in place that your chances of long term success will be higher. Try to focus in all aspects to have good results for the rest of your life.

If you need to take any X-Rays, there isn’t any cost, our doctors would be happy to review them and give you their opinion on the quality of your sleeve.

If you have any questions remember to visit mexicalibariatric.com or call us toll free at 888-344-3916.

Can I drink alcohol after having weight loss surgery?

Drinking alcohol after weight loss surgery

Welcome to Mexicali Bariatric Center. Today I would like to talk to you about another very popular question, “can I drink alcohol after my surgery?”. The answer is yes, definitely not immediately after surgery. You need to wait at least until you are on solid food. We recommend 3 to 6 months after surgery that you start considering having a drink now and then… on occasion and in moderation.

Now, there are several things to consider. If you are experiencing reflux, please do not start drinking, it will make it worse so avoid that. Another thing to consider is: alcohol has a lot of calories! So you might want to do the math and figure out if your having a few drinks and how many calories are in those. It may not be worth it. Finally, definitely alcohol will have a greater effect in your body, no doubt about that. Some studies suggest if affects you four times as much, but definitely it will affect you more. Take your precautions, never drink with an empty stomach.

Another recommendation we have: it does cause acid. If you know you are drinking tonight, in the morning you may take acid inhibitors and a few hours before drinking take another dosage, it will help you protect your stomach against the acid. Now, of course these are just recommendations regarding the physical aspects between alcohol and bariatric surgery. This has nothing to do with the psychological and emotional reasons on why would someone drink after surgery. I would leave a psychologist to talk about. But please drink responsibly, and of course never drink and drive.

I hope this helps and hope to see you soon For more information remember to visit mexicalibariatric.com or call us toll free at 888-344-3916.

Can I drink coffee after Bariatric Surgery?

Hi everyone, welcome to Mexicali Bariatric Center. Today I would like to talk to you about drinking coffee after surgery. I get asked a lot, “will I be able to drink coffee after surgery?” The answer is yes… but not right after surgery. There are two reasons why. The first one is that coffee has caffeine, and as you know caffeine is a diuretic. So right after surgery remember that our main concern is that you don’t get dehydrated, getting all your liquids in daily is very important. So by drinking coffee you are working against what we are trying to do. The second thing is that coffee makes your stomach produce more acid. As many of you know, with the gastric sleeve one of the “side effects” is acid reflux. For all our procedures (except the lap-band), we ask our patients to take acid inhibitors to regulate the amount of acid in your stomach. By trying to achieve that with medication, drinking coffee means going directly against what we’re trying to do. But again: you may drink coffee just not right after surgery.

Our recommendation at MBC is to wait at least 3 months. After that you can start introducing coffee into your daily routine, just two things: moderation and quantity. Don’t start with 5 or 6 cups a day, try one or two and see how it goes. If you see some negative effects such as nausea or acid reflux  then stop. Also be really careful on what you put into your coffee. Sometimes we receive  calls telling us that their weight loss has stalled, and when we go over what has changed, some patients make a stop at the coffee shop and add sweet flavors and cream to their drinks… when you check, sometimes it is 600 calories in just one drink. It won’t make sense cutting portions on food and then drinking it all in your coffee. Remember, the word is moderation.

I hope this helps. For more information remember to visit mexicalibariatric.com or call us toll free at 888-344-3916. 

Pre Op Diet for Bariatric Surgery

Pre Op Diet for Lap Band, Gastric Sleeve, Gastric Bypass and Duodenal Switch

Hi, my name is Nina and welcome to Mexicali Bariatric Center. Today I would like to talk to you about pre op diets. As you  already know we perform many types of surgeries and we’ll start with the pre op diet we ask our patients to do for the gastric sleeve and the lap band. For the gastric sleeve we don’t ask for an all-liquid diet. What we do instead is a high protein low carb diet. Before we schedule the procedure we ask our patients to to fill a medical form so the doctors can know more about them. These are reviewed by the internal medicine doctor and the surgeon, and they give a specific pre op diet to each patient. But the most common is a high protein low carb diet, which is not a liquid diet, for a period of seven, ten days, to 2 weeks. 

There are some circumstances where we have patients with a high BMI (60-90), for them we do a combination of liquid and solid diet. What we usually say to patients is that they have to start with a protein shake in the morning, they do one meal in the day, then another protein shake at night. They are able to have a couple of snacks during the day. Sugar free jelly, for example. We also give them a goal for the amount of protein ingested during the day, for the maximum amount of carbs and daily water intake. This is for the lap band and the gastric sleeve. 

For the gastric bypass it is a little bit different. Like in the other procedures, depending on the BMI we may start with a combination of a liquid and solid diet. Let’s say a patient gets a week or two of a liquid/solid pre op diet, then we ask for an all-liquid only diet 3 days before surgery with special guidelines for this part of the diet. As you know, with the gastric bypass the intestines are manipulated so the doctors need them to be in shape for surgery. 

Now, for the pre op diet before Duodenal Switch surgery, if we need patients to lower their BMI’s we start with a period of  the combination of solid and liquid diet, and the last 5 days prior  to surgery we do an all-liquid diet. We get some patients with very high BMIs and with them the mixed diet may take longer than two weeks, but as with other patients the last 5 days they need to follow an all-liquid diet. We also give our patients a list of foods to avoid two weeks before surgery that might fit into the pre op diet. 

Many patients ask us what happens if they want to follow these dietary guidelines for a longer time and that’s perfect. The longer you do it, the better. Risk will be reduced, the liver will shrink more… but patients need to be realistic. If you want to do it for four weeks instead of two, that’s fine. But make sure that those two weeks before surgery you are extra strict. Please, no cheating! It is important to not bend the rules and follow them strictly before surgery and according to what the doctor said. 

I hope this helps and hope to see you soon.

Gastric sleeve revision to Duodenal Switch by Dr. Ungson at MBC

Gastric sleeve revision to Duodenal Switch by Dr. Ungson at MBC

Hi, I’m Nina and welcome to Mexicali Bariatric Center. Today I will talk to you about revisions from the Gastric Sleeve to Duodenal Switch (DS) performed by board certified surgeon Dr. Gilberto Ungson. I wanted to share two cases that we had last month that are very interesting. In the first case a lady with a BMI in her mid 40’s contacted us. She had a sleeve done several years ago but it wasn’t very successful, she was sure she was eating too much because her sleeve was too big. So she was considering having her sleeve redone and then having a DS portion done as well. We scheduled her and it was agreed that the day before surgery we would check her sleeve to determine if in fact it needed to be received* or not.

Same day we had a lady scheduled that had a band converted to a sleeve. She knew she could only eat very little, she was sure her sleeve was small but she had lost very little weight and in fact, she started to regain some of it. She knew she needed the second part, she needed the malabsorption of the DS. Again, we rechecked her sleeve to make sure we were doing the right thing.

The ladies came in the day before surgery and we do case number one. After the X-Rays we confirmed that indeed her sleeve was very big, it had bulges at the top and at the bottom. Basically she had a sleeve that could hold two or three times what a tight sleeve should hold. We decided she needed to have her sleeve redone and at the same time have a DS. At that point we thought that if she had a tighter sleeve, a regular one, she might have been successful. In the second case, the lady with the low BMI, her sleeve was very tiny, very nice...so we stuck to the plan to do the DS part.

The day of surgery the first lady goes in and the doctor resleeved her, but when he starts doing the DS part he needs to measure in order to determine the lengths of the limbs. He found out that the lady had very long intestines way over the average. The doctor knew at that point that even with a tight sleeve she most likely wouldn’t have been successful. She needed the malabsorption, therefore she was happy to decide to have both parts done and not stay just with the resleeving. The second lady comes in and again the doctor starts measuring and again, this lady had very long intestines. This means that these two ladies could absorb more fat, more carbs, more calories basically. This was a lady that was eating very small portions but this wouldn’t work for either of them. We were happy that they scheduled for a second part and we are very sure they are going to be very successful.

I was very excited about all of this so I asked the doctor “how can we know if a patient’s intestines are too long? Is there a test, an X-ray or something to determine if they need a DS from the get-go and not need to wait until a sleeve fails”. Sadly the answer was no. There’s no not-invasive procedure to determine the length of the intestines. Only at the time of surgery when the doctor is measuring will he know how long they are. Nevertheless, that is good information to have for the patient to consider a malabsorptive procedure like the Duodenal Switch or the bypass. Do you notice that when you eat small portions you still won’t lose weight? Do you think you need something more? That’s something to consider.

I hope this helps and hope to see you soon.

What are my options for lap-band revision surgery?

Options for lap-band revisions

Hi everyone, I’m Nina. Welcome back to Mexicali Bariatric Center. I’m going to talk to you about revision surgery, specifically those for lap-bands. There are many reasons why someone would want to have a possible revision from their original surgery. Most of the times is lack of weight loss or weight regained, sometimes is because a patient started to have technical problems with their bands. We are a revision center with doctors specialized in revision surgery, and there are some procedures we recommend the most.

First let me tell you what we longer do because of poor long term results for our patients. We are no longer relocating bands. Years ago, when somebody had a slipped band, we used to go in and put the band back in place and stitch it back where it’s supposed to be. But invariably over 90% of the time the band would slip again and would have to be removed. So that wasn’t even a short term solution since sometimes that took about a year to happen. Another thing we would be doing is that when someone wanted to have their band removed and wanted another lap-band, we would go ahead and do it, sometimes a larger one, sometimes a newer one… but then again, the results were not very good. In a short to medium term the band was usually removed. We are not comfortable with that.

The options that we do recommend that are long term solutions is revising from your band to the sleeve, DS or gastric bypass. We do these revisions laparoscopically and in a single procedure. The only reason we wouldn’t do it in a single stage is in the case of an eroded band. In those cases the protocol is to remove the band, let the stomach heal somewhere between 6 months and a year, and afterwards the patient can consider another weight loss surgery like sleeve, DS or bypass. Certainly in some cases the risk is higher, so the patient needs to evaluate that plus the cost, his needs and then move forward. But it can be done. Having said that, the other cases we do them 100% of the time in a single procedure. If you find that you are being told that there's a 30% chance or a 50% chance of not having it done in a single procedure, you might consider visiting a Revision Center where doctors are highly experienced in revision surgery. We have been doing them for a very long time and revision for lap-bands are the ones we do the most.

Lets start off with the revision from band to sleeve. Some doctors recommend that if you already failed in a restrictive procedure like the lap-band do not go to a restrictive one like the gastric sleeve. They would recommend to go to a malabsorptive procedure. There are many patients, though, that after failing with the band do very good with the sleeve. So when patients contact us wanting us to decide for them and tell them what to do, we can only make recommendations and encourage them to analyze why the band didn’t work for them. If, lets say, you lost 100 lb or 150 lb and then started to have technical problems, i.e. a leak in your port, or it suddenly is too tight or too loose and afterwards you regained weight, you can conclude that just cutting portions is not enough for you. If you limit your food intake it will be enough to lose weight. So then a restrictive procedure would be a good option. Now, it is very important to be honest moving on. Were you following the guidelines? If you did but you did not get the results you were hoping for, then most likely another restrictive procedure would not be very helpful, you most likely need a malabsorptive one.

If you are going for the sleeve in your revision surgery because you think this procedure is enough for you, you still need to have a good effective sleeve. We redo many of them so we know some are done very irregularly (some of them are too big), so have it done at a place where they know how to do revision surgeries, it's not the same thing. Some times we find that they just go around the band's scar tissue, so patients end with a bulge on the top that holds a lot of food, you must pay attention to that. But if you have your sleeve done appropriately, that should be enough for you.

There are some other patients that know that just cutting food portions is not enough. Sometimes when we go over what they have been eating it really isn’t very much. After analyzing their calorie intake and exercise done, it is very obvious that they need something else. Is just the way people are and some patients need the help of a malabsorptive procedure. There are some revision surgery options like the gastric bypass or the duodenal switch. Either of them is a very good option and both are safely done in a single procedure and by laparoscopy.

These procedures are the ones we truly believe will help you lose weight and keep for long term success.

Hope to see you soon.

Can I get pregnant after a Gastric Sleeve Surgery?

Can I get pregnant after having Gastric Sleeve Surgery?

Hi everyone, I’m Nina, welcome to Mexicali Bariatric Center. The question that I wanted to share with you today is about a call I got yesterday from a very young patient that just scheduled surgery for next month. Her wedding is only a year away. She’s actually having surgery to be ready for her wedding and she wanted to know if she can get pregnant after gastric sleeve surgery. The answer is: yes you can. Same answer applies to other weight loss surgeries like the gastric bypass, lap-band, DS, etc.

We actually have patients that want to have gastric sleeve surgery because they want to get pregnant. Sometimes the doctor has told them they cannot get pregnant because of their weight so they come in to have surgery and several months or a year later, we receive pictures all the time of them getting pregnant or even of the baby himself. Weight loss surgery is actually something that helps you become pregnant by becoming more fertile. 

Now, there are recommendations of course: we ask you to wait at least a year before getting pregnant. During this first year is when you will be losing weight very rapidly, your sleeve will still be very small, so take advantage of that period and try to avoid getting pregnant. Another recommendation is please take some form of birth control. Some of our patients tell us “no, I don’t have any problem, my period is very regular, I can take care of myself and it’s been a while since I became pregnant”. But as you lose weight you will become more fertile. We have patients that get pregnant without planning it and sometimes only a few months after surgery, so please do take some form of birth control.

Now, the good thing is that when patients have gastric sleeve surgery and then get pregnant, their pregnancies are much healthier. They gain only a little weight, so it is very easy to lose it afterwards since the stomach is still very small. Another concern patients have is about eating enough food for them and their babies with the sleeve. The answer is yes you will. You will follow the same protocol and recommendations as you would without surgery. Go to your doctor monthly, take the supplements they give you… just to everything the same. The only difference is that instead of eating three big meals a day, you will be eating several small meals. That’s the only difference. Besides that, resting, water, etc, stays the same.

I hope this helps and hope to see you soon.