Laparoscopic Bariatric Procedures


		Laparoscopic Bariatric Procedures

Laparoscopic Bariatric Procedures: Physician Section: Patients Instructions

DISCLOSURE DOCUMENTS: SECTION 4

Outcome Analysis

Desirable and Undesirable Outcomes after Gastric Bypass with Roux en Y Reconstruction (Open or Laparoscopic)

It is reasonable to undergo a bariatric surgical procedure to improve your health. However, patients should not enter into this surgical commitment for cosmetic reasons or for other social factors. A bariatric surgical procedure will not resolve all you weight and eating problems. It is simply an instrument or a "catalyst" to help you manage your weight. Motivated patients who really want to change their life style and improve their health will do well.

Surgical Outcome Analysis

The overall performance results of the Laparoscopic or Open Gastric Bypass with Roux enY Reconstruction can also be broken down as follows:

Optimal Surgical Outcome	70 to 75% of Patients: Patients achieve sustained, major weight loss [over 80 % of their excess weight loss} without major complications and significantly improve their co-morbid factors.
Sub-optimal Surgical Outcome	20% of Patients: Patients have lost a significant excess weight but have failed to reach their target weight. Some patients in this group will require "coaching" to reach their target weight or to lose more weight.
Poor Surgical Outcome	5 - 10% of Patients: Patients will initially lose a significant weight but will ultimately failed to reach their target weight.

However, statistically, the morbidly obese patients who decide to undergo a bariatric surgical procedure do better and live longer than if they did not.

Surgical Complications Analysis

Our surgical complication rate can be summarized as follows.

- 2- 4 % of the patients may develop a surgical complication which may require a surgical re-exploration [a second procedure]. This is usually secondary to post-operative bleeding or occasionally secondary to a intestinal obstruction. Our most recent statistics are demonstrating this rate is decreasing.

- 1 to 0.2% of the patients may develop a pulmonary embolus [blood clot traveling to the lung]. This is a very serious complication which has prompted our surgical team to initiate extensive preventive measures.

- To date, we have had no mortality or death. However the mortality or death rate for this procedure is reported to be 0.1 to 0.4% nationally.

- 96 to 98% of all patients will undergo this procedure without experiencing any significant complications or problems.

Pshycho-social Impact of the Procedure

Prospective patients must be aware that if the surgery creates the effects it is intended to, it will also cause dramatic and irrevocable changes in their lifestyle, in all of their personal relationships (not always good changes) and in their relationship with food. A social and psychological re-adjustment will be necessary. For these reasons, we promote the extensive use of our support groups by our patients.

Medical Impact of the Bariatric Procedure

Weight loss and the subsequent improvement in medical problems generated by the morbid obesity are the desired outcomes of any bariatric surgical procedure. The average patient will lose on the average 75 to 80 % of their excess weight. About half of this weight loss occurs over the first 3 months after surgery, and then gradually until the patient reaches a weight equilibrium 12 or 15 months following the laparoscopic gastric bypass with Roux en Y reconstruction

The weight loss generated by this bariatric procedure will have a significant, positive impact on various medical conditions associated with obesity. These expected effects are outlined below:

	Very likely to improve or resolve: Diabetes, High Blood Pressure (Hypertension), Obstructive Sleep Apnea, Pickwickian syndrome, Gastro-esophageal Reflux Disease (GERD), Knee pain.
	Most likely to improve: Congestive Heart Failure (CHF), Hypercholesterolemia, Hypertriglyceridemia, Urinary incontinence, Menstrual irregularity, infertility, Back pain, Hirsutism (women), Infertility (women), Pseudotumor cerebri.
	Unlikely to improve: Depression, Vascular disease, Arthritis.