REVOLUTION BARIATRIC

Our goal is to ensure your experience is positive, helpful and effective. 

You are not “auditioning” or “trying out” for surgery.  Your autonomy is paramount for your experience in preparing you for surgery to be positive and helpful.  Perfection is not required.  We understand that there can be wide variation among our patients in terms of the challenges to behavioural change and the amount of changes that are required.  Our goal is to help support you, and meet you where you are in the process.  We work with patients along the way helping support, guide and coach you in your readiness for life post surgery.  You are followed long term after surgery.  Many of these behaviours will be a ‘work in progress’ even after surgery.  To ensure the safest and most effective health outcomes, with the least amount of complications post surgery, and to provide a more positive experience for you post surgery, requires that these evidence-based behaviours and targets are met.

TYPES OF SURGERIES PERFORMED:

Below are some details about the most common surgeries performed:

VERTICAL SLEEVE GASTRECTOMY:

The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.

The Procedure

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Advantages

1. Restricts the amount of food the stomach can hold

2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%

3. Requires no foreign objects (lap band), and no bypass or re-routing of the food stream (gastric bypass)

4. Involves a relatively short hospital stay of approximately 2 days

5. Causes favourable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Disadvantages

1. Is a non-reversible procedure

2. Has the potential for long-term vitamin deficiencies

3. Has a higher early complication rate than the AGB

ROUX EN Y GASTRIC BYPASS

(Pronounced: ROO-ON-WHY)

The Procedure

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 millilitres in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.

Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Advantages

1. Produces significant long-term weight loss (60 to 80 percent excess weight loss)

2. Restricts the amount of food that can be consumed

3. May lead to conditions that increase energy expenditure

4. Produces favourable changes in gut hormones that reduce appetite and enhance satiety

5. Typical maintenance of >50% excess weight loss

Disadvantages

1. Is technically a more complex operation than the sleeve or a lap band and has a small increase in complication rates.

2. Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate

3. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance

SADI- Single Anastamosis Duodenal Ileal Bypass

Laparoscopic Single Anastomosis Duodenal-Ileal bypass with Sleeve, also known as SADI-S, is one of the most powerful bariatric techniques to achieve weight loss. It is a good option for patients with severe obesity, either as primary surgery or as a revisional procedure after a sleeve gastrectomy. It can be done in a single surgery or a two stage procedure. It is a relatively new procedure (since 2015) that is gaining popularity in the bariatric world.

SADI-S is a laparoscopic procedure that can be performed.  It consists of two steps. In the first one, called “sleeve gastrectomy”, the stomach is reduced and narrowed like a tube to reduce the stomach capacity (almost 80% of the stomach is removed). In the second step, a small bowel bypass is performed to reduce the surface for food absorption. Specifically, the middle part of the small bowel is excluded from food transit.

After this second step, the first part of the small bowel, called the duodenum, is connected to the distal small bowel (named ileum). In short, after this operation, the food travels from the small new stomach to the distal intestine bypassing a long segment of the small bowel, which remains in the abdominal cavity, but is excluded from the food circulation. These anatomical changes decrease oral intake and reduce the absorption of the nutrients and calories eaten.

ADVANTAGES: Patients who undergo this procedure can lose up to 70% of excess of weight in one year, a weigh loss that is generally maintained afterwards. It is a bariatric procedure with high success rates in the resolution of Type 2 Diabetes, high cholesterol, high blood pressure and sleep apnea.

SADI-S is generally well tolerated.

Disadvantages: A SADI-S is a more complex surgery and surgical complications are more frequent than with other bariatric procedures. Furthermore, it might have other long-term side effects such as vitamin deficiencies (specifically fat soluble vitamins A, D, K and E), calcium, zinc and iron deficiencies as well as an increased risk for protein and fatty acid hypoabsorption.

Frequent bowel movements can also happen after surgery. Bowel movements frequency depends on the amount of fibre and water consumption. A few patients refer biliary reflux (bitter taste), in which case an endoscopy is warranted.

To reduce these side effects, adequate education and preparation of the patients is mandatory before and after the surgery. All patients should be followed closely by a bariatric clinic.