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Bariatric Surgery

This page is to help inform Veterans about bariatric surgery care here at the Ralph H. Johnson VA Health Care System.

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Obesity puts your health at risk

Living with excess weight has been shown to put your health at risk, which increases as your obesity becomes more severe.  Obesity dramatically increases the risk of type 2 diabetes, high blood pressure, high levels of triglycerides, heart disease and stroke, arthritis, and obstructive sleep apnea. Higher body weights are also associated with cancer and early death. Without the medical intervention that bariatric surgery provides, many patients with severe obesity are not successful in managing their weight and related health conditions.

Feel good about your decision

If you’ve been trying to lose and maintain weight but you haven’t had any luck, you may need to alter the complex relationship your body has with food and its metabolism.

Getting Started

Informational Sessions first Thursday of each month at 12:30 - 1pm Video Connect VVC

Contact Bariatric Dietitian to sign up for Information Session at 843-577-5011, ext. 205497

WHO QUALIFIES FOR BARIATRIC SURGERY?

BMI >30 at time of surgery consult

AGE <70

COMPLETED 3 MONTHS OF THE MOVE! WEIGHT MANAGEMENT PROGRAM and actively working with dietitian

Weight trending downward and maintained

NEGATIVE NICOTINE URINE TEST

NEGATIVE DRUG/ALCOHOL URINE TEST

STABLE CONSISTENT CLEAN/LEAN HEALTHY DIET

Consistent active lifestyle

Behavioral and mental health stability including home environment, social support, and coping skills

What you can expect

Bariatric surgery is done in the hospital using general anesthesia. This means you're unconscious during the procedure.

The specifics of your surgery depend on your individual situation, the type of weight-loss surgery you have.  Some weight-loss surgeries are done with traditional large incisions in your abdomen. This is known as open surgery.

Today, most types of bariatric surgery are performed laparoscopically. A laparoscope is a small, tubular instrument with a camera attached. The laparoscope is inserted through small incisions in the abdomen. The tiny camera on the tip of the laparoscope allows the surgeon to see and operate inside the abdomen without making the traditional large incisions. Laparoscopic surgery can make recovery faster and shorter, but it's not suitable for everyone.

Surgery usually takes several hours. After surgery, you awaken in a recovery room, where medical staff monitors you for any complications. Depending on your procedure, you may need to stay a few days in the hospital.

Procedures

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Here are video examples of the Gastric Bypass Procedure, Roux-En-Y Bypass, and Vertical Sleeve Gastrectomy Procedure.

Roux-En-Y Gastric Bypass

Roux-en-Y Gastric Bypass (RYGB) is known as the gold standard of weight loss surgery. Gastric bypass is the most commonly performed weight loss surgery in the United States. This surgery reduces the size of the stomach and  "reroutes” the intestines making it both a restrictive and malabsorptive procedure. In this surgery, the stomach is completely divided with staples creating a small (30 cc) stomach pouch. This becomes the new reservoir that holds food. The remainder of the stomach is no longer used, and is referred to as the excluded stomach. The small bowel is then divided using a stapler. The intestine that is further away (called the Roux limb) is pulled
up and connected to the newly formed pouch. The other end of the divided small bowel (known as the biliopancreatic limb) is connected into the side of the Roux limb of the intestine creating a “Y” shape.

Vertical Sleeve Gastrectomy 

The sleeve gastrectomy is a non-reversible procedure which provides gastric restriction and appetite suppression. In this surgery, the stomach is divided along its vertical length using a stapler. The left side of the stomach (80%-85% of the stomach) is sugicaly removed.  The remaining stomach will become a "sleeve" or tube shaped stomach about the size of a banana. 

Single Anastomosis Duodenal-Ileostomy Switch

SADI reduces the size of the stomach and re-routes the intestines making it both a restrictive and malabsorptive procedure.

In this surgery, the stomach is divided along its vertical length using a stapler. The left side of the stomach (~80-85% of the stomach) is surgically removed.  This part of the surgery is not reversible. The stomach that remains is shaped like a thin banana and measures 4 -7 ounces (120-250mL).

The intestines are divided and rearranged to separate the flow of food from the flow of digestive juices, thereby creating malabsorption.  These changes mean that your food does not mix with the enzymes and other digestive juices until very far down in the small intestines.  This results in a significant decrease in the absorption of calories, fats, proteins, vitamins and minerals.

At the Ralph H. Johnson VAMC, we routinely perform SADI using minimally invasive surgery.  This is done by making several small cuts in the abdomen.  Plastic tubes, called ports, are placed through these cuts.  A camera and other small instruments are then put through the ports. This allows access to inside the abdomen.  A robot may also be used to assist during surgery.  Sometimes, the surgeon may not be able to perform the surgery only using small cuts.  The surgeon may have to make a large cut in the abdomen

Getting to Know Your Team

Send us a secure email message using My HealtheVet at www.myhealth.va.gov to “Charleston Bariatric Surgery”

24-Hour Telephone Advice Line (TAP)

843-789-6400

1-888-878-6884

Surgeon

Dr. Rana Pullatt

Dr. Mary Kate Bryant

Program Coordinator/Physician Assistant

Emily Couture, PA-C

843-577-5011, ext. 205503

Registered Dietitian

Mary Walker, MS, RDN, LDN, CNSC

843-577-5011, ext. 205497

Pharmacists

Dr. Elizabeth Hamilton &

Dr. Natalie Kurtkaya

843-789-6081

Psychologist

Dr. Jeffrey Schneider

843-789-7406

Bariatric Vitamins/Mineral requirements

Required for Life!

Vitamin and mineral deficiencies may occur after surgery because your new pouch is simply too small to get all of the nutrition your body requires from food alone.

• These supplements do not take the place of a healthy diet, but they can enrich it! Supplements do not provide energy but are needed to stay healthy.

• Read labels on vitamins too! A serving size can very from 1 to 4 pills in order to get the nutrient content listed. Make sure the dose and form of the vitamin is what your bariatric team advised.

And if you’re not sure, ASK!

• While you are on the pureed diet, you will need to chew or crush your supplements. You may also switch from chewable to regular supplements after the first three months. 

• It is recommended that you start your vitamins prior to surgery

• Avoid gummies as the do not contain iron nor all the vitamins/minerals you will need

You will need to take the following supplements for the rest of your life unless you are told otherwise by your medical team:

A complete multivitamin – A serving size can very from 1 to 4 pills in order to get the nutrient contnet listed. This must contain Iron, Folate, and Vitamins A, D, E and K. (Try Flintstones Complete or Centrum chewables.) Start following discharge from the hospital.

Make sure the Multivitamin has the following:

Thiamine (B1)-12mg                                 Folate - 400-800mcg

Iron - 45-60gm                                           Vitamin D – 3,000IU

Vitamin E 15mg           

Vitamin A – 5,000-10,000 IU for Sleeve/Gastric bypass and 10,000 for Duodenal Switch/SADI,

Vitamin K - 120mcg for Sleeve/Gastric Bypass and 300mcg for Duodenal Switch/SADI

Zinc - 8-22mg for Sleeve/Gastric Bypass and 16-22mg for Duodenal Switch/SADI

Cooper - 1mg for Sleeve/Gastric Bypass and 2mg for Duodenal Switch/SADI

 

Vitamin B12 – you will need 500mcg per day. B12 can be taken as a liquid, a tablet that you place under your tongue (sub-lingual) or as a monthly injection. Start following discharge from the hospital.

Calcium Citrate/Vitamin D – you will need 1200- 1500 mg per day for Sleeve and Gastric Bypass. 

You will need 1800-2400mg/dl for Duodenal Switch/SADI.

You want to take Citrate, NOT Carbonate (which is not absorbed as well in the body). Do not take more than 600mg of calcium at a time, because more than that won’t be absorbed. This means taking your calcium citrate pill multiple times per day.

You can wait to start Calcium until 1 month post-op.

You may also be asked to take additional vitamins/ minerals based on lab values – Iron, extra fat soluble vitamins (Vitamins A, D, E, K), Vitamin C, among others. Your bariatric team will let you know.