Medically,
the word "morbid" means causing disease or
injury. Morbid Obesity
is a serious disease process,
in which the accumulation of fatty tissue on the body
becomes excessive, and interferes with, or injures the
other bodily organs, causing serious and life-threatening
health problems, which are called co-morbidities.
Obesity becomes "morbid"
when it reaches the point of significantly increasing
the risk of one or more obesity-related health conditions
or serious diseases, also known as co-morbidities. These
co-morbidities are conditions or diseases that result
in either significant physical disability or even death.
As you read about morbid obesity you may also see the
term "clinically severe obesity" used. Both
are descriptions of the same condition and can be used
interchangeably. Morbid obesity is typically defined
as being 100 lbs. or more over ideal body weight or
having a Body Mass Index of 40 or higher. Morbid obesity
is a serious disease and must be treated as such. It
is a chronic disease, meaning that morbid obesity symptoms
build slowly over an extended period of time.
HEALTH
EFFECTS OF MORBID OBESITY
Severe
obesity damages the body by its mechanical, metabolic
and physiological adverse effects on normal bodily function.
These "co-morbidities" affect nearly every organ
in the body in some way, and produce serious secondary
illnesses, which may also be life-threatening. The cumulative
effect of these co-morbidities can interfere with a normal
and productive life, cause endless frustration and can
seriously shorten life, as well.
Shortened Life Span
Dysmetabolic Syndrome X
This recently recognized syndrome, involving abdominal
obesity, abnormal blood fat levels, changes in insulin
sensitivity, and inflammation of the arteries, is
assciated with a markedly increased risk of heart
and blood vessel disease. It is also a precursor to
the onset of Diabetes in adults.
Heart Disease
Severely obese persons are approximately 6 times as
likely to develop heart disease as those who are normal-weighted.
Heart disease is the leading cause of death in the
world today, and obese persons tend to develop it
earlier in life, and it shortens their lives. Coronary
disease is pre-disposed by increased levels of blood
fats, and the metabolic effects of obesity. Increased
load on the heart leads to early development of congestive
heart failure. Severely obese persons are 40 times
as likely to suffer sudden death, in many cases due
to cardiac rhythm disturbances.
High Blood Pressure
Essential hypertension, the progressive elevation
of blood pressure, is much more common in obese persons,
and leads to development of heart disease, and damage
to the blood vessels throughout the body, causing
susceptibility to strokes, kidney damage, and hardening
of the arteries. If your doctor finds you have high
blood pressure, the first thing he or she will recommend
to you is weight loss (but doctors have never been
able to tell us how).
High Blood Cholesterol
Cholesterol levels are commonly elevated in the severely
obese -- another factor predisposing to development
of heart and blood vessel disease. This abnormality
is not just related to diet, but is an effect of the
massive imbalance in body chemistry which obesity
causes.
Diabetes Mellitus
Overweight persons are 40 times as likely to develop
Type II, Adult-Onset, Diabetes. Elevation of the blood
sugar, the essential feature of Diabetes, leads to
damage to tissues throughout the body: Diabetes is
the leading cause of adult-onset blindness, a major
cause of kidney failure, and the cause of over one
half of all amputations. Diabetics suffer severely
from their disease, and once Diabetes occurs, it becomes
even much harder to lose weight, because of hormone
changes which cause the body to store fat even more
than before.
Sleep Apnea Syndrome
Sleep apnea -- the stoppage of breathing during sleep
-- is commonly caused in the obese, by compression
of the neck, closing the air passage to the lungs.
It leads to loud snoring, interspersed with periods
of complete obstruction, during which no air gets
in at all. The sleeping person sounds to an observer
like he is holding his breath, but the sleeper is,
himself, usually unaware that the problem is occurring
at all, or only notices that he sleeps poorly, and
awakens repeatedly during the night. The health effects
of this condition may be severe, high blood pressure,
cardiac rhythm disturbances, and sudden death. Affected
persons awaken exhausted and often fall asleep during
the day -- sometimes even at the wheel of their car,
and complain of being tired all the time. This condition
really has a high mortality rate, and is a life-threatening
problem.
Obesity Hypoventilation Syndrome
This condition occurs primarily in the very severely
obese -- over 350 lbs. It is characterized by episodes
of drowsiness, or narcosis, occurring during awake
hours, and is caused by abnormalities of breathing
and accumulation of toxic levels of carbon dioxide
in the blood. It is often associated with sleep apnea,
and may be hard to distinguish from it.
Respiratory Insufficiency
Obese persons find that exercise causes them to be
out of breath very quickly, during ordinary activities.
The lungs are decreased in size, and the chest wall
is very heavy and difficult to lift. At the same time,
the demand for oxygen is greater, with any physical
activity. This condition prevents normal physical
activities and exercise, often interferes with usual
daily activities, such as shopping, yard-work or stair
climbing, making even ordinary living difficult or
miserable, and it can become completely disabling.
Heartburn - Reflux Disease
and Reflux Nocturnal Aspiration
Acid belongs in the stomach, which makes it to help
digest your food, and it seldom causes any problem
when it stays there. When it escapes into the esophagus,
through a weak or overloaded valve at the top of the
stomach, the result is called "heartburn",
or "acid indigestion". The real problem
is not with digestion, but with the burning of the
esophagus by the powerful stomach acid, getting to
where it doesn't belong.. When one belches, the acid
may bubble up into the back of the throat, causing
a fiery feeling there as well. Often this occurs at
night, especially after a large or late meal, and
if one is asleep when the acid regurgitates, it may
actually be inhaled, causing a searing of the airway,
and violent coughing and gasping.
This condition is dangerous, because of the possibility
of pneumonia or lung injury. The esophagus may become
strictured, or scarred and constricted, causing trouble
with swallowing. Approximately 10 - 15% of patients
with even mild sporadic symptoms of heartburn will
develop a condition called Barrett's esophagus, which
is a pre-malignant change in the lining membrane of
the esophagus, a cause of esophageal cancer.
Asthma and Bronchitis
Obesity is associated with a higher rate of asthma,
about 3 times normal. Much of this effect is probably
due to acid reflux (described above), which can irritate
a sensitive airway and provoke an asthmatic attack.
The improvement of asthma after surgery is often very
dramatic, even before much weight loss has occurred.
Gallbladder Disease
Gallbladder disease occurs several times as frequently
in the obese, in part due to repeated efforts at dieting,
which predispose to this problem. When stones form
in the gallbladder, and cause abdominal pain or jaundice,
the gallbladder must be removed.
Stress Urinary Incontinence
A large heavy abdomen, and relaxation of the pelvic
muscles, especially associated with the effects of
childbirth, may cause the valve on the urinary bladder
to be weakened, leading to leakage of urine with coughing,
sneezing, or laughing. This condition is strongly
associated with being overweight, and is usually relieved
by weight loss.
Degenerative Disease of Lumbo-Sacral
Spine
The entire weight of the upper body falls on the base
of the spine, and overweight causes it to wear out,
or to fail. The consequence may be accelerated arthritis
of the spine, or "slipped disk", when the
cartilage between the vertebrae squeezes out. Either
of these conditions can cause irritation or compression
of the nerve roots, and lead to sciatica -- a dull,
intense pain down the outside of the leg.
Degenerative Arthritis of Weight-Bearing
Joints
The hips, knees, ankles and feet have to bear most
of the weight of the body. These joints tend to wear
out more quickly, or to develop degenerative arthritis
much earlier and more frequently, than in the normal-weighted
person. Eventually, joint replacement surgery may
be needed, to relieve the severe pain. Unfortunately,
the obese person faces a disadvantage there too --
joint replacement has much poorer results in the obese,
and complications are more likely.. Many orthopedic
surgeons refuse to perform the surgery in severely
overweight patients
Venous Stasis Disease
The veins of the lower legs carry blood back to the
heart, and they are equipped with an elaborate system
of delicate one-way valves, to allow them to carry
blood "uphill". The pressure of a large
abdomen may increase the load on these valves, eventually
causing damage or destruction. The blood pressure
in the lower legs then increases, causing swelling,
thickening of the skin, and sometimes ulceration of
the skin. Blood clots also can form in the legs, further
damaging the veins, and can also break free and float
into the lungs -- called a Pulmonary Embolism -- a
serious or even fatal event.
Emotional/Psychological Disease
Seriously overweight persons face constant challenges
to their emotions: repeated failure with dieting,
disapproval from family and friends, sneers and remarks
from strangers. They often experience discrimination
at work, and cannot enjoy theatre seats, or a ride
in a bus or airliner. There is no wonder, that anxiety
and depression might accompany years of suffering
from the effects of a genetic condition -- one which
skinny people all believe should be controlled easily
by will power.
Social Effects
Seriously obese persons suffer inability to qualify
for many types of employment, and discrimination in
employment opportunities, as well. They tend to have
higher rates of unemployment, and a lower socioeconomic
status. Ignorant persons often make rude and disparaging
comments, and there is a general societal belief that
obesity is a consequence of a lack of self-discipline,
or moral weakness. Many severely obese persons find
it preferable to avoid social interactions or public
places, choosing to limit their own freedom, rather
than suffer embarassment.
Deciding to have weight loss surgery can be difficult.
But for many obese people, it offers a treatment option
that can lead to a healthier life. Weight Loss Surgery
Options provides you with an introduction to obesity
surgery and explains who qualifies for weight loss
surgery.
Many obese people are turning to stomach surgery
to help them get on the road to a healthier life.
Learn about the different procedures doctors are performing
for weight loss
Benefits of Bariatric Surgery
The benefits of this surgery are more than skin deep. Baraitric Surgery will not only help you look better; more importantly, with proper post-surgical care, it will help you feel better and healthier.
Most patients lose at least 50 per cent of excess body weight. Most people with hypertension and/or diabetes no longer need medications.
A return to normal periods for young women with abnormal or absent menses and improvement of fertility. Improved sexual function for many males. Reduction of periods of sleep apnea. Eliminates or slows the disabling effects of arthritis. Improved self-esteem and more energy.
PROCEDURES
FOR OBESITY SURGERY
Different
types of surgery for treating Obesity or Surgical Operations
for Morbid Obesity
The
Laproscopic Adjustable Gastric Banding
The
band is placed laparoscopicaly “key hole surgery”.The
band can be adjusted by injecting fluid into it as an
outpatient.Reversible Hospital stay 2-3 days
In this procedure a band made of silastic
material is placed around the stomach near its upper
end creating a small pouch and narrow passage into the
larger remainder of the stomach.
The surgery involves forming a small pouch in the upper
part of the stomach that effectively becomes a new baby
stomach. The sialistic band is wraped around the upper
portion of stomach all around to form a "baby stomach."
The narrow opening or stoma is formed by the bands two
ends joining together. This band has a balloon on it
which can be inflated or deflated in later stages so
as to increase or decrease the size of stoma. This step
makes the SAGB a stoma adjustable operation. This can
be done anytime after the operation with the help of
port kept under the skin at the time of operation, Now
the food still goes down the normal way and is digested
in the bowel normally. The big difference is that the
pouch will only allow a very small amount to be fitted
in at one time and when this happens satisfaction is
achieved and hunger will subside until the pouch eventually
empties into the duodenum. So you feel full after eating
a small amount of solid food and your intake of food
can be kept to two or three tiny meals a day with no
desire to eat between meals.
Advantages
of The Laproscopic Adjustable Gastric Banding
There are several weight loss surgeries available today
but adjustable Gastric Band is superior to many of them.
It has several features that make it the safest method
of weight control.
Simplicity - The procedure is simple to perform
with a short operating time.
It can be placed laparoscopically without a large
incision.
It does not require any opening in the gastrointestinal
tract that reduces the risk of infection.
Safety: There is no staple line to burst.
It is adjustable and can be customised to individual
needs.
It is fully reversible. The band can be emptied,
for example, during pregnancy or prolonged illness
allowing your stomach to return to former configuration
or it can be removed (although removal is not indicated)
It is tolerated well by most persons of all ages
and physical conditions.
This operation may be particularly suited to persons
who are from 80 to 200 pounds overweight.
Short hospital stay (around 24 hours)
Lowest complication rate.
There is no mal-absorption or "dumping syndrome."
The person can fully digest vitamins and minerals
Frequently
Asked Questions for Laproscopic Adjustable Gastric Banding
Who
is a Good Candidate for Adjustable Gastric Banding?
You may be eligible for the lap band system surgery
if :
Your BMI is =40, or you weigh twice your ideal
weight or are at least 100 pounds (45Kgs.) more than
your ideal weight.
You have been overweight for more than 5 years
Your serious weight loss attempts have had only
short-term success.
You are not suffering from any other diseases that
may have caused your obesity.
How
much weight will I lose?
This is not predictable; most of the
patients will never be skinny people. But the majority
can and do achieve a normal, healthy weight for their
height and bone structure. Success after bariatric surgery
is defined as losing 50 percentage of excess body weight.
After a Laparoscopic Adjustable Gastric Banding, one
loses an average 60 percentage of excess body weight
at 18 months.
What
are the main differences between the Adjustable Gastric
Band and the gastric bypass?
A
Lap-Band
Gastric Bypass
Complexity
Simple
Moderate
Reversibility
Easier in general
Reversible but moderately difficult
Laparoscopic
Yes
Yes
Relative Early Risk
Lower
Moderate
Expected hospital stay
1 night
3-4 nights
Mortality
0.1%
0.4%
Statistical AverageWeight Loss (2 years)
50-60% of Excess weight
70 -75% of Excess weight
Possible Late-Term Risks
Band slippage, port complications, erosions, Lap-Band
infection, esophageal dilatation
Ulcers, anemia, stricture, vitamin/
calcium / iron defeciencies, intestinal obstruction
Risk of Malnutrition
Minimal
Low
With
both these options, how do I choose the right one?
After educating yourself to all the aspects of these
operations you can decide with your surgeon which is
the best operation. Both the operations can be performed
laparoscopically in almost everyone.
The Lap-Band requires significant post-operative
manipulation, has a re-operative rate that is high,
but is the simplest procedure to perform. The Lap-Band
probably has the lowest average weight loss and is a
much slower weight loss than the other operations. The
operative mortality is the lowest of all the procedures.
There are occasional patients that do not lose significant
weight after this operation
The gastric bypass is the most studied
of all the bariatric operations. It is generally a safe
and effective operation. There is a higher early complication
rate than the Lap-Band.
Is
it true that I'll never be able to enjoy eating again
if I have weight control surgery?
No. Patients who follow the guidelines to eating after
weight control surgery will become people who eat food
for quality and flavor, not for volume. They enjoy food
more after surgery than they did before surgery. They
pay more attention to what they are eating, are often
pickier eaters, and don't feel guilty about eating food.
Are
there foods I can no longer eat?
You will be on a liquid diet at first progressing to
a soft diet then to solids for the six-week healing
phase. When properly adjusted, there are some foods
that no longer are as easy to eat but most of bandsters
can eat anything, just very small amounts. One can have
trouble with soft mushy breads, tough or dry meats,
skins of certain fruits or vegetables such as grapes,
potatoes and tomatoes or very fibrous foods like asparagus
or pineapple.
What
should I be eating?
A. Protein and produce, if it isn't one of those two
items then it is something that should not be part of
your daily diet. Chicken and vegetables, Beef and vegetables,
Fish and vegetables, some fruit thrown in there and
a little dairy and you are good to go!.
Can
I drink alcohol or soda pop?
Alcohol is not a good idea because it is a stomach irritant
and is high in calories. It is always better to consume
solid food with daily 1200 calories rather than drink
them. However, one can have a drink occasionally. Beer,
soda pop or any carbonated beverage is not recommended
because of the potential to stretch your pouch. You
may find the carbonation very uncomfortable after you
are properly adjusted. However an occasional (once a
week) drink may be consumed in moderation.
What
if I go out to eat?
Order only a small amount of food, such as an appetizer.
Eat slowly. Finish at the same time as your table companions.
When
I reach my goal weight do I need to remove my band?
No, most of the patients plateau with weight loss when
they get close to a normal weight and stop losing. If
you continue to lose beyond your ideal weight, some
of the fluid may be removed from your band to stabilize
your weight. Most banded people regain most if not all
of their excess weight if the band is removed.
If
I get pregnant will I be able to get enough nutrition
for my baby?
Many patients have become pregnant after both gastric
bypass and the Lap-Band procedure. In fact, several
studies have demonstrated that significant weight loss
can improve fertility and one recent, excellent study
from Australia showed that weight loss after the Lap-Band
improves fertility in morbidly obese women. There is
also a syndrome called Polycystic Ovary Syndrome (PCOS),
which can lead to infertility. This syndrome involves
excessive hair growth and hormonal changes that generally
resolve with dramatic weight loss after bariatric surgery.
As far as getting enough appropriate nutrition to have
a safe pregnancy, this has not been a demonstrated problem
with either the Lap-Band or the gastric bypass. However,
you are recommended to consult with your bariatric program
nutritionist to be safe if you do get pregnant.
What
are the short term and long term dietary restrictions
after banding?
First week post-op: you will typically be on a full
liquid diet. Second week post-op: you will typically
eat puree/soft foods diet. High calorie liquids should
be avoided after the liquid stage. Other than that,
it depends on individual tolerances.
Gastric Bypass
Gastric
pouch 30 ml. Part of small intestine is bypassed. Greater
weight loss. Hospital stay 5-7 days Vitamin mineral
supplementation required.
In this procedure a small stomach pouch
is created by stapling the stomach. This causes restriction
of the food intake. Next a “Y” shaped section
of the small intestine is attached to the pouch to allow
food to by-pass the first part of small intestine. This
causes reduced calorie and nutrient absorption.
Advantages
of Laproscopic Gastric Bypass RNY
After gastric bypass surgery, weight loss is
more predictable and usually maintained. Average
excess weight loss is usually higher than with purely
restrictive procedures.
One year after surgery, weight loss can average
65% to 70% of excess body weight. After 10 to 14
years, some patients have maintained 50-60% of excess
body weight loss.
96% of certain associated health conditions (back
pain, sleep apnea, high blood pressure, diabetes
and depression) were improved or resolved according
to a 2000 study of 500 patients. It also helps in
leg swelling, high cholesterol, urinary incontinence
etc.
Sleeve Gastrectomy
With this procedure, the surgeon removes approximately 60 per cent of the stomach laparoscopically so that the stomach takes the shape of a tube or "Sleeve".
Technically most of these procedures are reversible but it is not advisable to contemplate reversal as person can regain the loss weight. Band slippage incidence has reduced with the modified band placement technique, improved band design and standardization of band adjustment protocol.
Bariatric surgery continues to benefit people struggling with morbid obesity, most importantly it saves lives. But finally it is you who has to remember that "health is the thing that makes you feel that now is the thing that makes you feel that now is the best time of the year!!"
Frequently
Asked Questions for GASTRIC BYPASS
How
do I know if I qualify for weight reduction surgery
You qualify if:
You weigh twice your ideal body weight or You are
overweight by 100 lbs or more
You have a BMI (body mass index) more than 40 or
You have a BMI more than 35 with co-morbidities
(illnesses related to being overweight).
You are overweight for 5 years or more
You have failed to lose weight or sustain weight
loss under supervision
You are willing to comply with lifestyle and diet
changes
Will
I have to stop smoking?
Patients are encouraged to stop smoking at least one
month before surgery. Smoking increases the risk of
lung problems and can reduce the rate of healing. It
increases the rate of incisional hernia and leaks by
interfering with the blood supply of healing tissues.
How
long will I stay in the hospital?
As long as it takes to be self-sufficient. Although
it can vary, hospital stay (excluding the day of surgery)
can be 3 to 4 days for a laparoscopic gastric bypass,
and 5-7 days for an open gastric bypass. After leaving
the hospital, you may be able to care for all your personal
needs, but will need help with shopping, lifting and
with transportation.
How
soon can I drive?
For your own safety, you should not drive until you
are no longer taking narcotic medication for pain and
can respond quickly to traffic. Usually this takes 7-14
days after surgery.
What
will I eat after surgery?
You will be on intravenous fluids on the day of surgery.
The day after we may do a swallow study to be sure there
is no leak in the staple line. If there is no leak,
you will be started on liquid diet 24 to 48 hours after
surgery. Intake is limited to 1 or 2 ounces per meal
so that the stomach can heal properly. If this is well
tolerated, next day you will be advanced to blanderised
soup. You will be discharged on liquid diet. We begin
patients with liquid diets, moving next to semi-solid
foods and about 4 to 6 weeks later, back to solid foods.
This transition is necessary to allow time for your
newly created stomach pouch to heal properly. Drink
2 liters or more of water each day. Water must be consumed
slowly, 1-2 mouthfuls at a time, due to the restrictive
effect of the operation.
What
happens to the lower part of the stomach that is bypassed?
The stomach is left in place with intact blood supply.
In some cases it may shrink a bit and its lining (the
mucosa) may atrophy, but for the most part it remains
unchanged. The lower stomach still contributes to the
function of the intestines even though it does not receive
or process food. It still produces the secretion necessary
to absorb Vitamin B12 and contributes to endocrine hormonal
balance and motility of the intestines in ways that
are not entirely understood.
What
if I am really hungry?
This is usually caused by the types of food you may
be consuming, especially starches (rice, pasta and potatoes).
Increasing protein intake is helpful. There may also
be a psychological problem with lack of food in your
life “head hunger”. Be absolutely sure not
to drink liquid with food since liquid washes food out
of the pouch.
Is
sexual activity restricted?
Patients can return to normal sexual intimacy when wound
healing and discomfort permit.
I
am thinking about getting pregnant. Will I be able to
have children after weight loss surgery?
Many women have had successful pregnancies after weight
loss surgery. There is nothing per se that would prevent
pregnancy. Infact, bariatric surgery enhances fertility
in those who have had difficulty in conceiving. We recommend,
however, that you wait until your weight loss is complete
before becoming pregnant. This may take a year or more.
The effect of rapid and prolonged weight loss on the
developing fetus is unknown but it could have dire consequences
and pregnancy is not recommended until a stable weight
has been attained.
What
can I do to prevent excess hanging skin?
The amount of excess skin depends on the age, skin elasticity,
total weight loss and how much the skin was stretched.
Many people, heavy enough to meet the surgical criteria
for weight loss surgery have stretched their skin beyond
the point from which it can "snap back". Some
patients will choose to have plastic surgery to remove
loose or excess skin after they have lost their excess
weight.
Will
exercise help with excess hanging skin?
Exercise is good in so many other ways that a regular
exercise program is recommended. Unfortunately, most patients
may still be left with flaps of loose skin.
What
will my long term diet be like ?
Eat three small meals a day.
Keep a record of your dietary intake. Include
everything you eat and drink: the date, time and
amount of each meal. Start keeping this record (food
diary) from one week after the surgery so if you
begin having problems with vomiting, diarrhea or
malabsorption. we can review your food record and
make recommendations.
Not only is there an adjustment to make about
the quantity but also quality of food you should
eat. When you are able to eat solid foods again,
eat food high in protein. Protein foods are very
important for the healing of staple line of your
pouch. Protein in the form of lean meats (chicken,
turkey, fish) and other low-fat sources should be
eaten first. These should comprise at least half
the volume of the meal eaten. Foods should be cooked
without fat and seasoned to taste. Avoid sauces,
gravies, butter, margarine, mayonnaise and junk
foods. Hair loss is one effect of not eating enough
protein.
You will also have to learn to eat slowly and
chew your food thoroughly. Food not chewed properly
will not pass through the narrow stoma and may cause
vomiting.
Stop eating as soon as you feel full. If you
do not stop, you may have vomiting and it will put
strain on the staple line.
Do not eat sweets! This includes sweetened chewing
gum, candy and regular sodas. Beware of hidden sweets
(cereals with honey or sugar coatings).
You may be unable to tolerate certain foods, especially
those containing fat and sugar. A balanced diet
of 1000 – 1200 calories a day is recommended.
Drink 2 liters or more of water each day. Water
must be consumed slowly, 1-2 mouthfuls at a time,
due to the restrictive effect of the operation.
Never drink water or any fluid with the meal.
Drink fluids thirty minute to an hour after meals.
Taking fluids before or at meal time may cause bloating,
low food intake, vomiting, or dumping syndrome.
It will also flush the food through the stoma and
you will feel hungry again.
Do not drink flavored beverages, even diet soda,
between meals
Will
I be allowed to drink alcohol?
You will find that even small amounts of alcohol will
affect you quickly. Alcohol is high in calories and
will significantly alter your calorie balance. It is
suggested that you drink no alcohol for the first year.
Thereafter, you may have a glass of wine or a small
cocktail for social purpose not more than once a fortnight.
Will
I need supplemental vitamins?
Most surgeons recommend a daily multivitamin for the
rest of your life. Vitamin B12 injections are sometimes
suggested once a month for the first year and every
six months thereafter. It may also be taken orally or
sublingually (under the tongue) by many patients.
The
band is placed laparoscopicaly “key hole surgery”.The
band can be adjusted by injecting fluid into it as an
outpatient.Reversible Hospital stay 2-3 days
Gastric
pouch 30 ml. Part of small intestine is bypassed. Greater
weight loss. Hospital stay 5-7 days Vitamin mineral
supplementation required.