Ask Us Anything About… Bariatric Surgery

Description – The video begins inside a conference room at Penn State Health St. Joseph’s Medical Center. Two people are standing next to each other. Standing from left to right is Dr. Allison Barrett and Scott Gilbert.

Scott Gilbert – From Penn State Health St. Joseph, this is Ask Us Anything about Bariatric Surgery. I’m Scott Gilbert. Well, for some people, bariatric surgery can be a life-saving choice. It’s not just about the weight. It can also help to improve conditions like diabetes, heart disease, and even sleep apnea. Undergoing bariatric surgery, though, does require a lifelong commitment to diet and exercise to keep the pounds off. We’re going to learn about all that today with Dr. Allison Barrett. She’s a bariatric surgeon here at Penn State Health St. Joseph. Dr. Barrett, appreciate your time today. Let’s start by talking about how people may know whether they could be eligible for bariatric surgery. Say someone says, “I’m a little overweight, perhaps even obese,” how do they go down that path to find that out?

Dr. Allison Barrett  – So most of the patients we see for bariatric surgery have been overweight for a number of years and have tried and failed a lot of times at other diets and exercise plans. We know specifically that people are good candidates for bariatric surgery if they have a body mass index, or BMI, above 40. If you don’t know what your BMI is, it’s easy to calculate it on the internet. A BMI above 40 automatically qualifies you for bariatric surgery. If it’s between 35 and 40, you may also be a good candidate as long as you other — have other medical problems like diabetes and sleep apnea as well.

Scott Gilbert – Conditions that truly can affect somebody’s life and life expectancy.

Dr. Allison Barrett  – That’s right, absolutely, so people who have extra weight, who are obese and overweight do have a shorter life expectancy, and we know that with bariatric surgery, or weight loss surgery, their life expectancy improves along with a lot of their medical problems like their blood sugar, their sleep apnea, high blood pressure, heart disease, etc.

Scott Gilbert – Those things can improve. I’ve heard that it can even cure things like diabetes. Is that an overstatement or true?

Dr. Allison Barrett  – That’s actually true. People who have type 2 diabetes for less than five years stand a very good chance of being cured of their diabetes just by losing weight from weight loss surgery alone. People who have been diabetic for a bit longer, 5 or 10 years or even longer, it’s harder to say that we cure diabetes with a weight loss surgery, but we certainly see significant improvements, especially with respect to how much medication they’re using for their diabetes.

Scott Gilbert – You’re watching Ask Us Anything about Bariatric Surgery from Penn State Health St. Joseph. We welcome your questions for Dr. Allison Barrett. Whether you’re watching this video live or if you’re watching it on playback, you can put those questions in the comment field below this Facebook post and we’ll make sure we get you some answers from Dr. Barrett. So I’m curious about the screening process. I know it is a rather rigorous screening process people go through to determine whether or not they are a good fit for bariatric surgery. What does that involve?

Dr. Allison Barrett  – That’s right. It does take upwards of three to six months to get a patient ready for bariatric surgery, and the reason for that is largely to make sure that they’re medically ready for an operation but also that they’re psychologically ready for an operation. Bariatric surgery is a very large change to how somebody lives their day-to-day life, how they eat, how they interact socially with their friends and colleagues, so it’s something that people need a lot of time to get ready for.

Scott Gilbert – Okay, and we’ll talk more about the preparation for it as well, but we’re talking about bariatric surgery a bit in the abstract, so I’d like to get specific and talk about the most common types of bariatric surgery, especially those done here at Penn State Health St. Joseph.

Dr. Allison Barrett  – There are several main kinds of bariatric surgery. The most common operation right now performed is a sleeve gastrectomy. We also perform a gastric bypass operation, which has been around for a number of years, and then sometimes patients need revision on surgery, specifically patients who have had lap bands in the past and may have some issues with those.

Scott Gilbert – So walk us through each of those. Let’s start with a sleeve gastrectomy. What’s going on with that?

Dr. Allison Barrett  – A sleeve gastrectomy involves removing about two-thirds of the stomach by using a surgical stapler. It’s called a “sleeve gastrectomy” because it looks like the sleeve on your coat. It’s long and narrow like a sleeve. That operation takes about an hour and it involves staying in the hospital just one night after surgery.

Scott Gilbert – Gastric bypass, I think “gastric” means “stomach.” Does this literally mean we’re bypassing the stomach in some regard?

Dr. Allison Barrett  – That’s right, gastric bypass operation has been around for many years. That does involve making the stomach much smaller by stapling it into a small configuration about the size of an egg and then attaching it directly into the intestines. So somebody who has had a gastric bypass is going to eat much less food and then their body won’t absorb all of the food either.

Scott Gilbert – And I imagine part of that screening process is determining which of those procedures is most appropriate for the individual.

Dr. Allison Barrett  – That’s right. Not every patient is a good fit for every operation, and part of the consultation visit with me and going through our preoperative process is making sure we’re picking the right operation for the right patient.

Scott Gilbert – So let’s say that screening determines that someone is indeed a good fit for some sort of bariatric surgery, what are those next steps in terms of preparing for surgery? I understand one of those steps is a diet people need to go on.

Dr. Allison Barrett  – That’s absolutely right. So we do expect patients to change their diet leading up to surgery, and losing some weight is a part of that process. During the three to six months of preparation for surgery, they’re going to be meeting with and communicating regularly with Luis Diaz who is our Bariatric Nurse Coordinator. He will help walk the patients through the entire process, including helping make appointments with a nutritionist, the pulmonary or lung doctors, if needed, getting their blood work done, endoscopy, etc. It is a lot of work for the patients to do, but we’re lucky to have Luis help coordinating that process for them.

Scott Gilbert – Right, I mean, it’s important to note, I mean, there are some surgical procedures where you go, you have the procedure done, you’re off and on your way, you never probably talk to the patient again unless there’s a complication. This is different. This sounds like more of a holistic approach.

Dr. Allison Barrett  – Bariatric surgery is a field that’s very unique in the surgery world because we really expect these patients to be invested in their care, not just from the surgery standpoint, but for the rest of their lives, and we are a big part of that process on the surgery team end, so patients don’t have a surgery and then just disappear. They stay with us for life. We do know that patients who are more likely to be seen in the office and patients who follow up with their nutritionist will absolutely have better results with their weight loss than patients who don’t follow up with us afterwards.

Scott Gilbert – All right, but patients obviously do have a very important role to play themselves, as you’re saying. You’re watching Ask Us Anything about Bariatric Surgery from Penn State Health St. Joseph. I’m Scott Gilbert alongside Dr. Allison Barrett. She’s a bariatric surgeon here and she welcomes your questions, so just put them in the comment field below this Facebook post and we’ll make sure we get you some answers. One question I imagine some folks have is how long the hospital stay would be after a procedure like this.

Dr. Allison Barrett  – Most patients are able to go home one to two days after surgery, and part of the reason we can do that is by using enhanced recovery after-surgery programs. These programs specifically target early functional return for patients, early back-to-work time for patients, and the way we do that is by limiting the amount of narcotics and opiate drugs they get as well as encouraging them to really be up and — up and walking as soon as they can after the operation.

Scott Gilbert – And probably a lot more of these they’re doing laparoscopically, that is, with a small incision than many years ago.

Dr. Allison Barrett  – Right, most bariatric surgery operations are done with minimally invasive techniques. That usually means laparoscopic surgery which involves using small incisions. I also do a large number of my operations robotically, which is using similar small incisions and also using the advanced techniques of a robot to do the operation.

Scott Gilbert – What kind of pain can people expect after the surgery?

Dr. Allison Barrett  – Most patients will need pain medications for three or four days after surgery, but we do a very good job of controlling that pain with other techniques and other medications to try to limit the amount of pain medication they need when they go home. So most patients who are working at an office job will be comfortable enough to go back to work within 7 to 10 days of surgery.

Scott Gilbert – Wow, that’s great, just about a week or so. And how fast can people expect to lose weight after the surgery? I’m sure it’s not as simple as you wake up and you’re 40 pounds lighter, but, I mean, what’s the reasonable expectation there?

Dr. Allison Barrett  – Most patients do start losing weight within the first few weeks after an operation. The patients who undergo weight loss surgery are on a liquid diet for two weeks after surgery, so by the time I see them in the office for their first post-operative visit, patients are often 5 or 10 or 15 pounds lighter already, and that weight loss is very quick the first six months after an operation.

Scott Gilbert – Now let’s get into some of those lifestyle changes people need to employ, because like you say, the surgery itself doesn’t do everything. People have to commit to some lifestyle changes, dietary changes, maybe exercise. Can you talk about those various components and how they factor in?

Dr. Allison Barrett  – Sure. There are a lot of issues that people need to address with the way that they eat food before they undergo an operation. We as Americans tend to eat very, very large portion sizes that are unusually large, and one of the largest adjustments for patients who undergo weight loss surgery is making their eyes match their stomach and reducing those portion sizes back down to what they should be. So that’s one of the biggest adjustments patients need to make. On top of that, we do expect them to be picking healthy foods to eat and trying to avoid greasy or fatty foods.

Scott Gilbert – You’re watching Ask Us Anything about Bariatric Surgery from Penn State Health St. Joseph. Just add your questions or comments for Dr. Allison Barrett in the comment field below this post and we’ll make sure we get some answers for you. And also, if you enjoy this information, you find it useful, as we hope you do, we hope that you’ll share this on your Facebook page. Let’s talk a bit about complications. Any type of surgery comes with a possible risk of complications. What are the kind of things that you as a physician look out for post-surgery?

Dr. Allison Barrett  – Specifically for patients who are overweight and undergoing surgery, we always do worry a bit more about blood clots in the legs. We do recommend that the patients get up and walking as soon as they can after surgery, which can be within six hours. Doing so will help lower their risk of having blood clots, on top of which we do make sure that they get blood thinners around the time of the operation. Other common complications people have after bariatric surgery is really dehydration. It’s hard to drink enough after your stomach’s been stapled, so the first few weeks can be a little difficult for patients, and we’re aggressive about taking care of people if they do have a problem with that.

Scott Gilbert – And how about if people have had things like abdominal surgery or if they have a hernia, are there factors like that that could limit their ability to have laparoscopic surgery, that small incision we’re talking about?

Dr. Allison Barrett  – Those are great questions that we always review with the patients at the time that they first see me for the consult. As we talked about before, not every operation is the right choice for every patient. Some people who have had a lot of abdominal surgery may have more difficulty with a complicated operation like a gastric bypass, so something a little similar like — simpler like a sleeve gastrectomy may be the right choice, but those kind of things are what we would discuss with them at the time of their initial visit and make sure we’re doing what safest and right for the patient.

Scott Gilbert – And this field has evolved greatly, right? Because if we were having this conversation 10 years ago or so, there may be other procedures on the table that really have fallen out of favor today, right?

Dr. Allison Barrett  – Right. Ten years ago, the landscape of bariatric surgery was largely based around open gastric bypass operations with a large incision or laparoscopic gastric band operations. The lap band operation has really fallen out of favor because it’s proven to be somewhat less effective than the others and prone to complications, so not many people are doing lap bands lately. Nowadays most operations are done laparoscopically or robotically with very small incisions, which, again, allows the patient to be back to their regular life pretty quickly after a major operation.

Scott Gilbert – And we’re talking a bit about surgery risk. What if someone has type 2 diabetes? They might say, “Does that make it more risky for me to have the surgery?”

Dr. Allison Barrett  – Only a little. We do worry about people’s blood sugars around the time of any operation and, of course, we pay attention to that when somebody’s having a bariatric operation, but we know from a lot of good medical literature that some of the patients who benefit the most from bariatric surgery are those who have type 2 diabetes and stand to benefit greatly from doing an operation.

Scott Gilbert – Now, how about somebody who’s hoping to get pregnant in the near future? How soon after bariatric surgery might it be safe for them to do so?

Dr. Allison Barrett  – That’s a great question. So I see — I do see a lot of young women who are overweight and maybe they haven’t been successful in getting pregnant because of their obesity. Having a bariatric operation gives them that fertility back, that ability to get pregnant that maybe they couldn’t before. Generally, I recommend that patients who are trying to get pregnant wait at least a year to 18 months after their weight loss surgery to have a pregnancy, but some of my favorite patients have been the ones who have come back after a weight loss operation with a baby in their arms.

Scott Gilbert – That must be very rewarding for you to see as a practitioner. So long term, what are ultimately the factors that determine whether the weight stays off and whether someone is successful 5, 10, 20 years from now in, you know, keeping that weight off?

Dr. Allison Barrett  – We talked a few minutes ago about seeing patients back in the office regularly. Having patients come back regularly to the bariatric surgery office to meet with me, our coordinator, and our nutritionist goes a long way towards making sure that patients are compliant and having good success in the long term. We always worry about vitamin deficiencies in this patient population, too, so having regular contact with our team is important to make sure that none of those complications are developing.

Scott Gilbert – If somebody loses a lot of weight, is there a possibility they may need to have plastic surgery after a bariatric surgery?

Dr. Allison Barrett  – Yes, it’s a frequent question that comes up: Do I need plastic surgery after I have my weight loss surgery? Sometimes the answer is yes. For people who are older, their skin is not as elastic as people who are younger, so older people who have a lot of weight loss do tend to have extra skin. How much it bothers them is really up to the patient individually. Some patients don’t have too much issue with the extra skin and some do. It’s a very personal decision.

Scott Gilbert – All right. Do insurance plans tend to cover bariatric surgery?

Dr. Allison Barrett  – They do. As with anything else, there are certain requirements to meet to make sure that insurance coverage is provided, but yes, overall they do.

Scott Gilbert – All right. And if people have questions and they want to learn more about the program here for bariatric surgery at Penn State Health St. Joseph, we will put some — we’ll put the contact info for you in the comment field below this Facebook post, and if you’re thinking, man, Dr. Barrett knows her stuff, she could have written the book on bariatric surgery, well, she didn’t write it, but she did edit this book on bariatric surgery. She’s one of four editors on this. This is a book used by medical practitioners across the country, right?

Dr. Allison Barrett  – Right. This is a book that we published last year that’s called The Manual of Bariatric Surgery. It’s the second edition of this textbook that’s meant for other bariatric surgeons in the United States and around the world. What we did, we were able to compile a lot of information and update everything that’s happened in the last 10 years since the first edition came out.

Scott Gilbert – And like you say, 10 years, that’s a long time when it comes to bariatric surgery. So much has changed, as we talked about before, so as a physician, I’m sure you’re trying to keep on top of what the next developments will be.

Dr. Allison Barrett  – Right, and part of the way I do that is through social media and keeping in touch with my colleagues around the world, but also making sure that we have access to the medical journals and the medical information we need. I’m also pleased to go to two conferences every year, including one that I’m presenting at in April, where we learn a lot more from our colleagues who are out there doing interesting and new things in the bariatric — bariatric surgery field.

Scott Gilbert – So the key takeaway of someone who’s overweight or obese, it’s affecting their health, and if it’s not affecting it drastically now, it could someday. They should see if this is an option.

Dr. Allison Barrett  – Bariatric surgery is a very good option for patients who have a good amount of weight to lose, and I think we are askew to think that the average bariatric surgery patient is 600 or 700 pounds and that’s just not the case. The average American now is overweight and obese, and so there are a large number of patients who would benefit from bariatric surgery.

Scott Gilbert – All right, Dr. Allison Barrett, thanks so much for your time today. Dr. Barrett is a bariatric surgeon here at Penn State Health St. Joseph. Again, contact info in the comment field below this Facebook post to learn more about the program here. Thank you so much for watching Ask Us Anything about Bariatric Surgery from Penn State Health St. Joseph.