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How Much Weight Should I Lose Before Bariatric Surgery?

scale with dumbbells, measuring tape, apple

It may seem counterintuitive, but as soon as you have learned you are a candidate for bariatric surgery, you should use the downtime before surgery to lose some weight. Several excellent reasons exist, including lower surgical risk and preparing yourself for your postoperative lifestyle. These are essential considerations, and after a quick chat, most patients understand the need for reduced weight during surgery, so much so patients will undergo a 10-day preoperative liver shrink diet to facilitate weight loss and get them on track.

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Is Hernia Surgery Painful?

Woman touches abdomen after hernia surgery

One of the most common reasons patients delay their hernia procedure is out of fear of pain. Well, we have great news for you! With advances in minimally invasive and robotic surgery, we have dramatically reduced the pain patients experience during their recovery. Today, we can perform virtually any hernia procedure using just a few tiny incisions in the abdomen versus the traditional large incision that was the norm a few decades ago. Even the mesh technology used to cover the hernia defect has improved, and the risk of complications associated with mesh is dramatically lower. However, any operation will come with some discomfort, so let’s talk about the pain associated with hernias and hernia repair.

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Colon Health – Rules for Taking Fiber Supplements

Fiber supplements and other nutritional supplements piled on table

Our modern diets have shifted away from fiber-rich complex carbohydrates, including whole fruits and vegetables. They have been largely replaced by highly processed foods and those with little fiber content. The result has been problematic with levels of excess weight and obesity reaching record highs and significant problems stemming from an imbalanced gut microbiome, including insulin resistance and worsened colorectal problems like diverticulosis/diverticulitis, irritable bowel syndrome, and more. There are trillions of microbes in our guts (more than the number of cells in our bodies!) most of which are very beneficial. However, to function correctly, they require a proper diet. Once that balance is lost, some beneficial bacteria may give way to harmful bacteria that can cause metabolic problems.

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Why I Never Wanted to Have Bariatric Surgery

Measuring tape coiled on the left half of the image

My story is one of senselessness, stubbornness, weakness, and despair – you get the point. It’s a classic story of someone seemingly on top that drops to the bottom and then quite a bit further below that. And I did it to myself – a classic self-sabotage. Is this a common thread in those needing a life-altering change like bariatric surgery? Maybe.

What you need to know for me to tell THIS story is that I suffered a personal trauma and, as a result, experienced an excruciating emotional collapse.

My life came to a complete halt. I didn’t care about anything. It was a struggle to get out of bed day after day. I stopped taking care of my body. I stopped going to the gym, and on top of that, I began to eat. I ate because it gave me a brief bit of pleasure. And that’s one of the problems with emotional eating – the pleasure derived from eating unhealthy junk lasts for moments. My weight ballooned, putting on almost 300 additional pounds. And that led me to where I am today. Or I should say where I was about four months ago.

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Choosing Between Robotic & Laparoscopic Surgery

Dr. Ringold performing bariatric surgery using the da vinci robot

A question we are often asked revolves around whether traditional laparoscopic surgery or robotic surgery is a better option. Some of the bariatric surgeons in our practice prefer the robotic approach while others stick to conventional laparoscopy. Let’s discuss why, and if, it makes any difference in the success and outcome of your procedure.

First, before we get any deeper, it is essential to understand the progression of surgical technology from the “old days” of open surgery. Before the early 1990s, the patient only had one option. A long, single incision allowed the surgeon to access the abdominal cavity using traditional surgical instruments and direct visualization. However, in the early nineties, we made a massive technological leap that dramatically changed the face of surgery and reduced surgical risk. Two pioneers of laparoscopic surgery were here at SAMPA – Drs. Lamar Snow and Steve Weinstein, both of whom have since retired. Doctors Hannon and Lane were also part of this significant transition that soon had ninety-plus percent of all our operations performed laparoscopically. The critical change revolved around a tiny camera known as the laparoscope.

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Mesh Hernia Repairs…the Right Choice or Asking For Trouble?

surgeon holding up a sheet of mesh in operating room

When discussing hernia repair, a few issues are more controversial than hernia mesh. To understand whether hernia mesh is appropriate for your repair, it is essential to understand what exactly it is, how technology has changed over the years, and what the concerns have been about hernia mesh in the past. As you may know, a hernia is a defect in the strong layer of the abdominal lining known as fascia. As this wears down, it can develop a hole, and the contents of the abdomen can begin to push through (intestine, fat, etc.), causing pain and a palpable or visible lump. Hernias in and of themselves are not dangerous, and many patients live their whole lives not even knowing they have one.

However, for those that experience lifestyle impediments or rare emergencies like incarceration or strangulation of the hernia, a surgical repair is necessary. Decades ago, hernias were repaired using a tension method by primarily suturing the hernia defect closed. However, tension repairs have several drawbacks that may result in many patients experiencing a recurrence – where the hernia defect re-opens. This is because the fascia does not repair itself like skin or muscle. It heals with a scar that is never as strong as the unscarred fascia. Further, the tension placed on the sutures can tear this tissue and allow the contents of the hernia to protrude once again. Continue reading →

Breaking the News About Your Decision to Have Bariatric Surgery

Two people hugging after informed about the decision to undergo bariatric surgery

Millions of Americans qualify for bariatric surgery, and many have researched surgical options for weight loss. However, while bariatric surgery is the single most effective long-term solution for patients suffering from obesity, only a tiny fraction of qualifying patients ultimately have the surgery. It’s hard to separate metabolic surgery from the idea that it is elective, despite excess weight causing so many significant medical conditions. This perception is partly because many of the comorbidities associated with morbid obesity, like type-2 diabetes, high cholesterol, and high blood pressure, do not produce symptoms until they become severe. Even with standard screening procedures, many patients do not adequately control their comorbidities for any number of reasons.

If you have finally decided bariatric surgery is an option, congratulations! Not only have you taken a massive step toward renewed health, but you’ve also decided to be vulnerable. And, to be honest, that really takes guts.

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Can Hormone Replacement Therapy Be the Answer to Our Weight-Loss Concerns?

stethoscope, and hormones surrounding text that reads "hormone therapy"

Hormonal factors play a significant role in the everyday workings of our bodies. Hormonal balances are very precise, and issues such as age, health conditions, medications, and even obesity can create imbalances that lead to minor or significant health issues. While many hormonal issues have a modifiable root cause (one that can be fixed with lifestyle changes), some of these issues are precipitated by something none of us can escape – the aging process. This is particularly true of the female sex hormone known as estrogen, and the male sex hormone, testosterone.

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Big News in Bariatric Surgery Guidance!

Man measuring stomach size with measuring tape to qualify for obesity under new bariatric surgery guidelines

With a continued rise in obesity in the United States over the past few decades, guidelines for bariatric surgery have been slow to be updated. There’s a good reason for this. As you may know, studies are often revised, retracted, and contradicted. Some foods we thought were good for us were later deemed harmful and are now good again. Think shellfish and egg yolks. According to studies in the past couple of decades, coffee was alternately an antioxidant and a cancer-forming substance. As such, when major societies like the American Society for Metabolic and Bariatric Surgery (ASMBS) and international groups like IFSO – International Federation for the Surgery of Obesity and Metabolic Disorders – put their names to new guidelines, it’s a big deal. This is precisely what happened last month. These 2022 bariatric surgery guidelines have finally been released as guidance to update 1991 requirements from the National Institutes of Health (NIH) that were getting long in the tooth.

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The Pros and Cons of a Gluten-Free Diet for Bariatric Patients Without Celiac Disease

various foods containing gluten, bread, crackers, pasta, next to gluten free sign

Gluten is a group of proteins stored with starch in the endosperm of various cereal grains. Even though “gluten” is a protein specific to wheat proteins, the term “gluten” is generally used in medicine to refer to the prolamin and glutelin proteins present in all grains shown to influence celiac disease. These grains include all wheat, barley, rye, and certain oats. Some people refer to the proteins found in corn and rice as “gluten,” but these proteins do not act as a trigger in celiac disease.

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