The IU Surgical Weight Management Center at Wishard reaffirms to you its commitment to provide the very finest surgical care for the disease of clinically severe obesity. It is our privilege and pleasure to serve you in that commitment. If we can be of further assistance or provide you with more information, please call our office at Wishard Health Services at (317) 630-2524.

"Can I ever lose too much weight?"

With the possible exception of the rare patient who develops obstruction of the stomach outlet, it is unlikely you will ever lose too much weight. On the other hand, snacking and high calorie liquids can put on weight readily.

"Will my skin sag?"

Because of the large amount of fat between the skin and the true body, the skin will surely sag as fat is removed. Since the weight loss is rapid in the first six months, the skin cannot keep up the pace and indeed does sag. During this period, however, elasticity of the skin is improving and the skin is also shrinking. This process will continue over the next one or two years and your appearance will be worse at about six months, although it will improve gradually thereafter. Regular and progressive exercise will also help the appearance of the sagged skin. The skin of younger bypass surgery patients recovers more rapidly. Some patients may wish to have excess skin surgically removed at a later time.

"Should I eat more and avoid the rapid weight loss in order to prevent sagging?"

No, definitely not! The sagging is related to the total amount of weight loss. It only appears worse during the rapid weight loss phase. If anything is done to slow down weight loss in the initial three to nine months, the opportunity for easy weight loss while the pouch is very small will be lost forever.

"What happens to the unused part of the stomach?"

It remains in place and its ability to function remains intact. The muscles may lose some of their contractile power, but each cell is still there and is capable of functioning in the unlikely event it should be called upon.

"Can the stomach be hooked up again?"

It is possible, but doing so would result in regaining most or all the lost weight. We have never been asked to reverse the operation.

"What is dumping?"

Dumping is the condition that results when sweets very rapidly empty out of the stomach into the jejunum through the small pouch. Sweets have a characteristic called "hyperosmolality" which means they have a high concentration of particles in solution. One of the functions of a normal stomach is to act as a reservoir where food will be held and emptied into the small bowel bit by bit, rather than "dumped" into the digestion/absorption part of the intestine. If the latter were to occur, the jejunum would react by sending off chemical signals to stop the intake of such materials on such a rapid basis. These chemical signals cause nausea, dizziness and faintness, which is an awful feeling. The chemical signals are relatively harmless, but to avoid these unpleasant symptoms, they should not be repeated in order. This might be a bad thing if one continued to crave sweets, but most sweet lovers will come to loathe sweets after this symptom occurs a few times. The avoidance of sweets by the patient who has had a gastric bypass procedure probably accounts for a significant part of the weight loss results.

"Why do some suffer more gas or diarrhea than others?"

Most gas is simply the 80 percent of swallowed air, which is nitrogen, the oxygen part of all being absorbed. Some people, more than others, tend to be air-swallowers, and swallow air during eating, talking, etc. Nitrogen, which constitutes 80 percent of the air swallowed, must go all the way through the intestinal tract to the rectum. Others may have the "irritable bowel syndrome" in which, because of anxiety, the colon becomes irritated, causing cramps, with alternating constipation and diarrhea.

These symptoms can be reduced by the use of bran or other stool softeners to keep the stools quite soft and the work of the colon to a minimum. The tranquilizer effect of aerobic exercise also benefits the irritated bowel.

"May I have my pouch made smaller if it grows too much, and what is involved?"

It can be made smaller by another operation, but it is more difficult and dangerous than the first due to the scaring around the stomach from the previous surgery.

"How do you know how large the pouch has grown to?"

The size of the pouch after surgery is the most difficult parameter to measure. An upper GI series, endoscopy (looking at the stomach directly through a tube), and other tests have not been of much help.

"Will it be dangerous or difficult to get pregnant and carry to term?"

It is known that many healthy babies are born to bariatric surgery patients. Many of these women were unable to conceive previously due to their obesity. We strongly recommend that women wait 18 months to 2 years before becoming pregnant. Women should use some sort of barrier method during this time, as they may be more fertile as they lose weight. During the first six to nine months after surgery, the woman is losing weight at a relatively rapid rate; it would be unsafe to be pregnant during this time.

"Is there a chance to regain weight?"

Some patients may come to feel frustrated and discouraged after weight levels off but is yet too high, or when slow weight regains occurs. This cannot go uncorrected. While responsibility to continue making progress and to avoid regression remains with the patient, help will be available. It is important to constantly realize that the pouch is there only as a tool and must be used properly. If this leveling off or regression happens, support may be necessary and it is important to come back to see us so we may evaluate your case. We will then go back into your history and review the things you have learned in your first evaluation and this information. Re-evaluation does not mean either the operation or you have failed. We are aware it often requires considerable time and effort to change the habits of a lifetime. We understand your predicament. We want to be viewed not as a critic, but as a coach and friend.