Q&A with our Doctors

After Weight Loss Surgery, Can A Woman Become Pregnant?

It’s known to us, the bariatric surgeons, that whether it’s a man or a woman, the hormones that have the sex drive–the estrogens in the case of a woman, and testosterone in case of man–they are all depressed to pretty low levels, and they all are elevated after the surgery. So, actually we’ve had several patients that we have caught into it that “Well, you know, I couldn’t get pregnant before and all of a sudden how come…you know,” even though we have done that explaining before. So it does increase the fertility in men, sex drive in both the male and female.

Eighteen to 24 months we try to advise, please don’t go and conceive. It could be hazardous to the child. You do need more nutrition and so forth. After that, your chance of having any abnormality and all that are just the same as you would have been otherwise, and that’s why the advice is given that for the first 18 to 24 months, please use contraceptive for the sake of the baby so that you can lower the chances of the abnormality.

And sex drive–it also is half mental. So if you are depressed all the time, that’s not going to work either. So it takes sort of the depression also at the same time, along with the hormones. So all of that is a wonderful positive impact.

– Shyam L. Dahiya, M.D.

What can I expect after weight loss surgery?

After, during the first visit you would be told you are a candidate, but it takes about three to four weeks before you will be approved because to be a candidate means that you weigh a certain amount, which is usually described in terms of BMI. BMI is a term we use to categorize the amount of weight a person has. It is the weight in kilogram divided by the height in meter square, which is… you can find that information on your computer, just look for BMI.

People who have a BMI of 35 and above are candidates for weight loss surgery. That stops there, but to be eligible for the surgery there are other things you have to go through – you have to go through the psychotherapy, the nutritional evaluation, the cardiology evaluation, the pulmonary evaluation. There are some people who come for weight loss surgery with different motives. Those are not good candidates. You cannot come to have weight loss surgery because that will help you find a husband, because there are many skinny women who don’t have a husband.

If you did with surgeon or such a person you are going to have a poor result because when they have the weight loss and they don’t have a husband they are going to be miserable. First they can’t eat, now they don’t have the husband they are looking for, so it’s a disaster. So you have to make sure that the patient’s motivation to have surgery is appropriate and then, getting the approval from the insurance companies after they have been evaluated and felt to be safe for the surgery is the next step, and once that is done then the patient is scheduled for surgical treatment.

– Mathias A.L. Fobi, M.D., F.A.C.S.

Is weight loss surgery a life saving procedure for some patients?

Definitely. It’s been shown that people who are overweight don’t live as long as people who have lost weight and are healthier. So that’s been documented, and I think that this is a life-saving procedure, and if you ask any of my patients, they will tell you that their life has changed.
Well, I have done about a thousand weight loss surgeries. So every patient is unique in his case. There’s always things that stay in your mind. I have to say that my youngest patient is 12 years old, so she has lost about 40-50 pounds. She is very happy, and my heaviest patient is about 640 pounds. He has lost about 300 to 350 pounds, and he is very happy. So they are all unique.

Very interesting that sometimes people, when they go under this stomach banding operations, I have a few patients that their husband even does not know about it. I don’t usually recommend this. I think that having a family support is important, but because these procedures are done so safely, it’s about half an hour procedure, they go home the same day. It’s interesting that the significant other would not even know that they had a stomach banding.

– H. Joseph Naim, M.D.

How will weight loss surgery evolve in the coming years?

What is interesting about bariatric surgery is that, when we started doing it, we did the procedures. Most of bariatric procedures evolved from observing complications from other surgical procedures. So we adopted the procedures and we did them. We are just beginning to understand the physiology of the operations we do. For instance, in the Fobi pouch and the gastric bypass, we are now understanding that there are hormones that are released by the body by bypassing part of this stomach and the duodenum that controls the appetite center, and the way I look at it and I talk about this all the time, I see in 10 to 15 years that a medication would be developed to do exactly what the surgery does once we understand how the surgery works. We have been able to get a good understanding and there are more academic centers now that are doing bariatric surgery and studying the hormonal effects and this is going to go to same way as ulcer surgery went.

For those who are old enough to know, when people used to have ulcers we used to do ulcer surgery by cutting their stomach and that’s how we found out about weight loss surgery. Now, we give medications for people with ulcers because we have finally found out how the ulcer surgery worked and we were able to develop medications to do what they do.

So my prognosis is that 20 years from today there will be very few bariatric operations done and most of the obese will be treated with a medication that would mimic what the surgery does, but in the next five to ten years, the number of people having bariatric surgery is going to keep increasing. As I stated before, only two percent of those who qualify are able to have surgery. I anticipate that by 2013 we would be doing about a million bariatric operations a year from the 200,000 we are doing today.

– Mathias A.L. Fobi, M.D., F.A.C.S.

What is single incision weight loss surgery?

Single incision is an evolution of our laparoscopic procedure where we used to do multiple incisions, and we are putting instrument from different directions. With experience, we have gotten to a point that we can make one little single cut that’s going to be slightly larger than the single one. But when you combine five or six little cuts, this one is much smaller than that, and we also give it in the belly button where the incisions hide very well.

We are able to put instrument all from one cut, and it applies mostly to LAP-BAND® procedure. So, cosmetically, rather than having tic-tac-toe at about four or five little cuts, now you got one cut that’s hiding in the belly button nicely. So, it’s cosmesis and a pain issue because every single cut has its own pain. So we are decreasing the pain, and cosmetically, it’s great.

– Shyam L. Dahiya, M.D.

What is the Fobi Pouch?

When I describe this procedure, there were two reasons why I described it. One, before I described it, the gastric bypass was done with the stomach stapled in continuity. That’s when they call it the stapled operation. At that time, staples would break loose and the stomach will reconnect and people would gain weight. So the first thing I introduced was to cut the stomach in two, and at that time I also found out that patients who gained weight, when the opening between the small pouch and the small bowel was straight, so I put this ring here to stop that from stretching.

So those are the two characteristics of the Fobi Pouch. Right now all gastric bypass that are done are transected to stop them from having the staple line disruption and the Fobi Pouch has the ring to keep that opening from stretching and therefore, the weight loss is more than with the gastric bypass and the weight loss lasts longer with this procedure, with a success rate of 90% when you used the Fobi Pouch as opposed to about 70% when you used the regular gastric bypass.

– Mathias A.L. Fobi, M.D., F.A.C.S.

What do I have to do after my surgery about diet?

I want to emphasize that these are not diet programs. These are surgeries, and basically the only diet then you have to be on to is eat healthy and be active. So we will have booklets that we will provide you and have dietitian that will contact you, and we will tell you what to do today to make the right choices. Basically low-calorie diet, it’s what you are recommended, and if you make healthy choices, that’s all you need to do to have the good results.

– H. Joseph Naim, M.D.

How much weight will I lose after surgery?

The rough guide for a bypass is about ten percent of your excess weight per month, and that sort of tells you that it’s going to taper down. So if you use the example, “I am 100 pounds overweight,” so first month roughly 10 pounds; second–“Well, now I have only 90 pounds left,” so nine and so forth.

With the LAP-BAND®, the weight loss is slower. It probably takes twice that much to lose. So if you have LAP-BAND®, then you got to be patient as far as the time-frame is concerned. But that’s a rough guide, and I don’t tell my patients that you have to sort of take it to such a guideline, that well, if you didn’t lose or lose too much, then that’s a matter of concern because men lose faster, women lose little less. And everybody is an individual, and there are some variations in that.

– Shyam L. Dahiya, M.D.

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