Bariatric Surgery

Count on the experienced bariatric surgeons at Essentia Health to help you reach a healthy weight and improve your quality of life with safe and effective weight-loss surgery. This service is available in Duluth, and Park Rapids, Minnesota.

What is Bariatric Surgery?

Bariatric surgery alters your digestive system to help you lose weight by:

  • Limiting the amount of food your stomach can hold so you can’t eat as much
  • Reducing food absorption by shortening or bypassing part of your small intestine

In the video ahead, Annabelle Butler, MD talks about bariatric surgery and how it helps people live healthier lives.

Medical Insight: Bariatric Surgery - Essentia Health

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Text, Medical Insight, The Essentia Health logo appears, consisting of three leaves in a circle. Text, Essentia Health.

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SPEAKER: Welcome to Medical Insight, a weekly health care feature brought to you by the experts at Essentia Health. Here's your host, Louie St. George.

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A man in a suit and tie.

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LOUIE ST. GEORGE: Today on Medical Insight, Dr. Annabelle Butler discusses bariatric surgery, which aims to significantly and sustainably reduce body weight. ANNABELLE BUTLER:

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Dr. Annabelle Butler, Bariatric Surgeon

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Bariatric surgery is really meant to treat the disease of obesity. And the disease of obesity comes along with several other chronic metabolic diseases. And the ones that are most common that we see would be high blood pressure, high cholesterol, diabetes, sleep apnea. A patient with diabetes who comes in for their weight loss surgery will go home and notice that they are using much less insulin, if not completely off of their insulin after surgery. Not every patient that gets bariatric surgery has a medical condition related to their obesity. But the great thing about bariatric surgery is it actually helps prevent them from developing those conditions. Really, bariatric surgery ends up adding years to a patient's life.

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Text, Quality of Life Improved in 95% of patients. Mortality Reduced by 89% in five-year period.

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LOUIE ST. GEORGE: Dr. Butler says bariatric surgery is a proven tool for long-term, meaningful weight loss, though she knows there are misconceptions among her patients and others. ANNABELLE BUTLER: I tell them it's not a willpower issue. And that's part of the stigma of weight. But we have to change the way that we view obesity. And I keep coming back to, obesity is a disease. Patients after weight loss surgery tend to enjoy a new lease on life. They have improved physical function. They are coming off of a lot of chronic long-term medications, and in general have a higher quality of life after surgery. LOUIE ST. GEORGE: Bariatric surgery patients generally return to work within two weeks. For Medical Insight, I'm Louie St. George. SPEAKER: To learn more about this and other health topics, visit essentia health.org/medical insight.

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The Essentia Health logo appears, consisting of three leaves in a circle. Text, Essentia Health. Medical Insight

Conditions Treated

See the full list of conditions we treat, and select a condition to find providers and locations near you.

Conditions

Types of Surgery

Essentia Health offers several types of weight-loss surgery including:

  • Roux-en-Y gastric bypass – Creates a small stomach pouch and attaches it directly to the middle part of your small intestine; reduces food absorption because food bypasses the upper small intestine
  • Sleeve gastrectomy, also known as vertical sleeve gastrectomy – Takes out 80 percent of your stomach and forms the remaining portion into a tubular pouch or “sleeve” that holds less food; decreases the hormones that cause you to feel hungry
  • Revisional bariatric surgery – Modifies or repairs previous bariatric surgery
  • LAP-BAND® adjustments

Do I Qualify for Surgery?

You may qualify for weight-loss surgery if you have a body mass index (BMI) of 40 or more. You may also qualify if you have a BMI of 35 to 39, and at least one condition, such as type 2 diabetes, high blood pressure, or sleep apnea, that may improve with treatment for obesity. Calculate your BMI by entering your weight and height into the American Society for Metabolic and Bariatric Surgery’s BMI calculator.

Your Essentia weight management team also will consider your physical and mental health and whether you’ve had trouble losing weight with other weight-loss plans.

Benefits of Weight Loss

Long-term weight loss through surgery, lifestyle, and eating changes can increase your self-esteem, energy and ability to move. It can also prevent or improve weight-related health conditions, such as type 2 diabetes, high blood pressure, high cholesterol, and sleep apnea.

Patient Stories

Learn how bariatric surgery has changed the lives of some of our patients.

Multidisciplinary Care

Count on Essentia to help you achieve the best possible outcome from your surgery. Your weight-loss team includes:

  • Bariatric surgeons – Discuss your health conditions, review your progress, plan and perform your surgery
  • Nurses – Consult, coordinate, and support your care and progress
  • Registered dietitians – Offer nutritional counseling, education, and resources
  • Exercise specialists and physical therapists – Create an exercise plan for you and your physical needs
  • Behavioral and mental health providers – Help you identify and focus on your weight loss goals

Online Surgery Seminar

If you plan on having your surgery in Duluth, Minnesota, you can watch our bariatric surgery informational seminar online.

After viewing the seminar, complete our online weight-loss registration form. Once you submit this required form, we will call you to schedule an appointment.

Essentia Health Weight Loss Management Program Video Transcript

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Essentia Health logo, three leaves in a circle. Text, Weight Loss Surgery, Roger, Gastric Sleeve Patient

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ROGER: I've never been a small person. But I played football in high school and college. And I was pretty active and enjoyed a lot of sports, and outdoor activities, and things. And then over the years, it was like anybody else. I was always fighting over the battle of weight and got to a point where I could lose 20 and gain 30. And over the course of 15 years, what was the decider for me, was when I went over 300 pounds. My health started deteriorating. I was on CPAP at night, and had medications that I was taking to control my cholesterol, and things like that. And having worked in the health profession most of my adult life, I understood the ramifications of these things. So I thought it was time to really get serious. And having a couple of grandkids come into my life enjoying them so much, I decided, I've got to really do something about this. That's how I got to it.

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Patty, Gastric Bypass Patient

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PATTY: I have been overweight, really, since I was probably about 12 years old. It just kind of started creeping on. I Grew up in a restaurant-- parents owned a restaurant. Started eating, and kept eating. And I'm a chef, so I'm constantly around food. And 10 pounds turned to 20, turned to 30, 40, 50. And I had my first daughter at 39 years old, and I gained about 50 pounds. And I never lost it. And all of a sudden, I was you know on the scale one day, and I weighed 286 pounds.

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Text, Gastric Sleeve Surgery

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I just thought, if I don't do something about this now-- I'm 43 years old, where am I going to be at 53? I'm almost 300 pounds now. Am I going to be 400 pounds, and I can't get up off the couch, and I can't play with my child? So I made the decision that weight-loss surgery was something I needed to look into.

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Matthew Bettendorf, MD. Weight Loss Surgeon

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MATTHEW BETTENDORF: Welcome to Essentia Health in the department of bariatric surgery. We're glad that you have chosen to come and visit our video seminar and learn more about bariatric surgery. On behalf of the staff here, including myself, Dr. Matthew Bettendorf and Dr. Charles Bertel, we'd like you to learn as much as you can tonight about bariatric surgery and figuring out if this is the best option for you for long-term weight loss.

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Welcome. It is important that you watch the whole seminar.

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If you are seriously considering bariatric surgery, we would like to make sure that you watch the entire video and learn as much as you can about the different procedures that are offered.

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Afterward, please complete the registration form so you can get credit for viewing the information session. Please answer a few questions about what you've learned.

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Following completion of the video, there will be several questions to answer to make sure that we know that you understand the material that is being presented. Once you have completed watching the video, we would like to make sure that you register so that we have your contact information. That way, we can contact you for appointments and answer any further questions that you have.

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You can schedule an appointment two ways. Note on the questionnaire that you want a member of our team to call you. You can contact us at phone number 218-786-7830 or 1 8 8 8 U-LOSE-W-T-- Please mention that you have viewed the online information session

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It's also important that we document that you have visited the site and answered the questions so we know that you have gone through the information seminar as an important step in this process.

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American College of Surgeons Bariatric Surgery Center Network Accreditation Program. Bariatric Professionals. Inpatient Unit. Minimally Invasive Surgery Operating Rooms, Outpatient Clinic, Specialized Equipment, Better Outcomes

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Our bariatric program is accredited by the American College of Surgeons so that we can offer the best care both preoperatively, and intraoperatively, and postoperatively for all of our patients.

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Nancy Johnson, RN, Weight Management Program

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NANCY JOHNSON: We have several options within the weight-management program. We have several weight-loss surgery procedures that people may wish to undergo. We also have a medical weight-management program for people either who do not qualify for surgery or may not want to consider surgery as an option at this time.

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Charles Bertel, MD, Weight Loss Surgeon

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CHARLES BERTEL: Now, we have two different paths for folks to follow. You can either follow the surgical path or the medical weight-loss path.

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Physician photos

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Medical weight-loss path is directed by three physicians-- Dr. Stephen Park, Dr. Maria Lao, Dr. Jean Van Pelt.

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Text, Medical Weight Management Program. Comprehensive nonsurgical medical weight loss. Regular visits with team of medical doctor, dietitian, behavioral health and exercise specialist, and exercise specialist. Personal trainer, gym use, and fitness classes available at Center for Personal Fitness

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They work in conjunction with the dieticians and psychological professionals as people need and provide a good bit of education as far as dietary changes and lifestyle changes that will help people be successful in their weight loss.

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Who qualifies for weight loss surgery? BMI = weight in kilograms over height squared in meters BMI over 40 BMI over 35 along with weight-related health problem

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NANCY JOHNSON: Criteria is determined by-- we go by the National Institute of Health standards. Qualify when you have a BMI of between 35 and 40, if you have medical conditions related to being overweight, or you would qualify with a BMI of over 40 based on the weight itself. The process can be lengthy. On average, it can run from six months to a year from the time people view the informational session.

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Step 1. Attend or view online information session. Register. Step 2. Verify insurance coverage and requirements. They are different. Step 3. Dietitian consult and teaching, nurse screening. Step 4. Behavioral health evaluation. Step 5. Dietary visits. Step 6. Surgeon consult. Step 7. Submit to insurance for approval. Step 8. Schedule surgery date and preoperative visits. Step 9. Surgery

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There are multiple steps, starting with the informational meeting. At that point, you schedule to meet with a nurse and a dietician for screening appointments to see if you qualify and to get a dietary history. At that point, we will work on getting you set up for a psychological evaluation. You will have several diet visits, based on both insurance and what your personal needs are. And along the way, you'll meet with a surgeon for a consult. Once the steps are completed, then we'll submit to insurance. And once insurance approves your surgery, we will work on scheduling that for you. Follow-up care is really important with weight-loss surgery. It's a tool to help you lose weight. And we're here to assist you in using that tool correctly. We have a multidisciplinary team. The same team you see before surgery we would have you see afterwards. So we can always include the dietician and the psychologist, as well as the nurses, physicians, and mid-levels to help you with the journey, lifelong, to ensure that your weight loss is safe and that you're healthy. The psychological evaluation is required for anyone wishing to proceed with weight-loss surgery. And the reason for that is so that we can proceed safely. A lot of times, there's emotional reasons why people eat. And over time, depression and anxiety may get worse. So we want to make sure that we have a good handle on that so that you can proceed and have successful outcomes. PATTY: I think that a lot of people that overeat or that have a weight problem-- you there's all sort of different reasons why you do that. And if you don't figure out why it is that you do that, the surgery itself, in a nutshell, will restrict the amount of food that you can eat at one time. But it doesn't change the reason why you're doing it. It doesn't change the reason why you want to eat or any of those things. You have to change that yourself. So I believe that what they're trying to do is actually make sure that you can mentally, that you're up to those challenges. CHARLES BERTEL: You're preparing right now while you're listening to me talk because you're learning about the tools and options that are available to help with weight loss. The preparation may take up to 9 to 14 months coming through the program with the education that we're offering. Just prior to surgery, we'll have you come in and speak with the nurses, either Nancy or Derry, and go through the educational pieces at that point in time. Likely, before the surgery, we'll ask you to be on a liquid diet anywhere from two to four weeks beforehand. Afterwards, we'll talk to you about some of the changes that we'd expect, and how we might have to shift your medications, and continue the education, as far as the amount of fluid that you'll need afterwards and the amount of protein. So in addition, prior to your surgery, aside from being on the liquid diet, we'll have asked you to stop smoking.

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Preoperative preparation. Learn changes of success. Stop smoking. Blood clots, pneumonia increase. Later ulcer problems.

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And we may well choose to check some blood test to see whether that is the case. And the reason we have to quit smoking before the surgery is to encourage your healing, have better lungs for coughing and deep breathing after the surgery, and probably the most important reason would be to help prevent ulcers for those of you that are choosing to have a gastric bypass because if you're smoking, you stand a reasonable chance of developing a sore where the small intestine and the stomach are hooked together. That can be quite painful and could even be life threatening.

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Stable behaviors. No abuse of alcohol, drugs. Find the time to exercise 1 month before surgery.

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We will ask you to be free of any current addictions. So if you have trouble with drugs, alcohol, gambling, we'll ask that you be treated for those before we proceed with the surgery.

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Birth control, 1 year, not BCP. High-protein, low-calorie diet for 2 to 4 weeks before surgery. Improves body's health early. Reduces size of liver, makes surgery easier.

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After the surgery, we're going to ask that you pursue birth control for at least a year's period of time. And as I said before, you'll still need to do the high-protein liquid diet for two to four weeks beforehand to help lose some weight, help shrink the fat inside the abdomen to make the surgery easier for us to do, and easier on you.

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Text, Gastric Bypass Surgery, followed by animation

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[VIDEO PLAYBACK]- To gain access to the abdominal cavity, small incisions are created on the abdomen. trocars, which serve as passageways for the surgical instruments, are placed into the incisions.

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Trocars placed into five of six incisions

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The surgeon examines the abdominal cavity using a laparoscope or video camera.

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Zoom into stomach above the intestines

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A small stomach pouch is created using a stapling device.

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Stomach separated into upper stomach pouch and lower stomach.

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This smaller stomach pouch restricts the amount of food that can be eaten before feeling full.

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Separation of intestine

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The small intestine is separated into two sections. The lower portion of the small intestine is attached to the newly created stomach pouch.

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Intestine attached to stomach pouch, over lower stomach

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This allows food to pass directly into the small intestine, where digestion continues. Bypassing a portion of the small intestine decreases the absorption of calories and nutrients. The upper portion of the small intestine is reconnected to the lower portion of the intestine.

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Animation of food flow separate from bile and pancreatic fluids

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The bile and pancreatic fluids from the liver and pancreas allow food to be completely digested. As with all weight-loss procedures, behavior modification and dietary compliance plays a critical part in determining the long-term success of the procedure. All surgery presents risks. Weight, age, and medical history determine your specific risks. [END PLAYBACK]CHARLES BERTEL: Well, in the immediate short term, if you're looking at the first year, you're probably going to notice some change in your bowel habits. And that would be expected. A lot of folks get constipated because it's hard for them to get the fiber in. Hopefully, you get something called the dumping syndrome, where, if you drink a high-caloric liquid or a high-sugar liquid, say fruit juice, or milkshakes, ice cream, you'll get really sick because the small intestine doesn't do well with a high sugar load. And it lets you know that with abdominal pain, flushed face, rapid-heart rate, and really feeling awful. So it will keep you away from those cheap calories.

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Possible future problems. Constipation, Dumping syndrome, food sticking, food intolerances, hair loss, malnutrition, emotional stress, family and friend adjustment, medication adjustments, other compulsive behaviors

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You will probably notice that the certain foods just don't work for you. They'll get stuck. And you'll have to work around that as you're learning over the first four weeks to three to four months what's going to work for you and what doesn't. And be reassured that that's going to change with some time so that probably, at a year, you'll be able to eat most anything that you wish, but just not as much of it. With a rapid weight loss, you may notice some thinning of your hair. That will get better once your weight stabilizes. And now as you're changing and losing weight, you're going to force the other folks that you have relationships with to change too. So there may be some more emotional stress than you might anticipate. But remember that we're always here to help. Immediately after your surgery, or after any surgery, you're at risk for certain complications.

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Short-term problems of gastric bypass surgery. Bleeding, infection, medical complications, anesthesia complications, et cetera. Intestinal leakage, less than 1%.

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Those would include bleeding so that you need a blood transfusion, or perhaps we need to take you back to surgery. That risk is reasonably small-- probably less than 1% or 2%.

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Leg blood clot, less than 5%. Blood clot to lung, 1%.

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No matter which operation you choose, you're at risk for developing blood clots in your legs. And occasionally, those blood clots will break off and go up to the heart, and stop the heart. We'll help prevent that by asking you to get up and walk around the day of the surgery and in the immediate days thereafter, and give you some blood thinners before and after the surgery to help prevent that.

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Nausea and vomiting, 10%. Marginal ulcers, mostly smokers and NSAID meds. Stricture, 2 to 3%. Bleeding, 1 to 2%. Wound infection, less than 5%.

(SPEECH)
Sometimes after the surgery, you'll develop some nausea-- more frequently after the sleeve surgery. But with the gastric bypass, that may be up to 10% of the folks and could last for up to two to three months, although for most folks, it's only for a day or two. Sometimes it's possible for us to sew the anastomoses or splices between your stomach and the small intestine or the small intestine-- of the small intestine too tightly. You'll know about that because you won't be able to get your liquids in. And you'll find that we may need to put a scope down to open things up if it's the upper anastomosis or splice. For the lower one, occasionally, we have to go back in and surgically revise that. Now, that doesn't happen very often-- only 1% or 2% of the time also. It's possible for you to get an infection in the incisions that we've made. If that happens, the skin edges are going to turn red, sore, tender. And if that happens, we'll need to open them up and let things drain and heal from the inside out. That's a little more common with a longer open surgery than with a laparoscopic surgery.

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Long-term problems of gastric bypass surgery. Most are totally avoidable or easily corrected. Mineral, vitamin problems. Gallstones, reduced with Ursodiol. Bowel blockage, 3%. Hernia, 5%. Nerve problems, 1%. Poor weight loss or weight regain, 5 to 10%. Kidney stones

(SPEECH)
Long term with the gastric bypass-- it's a reasonably stable operation. But you need to be good about taking care of yourself. You have to take your multivitamins, your iron supplements, and your calcium supplements because you're at risk for iron-deficiency anemias and osteoporosis, or decreased calcium in the body. There's a small risk for developing an ulcer where the small intestine and the stomach are hooked together. Usually you'll know that because you'll develop some pain just at the tip of the breastbone. That pain may be constant and associated with some nausea. If that does happen, you need to call us in the program, let us know. And usually, we can give you some medication that will make that better. Occasionally, we have to go back and surgically revise that. Because I've changed the plumbing around in the inside, you're at risk for a bowel obstruction, or a kink or twist of the small intestine. And that risk is also lifelong. Usually, that lets you know that it's happened because you develop pain in the left-upper abdomen. If that happens, you also need to let us know. The other thing that can go on, as far as long-term complications, would be about a 1 in 6 chance of developing gallstones that would cause you trouble and require the gallbladder to be taken out, and a slightly increased risk for kidney stones. Gastric bypass has become a reasonably safe procedure. The mortality rate across the board would be less than about 0. 3% to 0. 4%. And that would be similar to having your gallbladder out. And there are a number of other procedures that we do that are considerably more risky, including coronary-artery bypass, which would have about a 4. 8% mortality rate-- something about 10 times more lethal than having a gastric bypass.

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Text, Gastric Banding Surgery

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[VIDEO PLAYBACK]- The LAP-BAND adjustable gastric-banding system is a tool to help you achieve sustained weight loss.

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Animation of the band being inserted

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The LAP-BAND-System surgery is usually performed laparoscopically. The device is inserted through one of five or six small incisions and is wrapped around the upper part of the stomach. This creates a small upper-stomach pouch and a narrowed outlet between the new upper pouch and lower stomach.

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The sealed device with connecting tube

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The LAP-BAND System is connected by a tube to an access port fixed to the muscle wall, just below the skin of your abdomen. Using a fine needle, saline solution can be added or removed from the band to find the right level of restriction.

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Needle inserted through the abdomen

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As sailing inflates the inner surface of the LAP-BAND System, the stomach outlet becomes smaller. This helps reduce the amount of food you eat and slows the emptying of food from the upper to the lower part of the stomach.

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Particles flowing into stomach

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This helps you feel full sooner and stay full longer. [END PLAYBACK]CHARLES BERTEL: Gastric banding is a purely restrictive operation. In other words, it limits the amount of food that you can put in. With the band that we put around the top of the stomach, you have a small pouch that limited your intake and provides satiety. But with the band, you need to be exceptionally good about getting the majority of your calories in solid food because liquids will travel right through. And you still get a large caloric intake without having much satiety. The band itself is a reasonably safe procedure to perform. However, it isn't as effective as the bypass because it doesn't have the malabsorptive component that the bypass does, where we decrease the amount of small intestine that can absorb fats and sugars. Now the band itself-- weight loss is not as good. Probably about 35% to 45% of your excess-body weight will be lost with the band if things you're going well versus the bypass, where 55% to 70% of your excess-body weight will be lost.

(DESCRIPTION)
Risks of Lap Band. Bleeding, infection, medical complications, anesthesia complications, et cetera. Nausea, vomiting, 10 to 15%. Band/Gastric slip, 8%. Esophageal and swallowing problems, Band erosion, 1%. Device problems, infection, breakage. Poor weight loss, 15 to 20%. Weight Regain, much higher than gastric bypass

(SPEECH)
The band itself can have some complications. Frequently, the port that we put in underneath the skin can twist or become injured as we're accessing. Or it can get infected. And over the course of probably three or four years, about 20% of the folks will need the port revised. The band itself is usually well tolerated for three to four years. But folks can develop some significant heartburn after that. Or the band can slip down on the stomach and block itself off. We'll need to take the band out. We've been finding, with our experience, that a lot of folks are having trouble somewhere between three and five years out, either with insufficient low weight loss or with increasing symptoms so that they're coming back to us to talk about converting the band to either a sleeve or a bypass.

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Text, Gastric Sleeve Surgery

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MATTHEW BETTENDORF: Sleeve gastrectomy is a restrictive operation. What that means is it limits the amount of food you can eat at any one time. We typically have patients eat about a cup of food at one time three to five times throughout the day. And that meets both their caloric needs, and it satisfies them throughout the day. A sleeve gastrectomy is a laparoscopic procedure. What that means is we use a camera and several small incisions and go into the belly where we identify the stomach, take out a portion of the stomach.

(DESCRIPTION)
Device inside a stomach

(SPEECH)
What we do is we change the stomach from a large, round shape or a bag-like structure into a long, narrow tube. What that does is it causes you to feel full after eating a small amount of food. And by reducing the amount you eat throughout the day and reducing the amount of hunger that you have, it results in significant weight loss that's maintained long term. Complications are rare, but they do occur.

(DESCRIPTION)
Sleeve. Bleeding, infection, medical complications, anesthesia complications, et cetera. Nausea and vomiting, 15 to 20%. Reflux, 5 to 10%. Bleeding, 1 to 2%. Leaks, 1 to 2%. Obstruction, 1 to 2%

(SPEECH)
The most-concerning complication at the time of surgery would be a leak. A leak is where the stomach is divided with a stapling device, and at that site, it doesn't seal perfectly. And so you have some drainage of stomach contents through a small hole in the stomach. That needs to be repaired surgically usually and can mean going back to the operating room that day. Other complications that are also rare would be bleeding and infection, which are present with any major abdominal operation. Some folks that have a sleeve gastrectomy will have nausea that persists for several weeks. It usually does improve with time. Rarely, we see either a kink or a narrow area in the stomach develop from scar tissue. And that's called a stricture. That is typically stretched out or opened up using endoscopy or nonsurgical methods, but it does occur occasionally. Vitamin and mineral deficiencies can occur in a sleeve gastrectomy. They're less likely than with a gastric bypass because we haven't rerouted the small intestine. However, some people will develop vitamin B12- or iron deficiencies. And so that needs to be monitored on an annual basis to ensure that they're maintaining those levels. The usual weight loss with the sleeve gastrectomy is approximately 60%, or almost 2/3 of your excess body weight. That's the average. And so if you're more aggressive with your exercise program, if you're more cautious about your diet choices, you can lose more weight than that. But of all comers, most will lose about 60%.

(DESCRIPTION)
Revisional Surgeries Offered. Fixing some problems of older operations. Changing a vertical banded gastroplasty to a gastric bypass. Addition of an adjustable gastric band to a previous gastric bypass. Taking out a lap band. Fixing a lap band slip. Convert sleeve to gastric bypass.

(SPEECH)
Revisional surgery is for people who have had bariatric surgery in the past. They may have had a LAP-BAND that has not worked well, or they've had complications with it. They may have had an operation years ago called a "vertical banded gastroplasty," or a "VBG. "Many times, those fail for a variety of reasons. And at Essentia Health here, we're able to revise those, oftentimes, laparoscopically, into a different weight-loss operation, most commonly, Roux-en-Y gastric bypass.

(DESCRIPTION)
Text, What to Expect After SurgeryHospital Stay. Gastric Bypass, 1 to 3 nights. Sleeve Gastrectomy, 1 to 2 nights. Lap Band, 0 to 1 night. Light Activity, 4 to 6 weeks. Back to work, 1 to 3 weeks. Liquid Diet, Carnation. 1 to 3 weeks before surgery. 2 weeks after surgery to allow healing

(SPEECH)
CHARLES BERTEL: Initially, you're going to have surgery that day. If you've had a band or perhaps a sleeve, you might be able to go home that evening. Likely, with a sleeve, the next day-- you'd be headed home on a liquid diet. With a bypass, you could be in anywhere from one to three nights usually. All three operations will require you to be on a liquid diet for about two weeks, until you come back to visit either of the nurses in the office. Typically, we ask that if you live two or three hours away from Duluth, we'll ask that you stay in town-- in Duluth-- for probably three to four days after your dismissal from the hospital just to assure that you aren't having any trouble because it's a long way back if things aren't going right.

(DESCRIPTION)
Medications. Please ask your surgeon about NSAIDS and aspirin. Stop 7 to 10 days prior to weight loss surgery. Non-steroidal anti-inflammatory NSAIDS have been linked to cause stomach ulcers after weight loss surgery. List of medications associated with bleeding or ulcers. Advil, Aleve, Anaprox, Ansaid, Aspirin (bufferin), Bextra, Cataflam, Celebrex, Clinoril, Davpro, Feldene, Ibuprofen, Indocin, Indocin S-R, Lodine, Lodine XL, Toradol, Voltaren, Motrin, Naprelan, Naprosyn/E-C-naprosyn, Orudis, Oruvail, Relafen, Tolectin, Ecotrin. Stop diuretics and get S-R/XL medications switched under care of your PCP

(SPEECH)
After the surgery, we're going to ask you not to take any nonsteroidal anti-inflammatory drugs. Examples would be Aleve, Motrin, Celebrex, aspirin. Tylenol is still OK. But the reason we're asking you not to take those drugs is because they promote stomach ulcers. And if you've had a bypass or a sleeve, you're going to be at increased risk for developing those ulcers. And the more we can do to prevent that, the better. Afterwards, we don't want you doing a lot of heavy activity. No lifting heavier than 20 to 30 pounds for about three to four weeks.

(DESCRIPTION)
After release from the hospital. Pills. Take whole if smaller. Cut if large. Can be crushed if needed. Many are stopped after surgery. Enough fluid is work. 64 ounces daily. 60 to 70 grams of protein is important by 2 weeks. Supplements. Starting a week or two later. We will help you. Cost is around $20 to $30 per month

(SPEECH)
All of them are going to require you to be good about keeping up with your hydration. We're going to be interested in you getting about 60 ounces of fluid a day, and be good about taking in a fairly large amount of proteins, all within two weeks after the surgery. You should be able to get back to work somewhere between one and four weeks, dependent on the surgery that you've had. If you've had the band, quite likely, you'll be back to work in a week. If you've had the bypass, it may take two or three weeks, along with the sleeve. We don't want you going back to work until you are reasonably comfortable with your fluid intake and with the changes that your body's accommodating to after the surgery. You may find that some of your medications come in large pills. These-- we would ask you to cut or section up. Smaller pills-- you should be able to take on your own. I would expect that about two weeks after the surgery, you'd be able to take your multivitamins, the protein supplements, and other supplements as needed. After surgery, we found that most people will tolerate the pills that they've had. The openings that we leave are large enough for those pills to go through. Some larger pills may need to be sectioned or cut. But we'll speak with you about that at the time of your discharge. Frequently, if you have diabetes and you've had a gastric bypass, you may not need any more diabetic medication immediately after the surgery. We'll also ask you to stop your diuretics or your water pills immediately after the surgery just because it's hard to keep up their fluids initially after operation.

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Nutritional Support: Learn Changes to Succeed. Using the tool correctly improves success. Meals at least 3 times a day. Start meals with protein. Chew to mush. Eat slowly. 20-30 minutes. Separate liquids and solids. Avoiding high sugar foods.

(SPEECH)
Eating for any of these is just darn hard work for the first three to four months after the surgery. You need to be good about getting up to 64 ounces of fluid in a day. You need to be good about getting up the up to 60 to 70 grams of protein and getting all your multi vitamins and supplements in. So for a change, eating is going to be a conscious process and a fairly hard process. Some people's skin will shrink along with the rest of them. Other folks will develop large skin flaps. And it's possible to have those skin flaps removed by a plastic surgeon, whether that be along your lower abdomen, or a breast reduction, or sagging skin on your arms or your legs. But I'd ask that you look at that as a good problem to have because it means that your weight-loss tool has been effective, and you've effectively used it. The surgery itself helps as far as patients satiety goes. But the patients themselves have to change some behaviors to get the best results from the surgery. Those behaviors would include not drinking fluids with your meals, eating three meals a day, being good about taking your protein levels in first, and avoiding high-sugar foods. The other part of the behavior modification would be to pursue daily exercise. ROGER: Absolutely. I think that's why they do a lot of screening. They want to make sure that you're going to be able to follow through on the commitment to this whole process. And it's a lot of-- I guess that's a lot of resources, a lot of money. You put yourself at risk. It's never a good thing to go into surgery. So I appreciated that. And I think it does definitely take a commitment to it. And it's always in the back of my mind that if I wanted to mess with the system, I could just keep eating and keep eating, and it's going to come out right back with me. I certainly don't want that. I remember back when I was so heavy, and I was trying to lose weight, and it's that catch-22. You really need to get more active. That's a huge part of it. But I had so much weight that it was too hard. And I'd been an athlete half my life. And I thought, well, I must be kind of wimpy here. But it just really made it difficult. So to have this tool, now, it's easy to be active. It's almost like you're almost looking for things to do and keeping up. And so you have to commit to that. I think that the team here probably looks-- and I've heard it-- that I'm kind like the poster child. I had no problems. Everything went swimmingly. I lost 85 five pounds or so. And I felt great. And there was nothing ever negative for me. But that's not always the case. Some people-- it's not as clean and simple. And people that go into it need to know that you're not guaranteed that you're going to come out of here unscathed, that you're going to feel great and fine the whole time, and never have any issues at all. I was lucky. I probably had the physical makeup to do it. And I had the fortitude to follow. And I think that's helped me.

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Chart detailing statistics related to band and bypass surgeries

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MATTHEW BETTENDORF: With regard to the three types of surgery that we offer-- band, bypass, and sleeve, each has their advantages. Each has some disadvantages. The bypass is the most effective at eliminating most medical problems, such as diabetes and high-blood pressure. The other operations are also good at that, but statistically, not as aggressive. The most-effective weight-loss surgery that we offer would be the gastric bypass. The gastric bypass-- you would expect to lose 70% to 75% of your excess weight. That occurs over one year. So it's very rapid, very-intense weight loss during that year. The sleeve gastrectomy is also very fast weight loss, in that you lose the weight in about a year. However, it's only about 60% of the excess weight that you're carrying. LAP-BAND patients will lose approximately 50% of their excess body weight. And it's essential with each of these that you're following a diet plan and that you're exercising on a regular basis to maintain those numbers and keep the weight off.

(DESCRIPTION)
Roger

(SPEECH)
ROGER: So you really have to think it through. And some people can do it. And it's really important that you follow through with the directions and the instructions. That will make the whole process go better, you put yourself at less risk, you'll be more comfortable. But there's a period of time here where you're feeling it. There's a couple of months there where you're not real comfortable. And it's not fun eating and drinking liquid diets and things like that. They get old fast. And you have to be prepared to commit to it. My situation-- I think probably most people looking at it is-- you've gone through this for years, and you're not happy with where you're at, I think this is a viable solution or a way to address it. But you truly have to follow the instructions. PATTY: For me, it worked great. I don't suggest that it would be the answer for everybody. I think that you definitely have to be ready. You have to be at the place in your life where you're going to make that commitment and do it. 10 years ago, I wouldn't have been ready. So it wouldn't have worked for me at that point. I wouldn't have given it 100%. And you have to be able to make the changes.

(DESCRIPTION)
Dr. Bettendorf

(SPEECH)
MATTHEW BETTENDORF: One of the best parts of watching my patients succeed is seeing the weight come off, but also, seeing the medical problems that they have disappear-- hearing stories about grandmothers and grandfathers playing with their grandkids again, and being able to chase after them, and sometimes, catch them; being able to do new activities, like riding a bike, like jogging, or finishing a 5K running race.

(DESCRIPTION)
Patty

(SPEECH)
PATTY: What I would say is that you owe it to yourself to get the information because if you think that it's never going to be for you, at least get the information. And give a chance to hearing what they have to say. Maybe it isn't for you. Maybe there's another option. Maybe surgery isn't what you need. Maybe you need to go see a nutritionist. And maybe you need to start exercising. There are other ways to lose weight. Maybe you don't need a full bypass. Maybe you need to have a LAP-BAND. Maybe that's an option. But if you have tried and exhausted every other avenue, and it hasn't worked-- and it isn't for somebody that needs to, oh, gosh, I can't lose that 20 pounds-- then, I think, that at least you owe it to yourself to get the information. And find out. Maybe it isn't for you. But you know what? Maybe it is. And if you make it work, it can change your. Life If you give it the chance, and if you're willing to put the time in and things, it can truly change your life. It can make all the difference in the world. But it's not going to be easy.

(DESCRIPTION)
Text. Gastric Sleeve Surgery

(SPEECH)
The surgery is the start of the journey. But it is by no means the end. I mean truly, the surgery is the easiest thing because that's relatively painless. You spend two days or whatever in the hospital, you have five little tiny you know 1-inch scars-- it's not any big deal-- and your home. And so you're kind of miserable for a few days. But then basically, you work your way back to feeling fine. The big probably 80% of it is you deciding that you're going to make it work, that you're going to eat better, that you're going to exercise, that you're going to consciously make an effort to change your habits. You have to change your habits. And if you don't change your habits, you will not be successful. It will come back.

(DESCRIPTION)
Dr. Johnson

(SPEECH)
NANCY JOHNSON: This is a lifelong journey. It can be very beneficial in helping you to manage your weight. And we have staff here ready and willing to support you in whatever direction that journey takes.

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You will meet with an Essentia insurance specialist at your first appointment to see if your insurance benefits cover bariatric surgery. Your insurance company may require that you have your surgery at an approved Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) facility.

Follow-Up Care & Support

Our goal is to help you achieve and maintain your weight loss. Your care team will provide guidance on diet, activity, and healing after bariatric surgery.

Connect with other patients at an Essentia weight-loss surgery support group. Share experiences, exchange advice, and get encouragement.

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