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Metabolic and bariatric surgery for obesity

Weight loss surgery is also known as bariatric and metabolic surgery. In addition to treating obesity, bariatric and metabolic surgery is very effective in treating diabetes, high blood pressure, sleep apnea and high cholesterol, among many other diseases. These operations also have an ability to prevent future health problems. The benefits allow patients with obesity who choose to undergo treatment to enjoy a better quality of life and a longer lifespan. 

To learn more, watch this video of an introduction to bariatric surgery.

At Richmond Metabolic and Bariatric Surgery (RMBS), we give patients the tools to conquer obesity and realize their potential. We are one of two comprehensive multidisciplinary bariatric surgery programs in British Columbia. All our surgeries are done using laparoscopic techniques, also known as minimally invasive surgery.


Surgeries we perform

We offer four types of bariatric surgeries: VSG, RNY, BPD-DS and SADI-S. We do not offer lap bands or other types of surgeries. 

The Vertical Sleeve Gastrectomy is performed by making several small incisions in your abdomen. A vertical incision is then made to remove approximately 80-85% of your stomach. Your new stomach sleeve, which is shaped similar to a tube, holds approximately 100 -125ml l in the beginning. This new smaller stomach significantly reduces the amount of food and calories that can be consumed. It also causes favorable changes in gut hormones which help to suppress your appetite, improve the feeling of satiety (or fullness) soon after eating, and improve blood sugars.‎


 

‎Your laparoscopic surgery will involve 6 small incisions in your abdomen. A small pouch about the size of a large egg is made at the top of your stomach and then your small intestine is divided just past your stomach. One end of the intestine is attached to your new stomach pouch and the remainder of your stomach is bypassed (food no longer travels through this remnant stomach) though remains in your body. The other end of your divided intestine (the one attached to your remnant stomach) is reattached to your small intestine a little further down. This allows for digestive juices and enzymes to meet with the food stream. This procedure not only reduces the size of your stomach, but also reduces how much food you absorb by bypassing part of the small intestine. This is considered to be the Gold Standard for bariatric surgery as there is significant weight loss along with significant improvements in obesity related illness such as, Diabetes, high blood pressure, heart disease, GERD, etc.


This procedure is a modified version of the Duodenal Switch (described in detail in the next section). The duodenum is detached just below the stomach and reattached to a loop of small intestine about 3.6 meters downstream. This creates two separate pathways and one common channel. The shorter pathway (digestive channel) allows food to flow from the stomach to the common channel. The longer pathway (biliopancreatic channel) carries bile from the liver to the common channel. This diversion limits the amount of time that food mixes with digestive juices and reduces the amount of calories that can be absorbed, leading to weight loss.‎


‎Biliopancreatic diversion with duodenal switch (BPD/DS) or simply duodenal switch (DS) is a bariatric surgery that can help patients lose up to 80% of their excess body weight. It is performed laparoscopically and often done as a single stage surgery but can also be done for patients that have had a VSG in the past and still have significant weight to lose or struggling with comorbidities such as, DM2, HTN, dyslipidemia, etc. It can help you lose more weight and improve your comorbidities by its malabsorptive action via reducing the absorption of macro- and micronutrients (vitamins and minerals).

In this surgery, the intestine is bypassed starting from below the pylorus to the ileum, 50 to 125 centimeters from the colon. The bypassed portion of the intestine (biliopancreatic limb) delivers bile and pancreatic juices to the anastomosis at the ileum, where it meets the alimentary limb (proximal duodenum, through which food passes) to form the common channel. This is where food combines with bile and pancreatic juices for the first time and most nutrient absorption occurs.


 

When would you need bariatric surgery

Many patients with obesity have tried to treat this on their own, with diet and exercise. Many have had some success, only to have weight regain. More often, patients have little to no success with diet and exercise alone. This is not a result of lack of willpower or the wrong diet. When a patient has a body mass index (BMI) greater than 35, their chances of reaching a normal body weight for a lasting period of time is less than 1%. That's why surgery is an option for patients with severe obesity. 

If non-surgical methods for treating obesity have not succeeded, bariatric surgery could be considered. Before considering surgery, non-surgical means must have been tried and found to be ineffective in the long term. This may include weight loss medication, physical activity, dieting, and behavioural modification techniques. Surgery is an addition to treatment strategies, not a replacement.

Morbid obesity is a serious health problem with a high risk of disease and death. Weight loss surgery does not just treat the disease of obesity, but it treats other conditions like diabetes, heart disease, high blood pressure, arthritis, and acid reflux. In addition, surgery greatly reduces the risk of death from cancer, diabetes, heart disease, and other diseases. Learn more about risks related to severe obesity.

Although bariatric surgery can provide benefits, as with any surgery there are risks. Risks may vary from one patient to another. It is important to discuss all your concerns with your bariatric surgeon and ensure they have all your health information in order to assist in making the best decision. Your bariatric surgeon will be explaining all potential risks in your consultation.

Watch the video below on common problems and complications after bariatric surgery.

Eligibility

Watch video: Who qualifies for bariatric surgery

  • 18 years of age

  • < 65 years of age at the time of referral (Note: waitlist may be 24-36 months)

  • BMI > 40, or a BMI > 35 with at least one of the following comorbidities:

    • Heart Disease

    • High Blood Pressure

    • Sleep Apnea

    • Diabetes

    • Degenerative Joint Disease/Osteoarthritis

    • GERD

    • Dyslipidemia

  • Medical problems that increase the risk for elective surgery

  • Inability to follow directions or comply with recommendations

  • Active substance abuse

  • Smoking (must be smoke-free for 6 months)

  • Unstable mental health

    • Recent suicide attempt – within 18 months

    • Active suicidal ideation

    • Severe personality disorder

    • Major neurocognitive disorder

Managing expectations

Bariatric surgery is a great tool to help you reach your goal. However, you still need to make significant lifestyle changes in order to be successful in your efforts to lose weight and keep it off. Our team will help you work toward those sustainable changes prior to the surgery and will follow you up to 2 years after surgery to address any nutritional deficiencies and to support you through your journey.

The rate of weight loss depends on a number of factors, including your baseline weight, weight lost thus far, type of surgery, activity, hydration and diet. Each person's weight loss pattern is different. If you lose weight too quickly, you are at risk for muscle loss, hair loss, and nutritional deficiencies.

On average, weight loss will continue for 12 to 18 months after surgery. The expected excess weight loss goal for each surgical procedure ranges from 55 to 80%, more specifically:

  • 50-60%  for sleeve gastrectomy (VSG)

  • 60-70% for gastric bypass (RNY)

  • 70-80% for single anastomosis dudeno-ileal bypass with sleeve gastrectomy (SADI-S)

  • 80% for biliopancreatic diversion – duodenal switch with sleeve gastrectomy (BPD-DS)

Once you have reached your lowest weight after surgery, it is normal to re-gain some weight. For most people, their weight will stabilize at about 10% higher than their lowest post-surgery weight.

It is normal to experience weight plateaus where your weight may not change for a few weeks. During this time, your body is adjusting to the amount of food and exercise. Continue to follow your nutritional guidelines and exercise routine to facilitate weight loss.‎

For 70-80% of patients, the majority of their weight loss is maintained for many years. However, up to 30% of patients will regain weight. As with other methods of managing weight, weight loss will not be permanent without lifestyle changes. You will likely regain weight if you do not maintain healthy eating habits, exercise regularly, monitor your intake and manage stress. 

How long does it take to recover?



Process

You will be required to participate in an assessment to determine if surgery is the right option for you. It is important to take time to work on lifestyle changes and determine if surgery is the correct step for you. At any point, you may opt out of the program if you decide surgery is not suitable for you.

The assessment process consists of several appointments with our multi-disciplinary team. You are encouraged to ask questions and find out as much about surgery as possible.

  1. Attend orientation – This session will inform the patient about the RMBS program, eligibility criteria, surgeries offered through RMBS, multidisciplinary team and their roles, impact of bariatric surgery on lifestyle and program expectations in terms of nutrition, physical activity and stress management. 

    Watch the pre-orientation conditioning information session.

  2. Complete candidacy package – After orientation, the patient will have 2 weeks to confirm if he or she is still interested in proceeding with the program, and will then need to consent to our contract if they wish to proceed. 

  3. Pre-operative assessment – It is important to note that admission into the general orientation session and completing the candidacy package does not guarantee surgery. Beyond minimal NIH criteria, in order to qualify for bariatric surgery there must be surgical time available, the patient must be physically and medically fit for surgery, and complete all necessary investigations. The patient must also prove and demonstrate to the multidisciplinary team that they are compliant and competent with sustainable lifestyle changes (problem solving around nutritional, activity, and mental health challenges). Surgery times vary by person and patients cannot expect to have a surgery date within a pre-determined time.

  4. Schedule surgery – Once cleared by our team (including the bariatric surgeon), surgery arrangements are made. 

    If you are scheduled for a surgery, you must watch the nutrition for bariatric surgery presentation beforehand and will be reviewed with your RD at your mandatory pre-surgery appointment.

  5. Post-surgery support – The patient will be followed for a period of up to 2 years by our multidisciplinary team following surgery to support successful outcomes .However, patients who were referred to our program from medical weight management programs may return to their referring physicians sooner. 

If you are a resident of British Columbia, the BC Medical Services Plan (MSP) covers the consultation and bariatric operations offered by our program.

If you had bariatric surgery elsewhere, please inquire about coverage through your family physician.‎

You will need a referral from your family physician to Dr. Nam Nguyen, Dr. Sharadh Sampath or Dr. Yorke. Medical professionals can download our referral package on Pathways and fax it to 604-231-0583.

Before you inquire about the waitlist, find out when your family physician submitted your referral.

  • If it's been under 2.5 years, do NOT call our clinic about your referral as this is the current waitlist length of time

  • If it's been over 2.5 years, you may call us at 604-273-4447, extension 8 to inquire about your referral

Our staff are quite busy so calling the clinic will disrupt their work. The best way to get the answer is to contact the physician who sent the referral and then wait for our phone call. Please note that the bariatric surgeons' office stamps the referral and sends it back to where it came from as confirmation that it was received.

 
  • It is NOT recommended to become pregnant within 18 months after surgery. This is a strict recommendation from the Obstetrical societies, to ensure that >98% of women's weight has stabilized at that time point after bariatric surgery, thereby, likely also achieving a balance of nutrition at the same time. Getting pregnant within 18 months of bariatric surgery can risk the healthy development of your baby as you are still losing weight during this period. Please refer to the RMBS Manual for further details regarding pregnancy and birth control

  • Non-Steroidal Anti-Inflammatory drugs (NSAIDs) need to be AVOIDED after bariatric surgery as they can damage the new stomach pouch or sleeve which may result in gastric ulcers.‎

 


Contact

Richmond Metabolic and Bariatric Surgery Clinic

Unit 120 – 6091 Gilbert Road, Richmond, B.C.  V7C 5L9 
Phone: 604-675-3505
Fax: 604-279-1784

Get directions

The Richmond Hospital has the state of the art Minimally Invasive Surgery operating rooms with high-definition 3D digital video laparoscopes and bariatric operating tools to deliver surgical precision and improve patient safety.  The hospital is also equiped with bariatric-size patient transfer devices, ceiling lifts, scales, beds, chairs, wheelchairs, showers, wide bore MRI, and CT scan table threshold of 400 lbs.  Unlike daycare surgical centers that lack inpatient beds, sophisticated diagnostic imaging and interventional radiology, our patients have access to all of Richmond General Hospital’s state of the art technology as well as exceptional 24 hour nursing care.  Our patients are monitored closely and carefully in hospital until they are ready for discharge.  We feel our patients are worth it!‎

 

We require a minimum 24 hours' notice if you are unable to attend a scheduled appointment, unless an EMERGENCY (death in the family, sudden illness, hospitalization, etc.) occurs. You will be discharged from the program if you have two no-shows or cancelled appointments (less than 24 hours' notice), which were non-emergency.


 

Help increase funding 

Help advocate for people waiting for bariatric surgery. Sign the petition to ask BC to increase funding for more bariatric procedures.

Donate to the Richmond Hospital Foundation

Help buy equipment for bariatric surgery by donating to Richmond Hospital Foundation. Under "Tribute gift", select the checkbox and type "Richmond Metabolic and Bariatric Surgery" for the "Message on Card". Thank you for your support!‎


Frequently asked questions (FAQs)

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