What’s discussed in this episode with Dr. Elias Ortiz
- Can a hiatal hernia be repaired more than once?
- Does the gastric sleeve always cause gastric reflux and if so why?
- Is the recovery harder with the gastric bypass or the gastric sleeve?
- What’s the standard for blood products in Mexico vs. the USA?
- Why is the pre-op diet so important?
- Is it possible to follow the bariatric diet strictly but not lose weight?
Does the sleeve always cause acid reflux, and if so, why?
Yes. The smaller you make the stomach, the higher the pressure inside it. It’s more difficult for food and liquids to pass from the esophagus to the intestines. With the sleeve, it’s easier for them to go back up through acid reflux. It’s also important that the patient starts their medication right away and keeps it up for the next four to five months; otherwise, the acid reflux can get really, really bad. The technique for the sleeve is much better than in years past, so reflux issues will continue to decrease in the future.
You already answered this one: whether or not the bypass helps with heartburn.
If somebody has heartburn, we check their history to see why that might be. We might need to perform an endoscopy beforehand or run other tests. Many people have a hiatal hernia—thirty, even forty percent of obese patients. And if you have a hiatal hernia, there’s a big chance you’re going to have acid reflux. So what we do is fix the hiatal hernia during the gastric sleeve surgery, or we might opt to do the Roux-en-Y bypass.
Which surgery has a tougher recovery?
You might think the recovery is harder for the bypass because it’s the bigger surgery, right? Well actually, no. If two people have the sleeve and the bypass one day, the next day you’ll see the patient who had the bypass is better off than the one who got the sleeve. Why? Well, the restriction of the sleeve causes more nausea and a little more pain. When you drink up, you feel like you have bowel issues. People who get the bypass are able to breathe better compared to those who get the sleeve. Recovery is faster and smoother for the bypass.
Why is the pre-op diet so important?
All obese people have a fatty liver, fat around their organs, like the intestines. All of them. The reason we ask patients to follow the pre-op diet is because it’s been proven that when somebody loses about ten percent of their original weight, the volume of the liver reduces up to twenty percent, and all the fat around the organ sort of melts around it. When we go inside the patient, if they’ve followed the pre-op diet, they look normal, and the surgery is going to be easier, faster, and safer. If the patient didn’t follow the pre-op diet, we’re going to have problems. We’re going to see a fatty liver; we’re going to see a lot of it between the organs, and the surgery is going to be much more challenging. It’s going to take more time. Also, patients who do well with the pre-op diet are patients who will continue to do well post-op. When someone comes in and tells me, “I didn’t lose very many pounds. I don’t know why, I did everything,” I can be pretty sure that person won’t do well post-op. Make sure you’re on track beforehand, and chances are you’ll be on track after the surgery.
We do see that a lot—people saying they followed the diet strictly but didn’t lose any weight. Can you tell me how that might be possible?
Yes, they’ll tell me they did the diet and exercised but didn’t lose weight. I’d like to point out that you build muscle once you start losing weight and going to the gym—but you have to watch your diet. There are many people who snack too much and don’t notice. For example, just look at how many calories one almond has. It has a lot—thirty, I believe—but people don’t count those things. They snack, they drink a Coke, but they don’t realize all those things have calories. They might try to do a diet and exercise, but there are some things their mind just doesn’t record. It’s very important to keep that in check. I’m pretty sure that if you follow the pre-op diet and do some form of activity, you have to lose weight, but just do your best.
When that happens—when people say, “I didn’t lose any weight on the pre-op diet and I did everything right”—can you tell when you go in? Does their liver look all right?
Well, no. With the liver, you can tell. You can see their liver is jell, very greasy. But there’s only been two times we were unable to do the procedure because all their organs were huge, but we were still able to do so in the other nine thousand patients.