Chatting With Dr. Ortiz: Episode #6

What’s discussed in this episode with Dr. Elias Ortiz

  • Why do the US and Canadian health care systems suggest the gastric bypass over the gastric sleeve? (1:20)
  • Which surgery do you prefer and why? (2:57)
  • Why would the bypass be better than the sleeve and vice versa? (4:24)
  • Do you need a tetanus shot or any other shots before traveling to Mexico? (5:41)
  • Have you heard any studies about the mini-gastric bypass and esophageal cancer being linked? (6:31)
  • Is it possible for a gastric sleeve to be stretched out? (9:12)
  • How long have you been doing weight loss surgery for? (10:24)
  • Do you have restrictions with the mini-gastric bypass? (11:20)
  • Should I do the pre-op diet again to restart my weight loss? Does water affect weight loss? (12:30)
  • What are the chances of scar tissue after the gastric sleeve? (14:36)


We sit down once again with Dr. Elias Ortiz, gastric surgeon in Baja California, Mexico.

How long have you been performing surgeries?

Dr. Ortiz: General surgery, since I was twenty-six. Weight loss surgeries, since I was thirty-one, I believe. Right now I’m thirty-eight, so seven years doing weight loss surgery.

Do patients need a tetanus shot—or any other immunizations—before traveling to Mexico from the U.S. or Canada?

No, just the ones you would get in the U.S. Nothing special. When you go to certain countries, such as some in Africa, you need some vaccines because they have other types of bacteria and viruses over there, but here? No, nothing. Just the same as you’d get in the States.

Which surgery do you prefer as a first option and why?

I always prefer to do, first, the gastric sleeve surgery. For example, for all my family members friends for whom I had done the procedure, I never did a bypass, only the sleeve. There are indications for needing the bypass. For example, if somebody has very bad acid reflux, poor control of diabetes or blood pressure, then yes, you can do the RNY bypass. And there are contraindications—for example, if somebody has gastroparesis, it’s always better to get the bypass. But if somebody doesn’t have diabetes, high blood pressure, a BMI that’s not too high, and they don’t have a history of acid reflux, gastritis, or anything like that, my suggestion would be the gastric sleeve surgery. Why choose a bigger procedure with more complications if it’s not necessary?

You already touched on this next question. What are some reasons why the bypass could be better than the sleeve?

Well, it’s like I just said. If someone has already had a sleeve, my suggestion would be the MGD or RNY bypasses. If someone has a lap band, the suggestion would be to remove the band and go for the bypass. If one already has gastroparesis, it’s best to get a bypass. For those with a big hernia or bad acid reflux, it’s always better to choose the bypass. They should do the BSG.

Why do you think the American and Canadian healthcare systems seem to push the bypass as a better surgery or a first weight-loss surgery?

Actually, that’s changing. Bypass used to be the number one procedure in the US, but according to the last statistics I saw, the gastric sleeve is now performed more in the US. I don’t know about Canada.

When I ask, “Why are you choosing the bypass?” ninety-nine percent of patients say it’s because what their American doctor recommended.

That’s changing quickly. We don’t know if, in the future, we’ll go back to the RNY bypass again, but it’s changing. For example, the MGB bypass has just been approved in the U.S., so it’s soon going to become popular.

Do you have restrictions with the mini bypass? The size of the pouch, or perhaps lifting restrictions?

If you want restriction, go for the sleeve. Previously, you’d choose the lap bands, but we don’t do lap bands anymore. The lap band, sleeve, or duodenal switch all give you restriction, but the RNY and MGB bypasses don’t give you as much as the others. I always tell people that go for the bypass not to expect much restriction. The bypass works more with malabsorption; it keeps you away from sweets and fatty foods, and helps you maintain a better, healthier diet, but no, don’t expect much restriction with a bypass. That doesn’t mean it’s not a good procedure for not having restriction; it just doesn’t work like that.

Have you heard of any studies about the MGB or BSG and esophageal cancer being linked?

With the MGB, there aren’t many studies yet; I don’t think there’s any papers that mention a relationship between MGB and esophageal cancer. There is a relation between Barrett’s esophagus, which is a pre-cancer stage, and BSG. There is a correlation between the BSG and future cancer. But the techniques and procedures of the BSG have changed a lot; it’s much better now.

What are the chances of scar tissue from BSG?

If you’re talking about the skin, remember that the incisions are super tiny. The healing process will depend on your genetics. Some people are going to heal with keloid scars, while others heal very cleanly, and it looks like nothing happened. Your skin color also matters a lot. Regarding the inside, it’s pretty much the same.

To lose weight after the sleeve, should one follow the pre-op diet? And will not getting enough water affect weight loss?

Yes. Obviously if you want to lose weight, restarting the pre-op diet would work. It’d be a good option. And it’s super important that you get sixty-four ounces of liquids daily. If you don’t get enough fluids, many things can happen. You’re going to have very dry skin, which can lead to a lot of wrinkles on the face. Your hair will look unhealthy. You can develop kidney stones, gallstones, and urinary infections. Your sixty-four ounces of liquids don’t have to be plain water; it could be apple juice, soups, protein shakes. Even coffee counts. Every liquid counts.

One commenter asks, “I’m not even nine months post-op; it it possible for a sleeve to be stretched out already?”

The sleeve and pouch always stretch a little bit, yes, because it heals, and your body has to stay used to eating and drinking. It will never go back to the way it was because the part of the stomach we took out will never regenerate—the liver, for example, does that, but not the stomach. If you didn’t place any restrictions from the beginning, or had bad eating habits, the sleeve was probably left a little wide.

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