Q&A with Dr. Pickhardt: Options and outcomes for bariatric surgery

To continue our series on bariatric surgery and those who have had experience with it, Providence spoke with Dr. J. Bradley Pickhardt of St. Patrick Hospital’s bariatric services. Here, Dr. Pickhardt shares his own insight into the options and outcomes for those considering surgery.

How did you become involved in the field of bariatrics?

I had been working as a surgeon at St. Patrick’s for 10 years before the hospital introduced the weight loss program in 1999. However, I had trained in bariatrics during my residency, so I was familiar with its history and practices, and had always been intrigued with it. In general, bariatrics patients are very educated about what they are getting into, and motivated to do the work that needs to be done. I am able to see my patients become healthy as a direct result of the services we provide, which is remarkably gratifying. It is a privilege to be a part of it.

What are the Top 5 things that people should consider before going in for bariatric surgery?

1. The number one thing to consider is that the patient and the patient’s family must realize that being at a severely unhealthy weight represents chronic, life-threatening, life-long problems. Research shows us that this condition will shorten a person’s life by at least 7-10 years. And during that time, the patient’s life quality will continue to deteriorate due to illnesses such as diabetes, heart disease, high blood pressure, sleep issues, joint problems, and personal mobility limitations.
2. Secondly, the patient needs to have tried multiple other weight-loss programs that include diet modification and exercise without having any success, in order to demonstrate that nothing else will work for them. Except for one person, all of our patients have done this long before considering bariatric surgery.
3. Third, the patient must be motivated by and educated on the process. The goal of surgery is to get and stay healthy. They must know how to use the surgical tool they have chosen – sleeve or bypass – to make the necessary lifestyle changes sustainable.
4. Fourth, the patient needs to have a supportive family or network who understands what their loved one’s process is going to be, and how life will be different going forward. After surgery, the patient’s lifestyle will change. Eating habits will be different and exercise will become part of the daily routine. It will be a life-long process and commitment.
5. Fifth, the patient needs to realize this is a lifelong commitment. We see our patients several times the first year after surgery and would ideally like to see them on a yearly basis thereafter.

What are the differences between the two kinds of surgeries offered at Providence St. Patrick Hospital?

The current surgeries offered at St. Patrick Hospital are the gastric sleeve and gastric bypass surgeries. Both result in the patient feeling full quickly. The primary differences are:

• With gastric bypass, we divide the stomach and make a new “small stomach.” The small intestine is then rerouted to drain the new small stomach. No intestines are removed. But due to this rearrangement of anatomy, the gastric bypass patient is not quite as efficient at absorbing certain vitamins and minerals. The simple answer to this is basic over-the-counter vitamin and mineral supplements.
• With a gastric sleeve, 85–90 percent of the stomach is removed. This results in a long, skinny stomach. This “sleeve” is a high resistance tube. It takes longer for food to make its way through compared to a normal, large stomach. This results in an early sensation of fullness. Since there is no rearrangement of the intestinal tract, there is no difficulty with absorption of vitamins and minerals.

What are some of the best, most beneficial outcomes for patients?

To summarize, patients get healthy, and they get their lives back. After the surgery, a person can recover from diabetes, high blood pressure, and heart disease, as well as lower their risk of cancer. Activities that had been difficult or abandoned altogether are resumed; physical activity becomes easier. Parents can play with their kids again, or be a part of active groups with friends. Patients feel free to pursue passions that they had begun to think were no longer possible.

Are there any drawbacks?

As with any surgery, there are some risks. The patient certainly needs to be informed of these. However, the surgical risks are minute in comparison to the health risks of remaining morbidly obese. In our hands, we think this is a very safe surgery.

Are there other kinds of doctors or appointments required before having the surgery?

Patients need to attend an educational seminar. We offer both in-person and virtual options for this. We then see the patient in our clinic. If the patient has other medical issues, we will want to make sure that these are optimally managed prior to surgery. Also, the bariatric team will work with each patient and their insurance programs to help achieve the necessary insurance approval.

During the first year after having the surgery, there are frequent follow-up visits with medical staff, as well as recommended follow up support groups that patients can attend.