Q&A with Dr. Swannack: What you should know about bariatric surgery

Dr. Charles Swannack became involved in bariatrics when his fellow Providence bariatrics surgeon, Dr. Pickhardt, needed a partner in the practice he had just begun. Dr. Swannack soon learned to love working in the field, an affinity he credits to his patients and the gratitude they overwhelmingly show after going through the treatment and program.

Even when seen outside of the hospital, appreciative patients commonly stop to thank him again for “changing their lives.” In the doctor’s own words, “It is similar to being able to save lives by doing other more typically recognized life-saving procedures, such as major aortic aneurysm surgery. Being at an extremely unhealthy weight is a life-threatening situation, and also one that doesn’t allow for ‘life as usual.’ Bariatric surgery changes lives in such a way that patients are likely to live longer, and be able to live more fully in the meantime.”

What would you say are the top things people should consider before going in for bariatric surgery?

1. Patients will make major changes to their eating habits after surgery. The surgery makes it much easier to make these changes because of two major things; they have less of an appetite after surgery, and they feel full after eating small amounts. These changes help them create life-long habits that help them keep the weight off.
2. The weight loss from bariatric surgery is typically between 25-40% of their weight, compared to medical weight loss which is 5-10% of their weight. And the surgery helps keep the weight off, where with medical weight loss, over 90% of patients regain their weight.
3. Bariatrics patients will need to commit to taking vitamins for life. That said, the vitamin regime is simple. It means taking a multivitamin daily (as well as B 12 for gastric bypass).
4. Although there is some risk involved, it is less risky than having a gallbladder removed. And it is definitely less of a risk than continuing to remain at an unhealthy weight. 

What are the differences between the different kinds of surgeries?

With a Gastric Bypass, there is technically a little more surgery involved. But the advantage is more weight loss and a higher chance of resolving diabetes. Therefore this option is better for diabetics.  Also, the gastric bypass helps people with a sweet tooth stay away from rich foods, since patients are more apt to have cramps with rich foods. But since the surgery is more involved, there is a modest increase in the risk involved.

The Gastric Sleeve is a less complicated surgery, and therefore there is a lower risk for problems. The typical weight loss with a gastric sleeve has the same potential for improvement in most comorbidities as the gastric bypass. This list of comorbidities includes joint pain, back pain, hypertension, sleep apnea and many others. The most common reason to choose a gastric sleeve is that there is less risk involved.

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

It is highly rewarding to see patients get off of many of their medications. This includes the medications for things like diabetes or hypertension. Also patients with sleep apnea are commonly able to sleep without their CPAP machines after they lose weight. Although this doesn’t always occur, it is a common benefit.  Another common benefit that we see is patients going to events that they haven’t been able to for years. Things like watching their children or grandchildren play soccer or basketball. Previously they were in too much pain to sit on the bleachers or stand for any length of time. But after surgery, they become more involved in their family and friends' accomplishments. 

"My favorite part of the work I do is to see people really live again. For example, patients for whom travel is one of their work requirements can more easily and comfortably do so - so there is job security involved. Patients talk about getting to go to kids' and grandkids' events, and feel more at ease, as well as being able to interact with them. They are able to follow their passions."

Are there any drawbacks?

Patients with severe heartburn and gastric reflux may find that it is worse after a gastric sleeve. But if you have heartburn that is controllable with medication prior to surgery, it is very unusual to have heartburn that doesn’t respond to medication after surgery. On the other hand, almost everyone that has a gastric bypass experiences improvement with heartburn. Also the stomach is more sensitive to NSAIDs (like advil, ibuprofen, meloxicam, aleve), alcohol, caffeine and tobacco after these surgeries. If a patient uses any of these things daily after surgery, they are at a higher risk of developing an ulcer.

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

It is strongly advised that patients seek a psychological evaluation which may include behavioral coaching. For example, it is common for many of us on a “bad” day to eat more. After surgery, eating more is not possible, especially in the first few months after surgery. An idea for alternative coping behaviors for people would be to revisit one of their passions such as music, knitting or working in the shop. The psychologist or psychiatrist commonly will help patients think through this process and come up with a plan.

How would a patient go about getting approval for bariatric surgery?

The very first thing to do would be to attend a bariatric seminar hosted by Providence St. Patrick Hospital. Our program personnel will help you investigate your insurance and find out what they cover and what the requirements are. Most insurance programs require 6 months of medically monitored weight loss prior to surgery. Commonly a dietitian is involved in this and patients learn how to make healthier food choices and start on their weight loss program prior to the surgery. Dietitian training is one of the most helpful aspects of the program, according to Dr. Swannack, as this is the key to committing to a new lifestyle.