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Take a Second Look at Surgery Recommendations

Oct 16, 2018
 

Patient is male, 48 years of age, type 2 diabetes with hyperglycemia for eight years, class III obesity,  and very symptomatic GERD. Patient planned to have laparoscopic sleeve gastrectomy. I asked him why he chose that particular surgery. He said, “Because it’s less invasive.” I asked if his surgeon told him the sleeve gastrectomy could increase his GERD, and is not as effective for the treatment of type 2 diabetes nor for weight loss as is a bypass. He said, “No, the surgeon just left it to my choice. I said I wanted the sleeve and he was good with that.”

After our conversation, the patient contacted the surgeon who agreed with what I told the patient. The surgical procedure plan was changed to bypass. The patient is now 1 month post op, with no symptoms of GERD, losing weight and glucose numbers at this time are within normal range. We are in hopes this will continue.

 

FYI, other patients I’ve worked with who had GERD going into a sleeve gastrectomy have in many cases complained of continued GERD symptoms, sometimes even worse, post op.

Lessons Learned:

  • When patients are thinking of bariatric surgery, ask the type of surgery they are planning on.
  • Ask what prompted them to make the choice of the type of surgery they are planning.
  • If your patient has type 2 diabetes and/or GERD and has chosen a sleeve gastrectomy, recommend they discuss with their surgeon the outcomes of both the sleeve and a bypass on the patient’s specific problems and what is actually best for the patient in the long term. Or, have the discussion with the surgeon yourself on behalf of your patients.

Joy Pape, FNP-C, CDE
Medical Editor, Diabetes In Control

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