Will2014
Well-Known Member
- Joined
- Apr 2, 2014
- Messages
- 361
I might well have misspoke when I said ALL doctors require an Endoscopy before doing a DS. I should have said MOST do and ALL should. The endoscopy is necessary to rule out pre existing structural abnormalities such as strictures, the presence of pre cancerous cells in the lower esophagus (Barrett's Syndrome), and other possible exclusionary problems. I realize some may not have asked to do it...but I just really see so many reasons to do it and literally none not to. As for there being "no special vasculature around the liver" , I must respectfully disagree. There most certainly is a VERY large network of vessels produced by adipose tissue to sustain itself. In fact, you may be surprised to know that each pound of white adipose tissue contains over 1 mile of vasculature which would not exist if the adipose tissue wasn't present. There is an exciting new research under way to treat obesity by destroying this vascular network, resulting in the obliteration and reabsorption of the adipose tissue. For your reading pleasure : http://www.sciencedaily.com/releases/2004/05/040510012211.htm . This increased vasculature makes hemorrhage almost guaranteed when the liver is handled, the only question will be to what degree. Will it simply muck up the works by reducing visibility, make everything slippery etc. , or will the blood loss result in hypovolemia and actually become a threat to the outcome of the surgery itself. Rare, but it does happen. Anyhoo , I'm a HUGE fan of a pre op low carb diet plan to shrink the liver because there's just no good reason not to do it. I guess some doctors don't believe the surgical candidate can succeed in stemming their caloric intake before their procedures, hence the need for said procedure in the 1st place. I disagree and think almost ALL of we obese folks have been able to lose significant amounts of weight at times, we just couldn't keep it off. I say even if not asked to do it by ones Dr....what harm would a pre op diet to shrink the liver do to anyone? And I've already pointed out the benefits!@Will2014 I believe you are generalizing too much. My surgeon did not require a pre-op endoscopy and I didn't have one. He also didn't require a pre-op "liver shrinking" diet. Just clears the day before, and of course nothing after midnight the night before (very important to have an empty stomach to prevent aspiration of stomach contents into the lungs during induction of anesthesia for any surgery, not just bariatric). And while MO people do generally have a fatty, enlarged liver, the amount of variable and there is no special vasculature around the liver. The liver texture is more fragile and more, as you pointed out, harder to get out of the way, so some (not all!) surgeons want it shrunk pre-op.
My surgery went without complication without these measures. I did have a very experienced surgeon who does the DS all the time, and this probably makes a difference. However, if someone's surgeon does request this diet, you are pretty much stuck with it.