Aloha Surgery Blog

Weight Loss Surgery Resources, News, Tips and more

ASMBS Supports the Sleeve!

With Medicare reviewing its coverage criteria for the Vertical Sleeve Gastrectomy, the American Society for Metabolic and Bariatric Surgery, ASMBS, has decided to update its Position Statement. The ASMBS is the society that represents bariatric surgeons and is also responsible for setting up the Centers of Excellence (COE) Program. Up to now, ASMBS held the position that the Sleeve looked “promising” with early and intermediate follow up data, and that the procedure should be studied more, before a final recommendation for its use would be made. The new statement to be released considers the sleeve as a viable alternative surgery option to the Band and Bypass, and that the SLEEVE CRITERIA FOR COVERAGE SHOULD BE THE SAME AS FOR THE BAND AND BYPASS. This is a great step in the right direction for increasing options for surgical weight loss patients. All of these procedures have their distinct advantages and disadvantages. This should help us match an operation more closely to a patients’ expectations for improved health and weight loss.


Thiamine, Vitamin B1

Thiamine, Vitamin B1, is an important vitamin to be aware of. Although I don’t usually talk with my patients about this vitamin in terms of ongoing daily supplements, it does deserve some attention.

This vitamin is within the “B complex” family of vitamins and plays a part in sugar and protein breakdown. It is widely abundant in grains and meats, so healthy diets rarely put someone at risk of low levels. General multivitamins almost always have Vitamin B1 in the formulary.

This vitamin can be incredibly crucial when body stores are insufficient. You may have heard of medical terms like “Beriberi” or “Wernicke-Korsakoff Syndrome”, which describe specific symptoms of Thiamine deficiency. Basically, low levels of Thiamine can cause irreversible nerve injury. I have seen this before with traveling bariatric patients, and I can attest to the devastating consequences.

Not to scare you, but if you have chronic vomiting and you are not taking vitamin supplements, you are at high risk of developing Thiamine deficiency.

Low Thiamine can be easily reversed with many over-the-counter supplements. Like always, we will monitor your levels on a regular basis to ensure your safety. But remember your responsibility to maintain a healthy body through daily supplements recommended by our dieticians.


Hiatal Hernia

So what is a Hiatal Hernia and why should I care about it?

Hiatal Hernia is a condition where the opening from your chest to your abdominal cavity is abnormally large. The esophagus passes through this opening, or ‘hiatus”, so the most common problem associated with this condition is where part of the stomach gets pushed up into the chest. Hiatal Hernias are often small and asymptomatic.  Less than 10% of the population has one, and usually the only thing they notice is acid reflux symptoms. So if you have strong heart burn and have to watch what you eat, there is a possibility that you have this condition.

It is very important for your weight loss surgeon to fix this defect if it is found during the operation. Recent data suggests that an unrepaired Hiatal Hernia during placement of an adjustable Gastric Band is associated with early Band failure… i.e. slippage, pouch dilation, band intollernce, etc. For Bypass and Sleeve patients, the Hiatal Hernia should be fixed to ensure that the gastric pouch size or sleeve creation are the correct size. Repairing a Hiatal Hernia almost always can be done laparoscopically through the same incisions I create, and usually adds just a little extra time to the original procedure.


Hair Loss

Hair Loss after weight loss surgery can be a big issue for some people. Most of my patients would rather not deal with any hair loss, whatsoever! There is a ton of information available about what is the best thing to do to prevent this, but unfortunately a lot of the literature is poor on scientific facts and liberal on anecdotal marketing! Here’s the facts:

  • Hair loss is a response to the stress on the body from a surgical procedure and significant weight loss
  • Hair loss is temporary, and usually is most prominent at 6 months after surgery
  • If hair loss is still present after one year, this is rare and can be associated with a nutritional deficiency
  • Supplements may help, but your body needs to go through its normal response to stress

If you want to take something to try and minimize hair loss, be aware that results are not proven with any product out there. We do know that Iron and Zinc and protein stores should be at their normal levels to minimize hair loss. Taking a multivitamin (and iron if you’ve had a Bypass) should be adequate. Biotin has been a popular supplement, but there is no proof of efficacy.



Strictures are a problem unique to the Bypass and Sleeve patients. Basically, it is a narrowing preventing food to pass normally through your digestive system. With the Bypass, strictures occur at the gastro-jejunal anastomosis (the top connection where the small bowel is attached to the gastric pouch). Sleeve patients can have a stricture anywhere along the length of the stapled stomach. A stricture will almost always occur within the first three months after surgery. Generally, a patient will complain of not being able to advance their diet beyond liquids. They may have frequent vomiting episodes, or even night time regurgitation/reflux.

A stricture can be identified by an Upper GI Swallow, but the most appropriate test is an EGD (v). An EGD is where the doctor gives you an IV sedation, and they pass a long flexible scope with a camera on the end, down the esophagus to evaluate the narrowing. If there is indeed a stricture, the doctor can usually dilate it with a balloon. Strictures commonly are fixed withEGD dilations, but sometimes a surgery is required for persistent symptoms. One of the new options for treatment include placement of a temporary stent via the endoscope.

What causes a stricture? We can’t always say with certainty why one individual ends up with a stricture. But factors that can create this problem include how the surgery was done and how the patient responds to healing/scarring. Strictures are rare, anywhere from 1 to 8% in the literature. A reasonable stricture rate for a surgeon should be 1-3%.