Weight Loss Surgery

Bariatric Surgery – Cutting Edge Treatment?

Bariatric surgery is weight loss surgery to treat obese patients by operating on the gastro-intestinal tract to modify the intake and/or absorption of nutrients. It is distinguished from surgical procedures to remove fat from the body, such as abdominoplasty or liposuction, which frequently feature in TV’s Dr. 90210.

Some people fail to reduce weight to a healthy level by the usual means of diet and exercise. For them, bariatric surgery may be indicated. Generally, such weight loss surgery will produce the required degree of weight reduction. Different countries impose different criteria on those considering bariatric surgery. Typically, this will involve a minimum BMI, (see our article, Overweight); failure to reduce weight conventionally; a lower BMI combined with weight-related conditions such as diabetes, sleep apnea, and/or high blood pressure. In the US, the American College of Physicians recommends a BMI of 40 or more, together with failed conventional attempts at weight loss, and the presence of obesity-related conditions.

Surgical procedures

This is an area which is developing so that procedures once common, are now rare or in disuse. In preparation for this article, we attended an information evening hosted by a leading bariatric surgeon. We understand that the procedures discussed below are current and most common, (but there are others):

Vertical Banded Gastroplasty (Stomach stapling)
Laparoscopic Adjustable Gastric Band (LAGB)(Lap Band)
Sleeve gastrectomy/Sleeve gastrectomy with Duodenal Switch
Roux-en-Y gastric bypass

Vertical Banded Gastroplasty

In vertical banded gastroplasty, (stomach stapling), part of the stomach is stapled creating a small pouch which will become the de facto stomach of the patient.

Adjustable gastric band (lap band)

Usually using ‘keyhole surgery’, a silicone band is positioned around the stomach and tightened by the insertion of saline solution through a sub-cutaneous port to create a smaller effective stomach by constriction. Nowadays there are several band manufacturers making bands designed for laparoscopic insertion. Post-operative adjustments can be made by means of adding or subtracting saline via the port referred to above.

Roux-en-Y gastric bypass (Gastric Bypass Surgery)

Roux-en-Y is the most common type of gastric bypass surgery. A small stomach pouch is stapled which is connected to the lower small intestine. The upper small intestine is reconnected to from the Y-shape which gives its name to this operation. Gastric bypass is the most common weight loss surgery in the US.

Sleeve gastrectomy/Sleeve gastrectomy with duodenal switch

Sleeve gastrectomy is an operation by which the stomach is reduced by about 80 to 85% in size. After removing the required proportion of the stomach, following the major curve, the edges are brought together and stapled (commonly), to form a crescent-shaped tube.

In sleeve gastrectomy with duodenal switch, the stomach ‘tube’ is created as above with a volume of about 5 fluid ounces (US) or a quarter of a pint (US). The modified stomach is then connected to the lower small intestine. The duodenum and the upper small intestine are reconnected perhaps two and a half feet above the colon.

Post surgery diet

Immediately after surgery the patient has to contend with a clear liquid diet (broth, fruit juice with water, etc.), then comes the pureed sugar-free diet for perhaps 14 days. Patients cannot eat large quantities of food so a high protein/low carb diet, together with daily multivitamin pill, is the lifelong prescription. Overeating may well cause vomiting, so patients tend to self-regulate to avoid such an undesirable outcome.

Effectiveness of surgery

Weight loss

All the procedures discussed above lead to weight loss over two to three years after the procedure. There may be plateaux, and there may be some regaining of weight but at three years substantial weight loss is very likely to be achieved and maintained. Depending on the starting point, substantial weight loss might be 50 to 100 pounds or more.

Positive effects

Studies show that at about 10 years after surgery, patients have improved life expectancy, compared to a control group. Not only life expectancy is improved, so too are other medical conditions related to overweight such as Type II diabetes, elevated blood pressure and cholesterol.

Adverse effects

While mortality in the first six months after weight loss surgery is low (about 0.2%), complications do occur in about 40% of patients in that period. Experienced surgeons in specialist units get the best results i.e., less ‘post-op’ complications.

Advice

Do not rush into weight loss surgery. It is not a quick fix. It is a long-term commitment to diet and exercise after the operation. It may give rise to complications. As with any major surgery, there is a risk of being one of the mortality statistics. Take advice. Consult more than one specialist. Educate yourself about the procedures and the specialist surgeons in your area. Weigh up the potential benefits to your health against the actual and potential downside. Take your time and make a decision you know you can live with.

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