Surgical Weight Loss
Surgical weight loss, also called bariatric surgery, refers to a
number of procedures that can help morbidly obese individuals lose
weight.
Surgical weight loss procedures are receiving a lot of attention in the media today, especially given the mounting evidence of the link between obesity and a number of life shortening chronic diseases, and unhealthy conditions such as:
Weight loss surgery can help reduce important health risks in obese individuals.
Obesity is a condition
in which the natural energy reserve, stored in the fatty tissue of
humans and other mammals, exceeds healthy limits. It is commonly
defined as a body mass index (BMI) (weight divided by height squared) of 30 kg/m2 or higher.
Types of Weight Loss Surgery
Weight loss operations generally fall into three basic categories:
- Malabsorptive techniques reduce the amount of intestine that comes in contact with food so that the body absorbs fewer calories
- Restrictive procedures make the stomach smaller to limit the amount of food intake
- Combination operations employ both restriction and malabsorption
Restriction Weight Loss Operations
Restrictive weight loss operations are the least commonly performed. They encourage weight loss two ways:
- Reducing the amount of food that can be eaten. This is done by reducing the size of the stomach by creating a small pouch at the top of the stomach where food enters from the esophagus. This makes it impossible for the patient to each much since the pouch only holds about 1 ounce of food. It expands to hold 2-3 ounces over time. One of the many drawbacks to this procedure is by shrinking the stomach to such a small size, getting the required nutrients through food can be challenging.
- Slowing the speed of which food empties from the stomach. The lower outlet of the pouch is only about 1/4 inch in diameter (vs. a normal unrestricted size opening). Because it's so small, food empties slowly, leaving a sense of fullness longer. This increases satiety, which in urn decreases hunger and the need to eat additional food.
Types of Restrictive Weight Loss Operations:
- Gastric banding (laparoscopy aka "lapband"). Laparoscopy (lapband) is a minimally invasive surgical technique where a silicone gastric band placed around the top
of the upper part of the stomach. A band of special material is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach. It works by helping you control your food intake and supporting long term, sustainable weight loss.
- Vertical banded gastroplasty. This common procedure creates the pouch with both a band and staples.
Laparoscopic Weight Loss Surgery
Although open surgeries are the most common treatment methods for obesity many surgeons are now beginning to offer the less invasive laparoscopic
procedure whenever possible. The less invasive procedure is being more routinely prescribed earlier in the obesity process (for patients before body mass index (BMI) rise). It has become a preferred method in the battle against obesity because patients who
have had laparoscopic weight loss surgery experience:
- Less pain
after surgery
- Easier breathing and lung function
- Fewer wound
complications such as infection or hernia
- Quicker return to
pre-surgical levels of activity.
Gastric Bypass Weight Loss Operations
Gastric bypass surgery is a more invasive surgical procedure that alters the process of digestion.
There are several types of gastric bypass procedures, but all of
them involve bypassing part of the small bowel by greater or lesser
degrees. For this reason, procedures of this type are referred to as
malabsorptive procedures, because they involve bypassing a portion of
the small intestine that absorbs nutrients.
Some of the gastric bypass weight loss procedures also involve stapling the stomach to create
a small pouch that serves as the “new” stomach or surgically removing
part of the stomach.
Depending on the specific weight loss procedure used, the gastric bypass procedure can be considered both restrictive and malabsorptive because the size of the stomach is reduced so that the
amount of food that can be eaten is “restricted” due to the smaller
stomach. It is important to note that weight loss procedures that are restrictive and malabsorptive carry more risk for nutritional deficiencies.
Main Types of Gastric Bypass Weight Loss Procedures
Roux-en-Y Gastric Bypass (RGB)
Roux-en-Y gastric bypas is the most common bariatric procedure today. This procedure involves creating a small stomach pouch with staples or a vertical band to shrink the stomach and restrict food intake. The surgeon then attaches a Y-shaped section of the small intestine to the pouch to allow food to bypass the first section of the small intestine (the duodenum) and the second
section of the small intestine (the jejunum) reducing body's ability to absorb nutrients and calories. The effect of
bypassing these sections of the intestine is to restrict the amount of
calories and nutrients that are absorbed into the body.Because this weight loss procedure is both malabsorptive and restrictive it can result in rapid weight loss.
Note: the Roux-en-Y gastric bypass may also be performed with a laparoscope rather
than through an open incision in some patients. This procedure uses
several small incisions and three or more laparoscopes - small thin
tubes with video cameras attached - to visualize the inside of the
abdomen during the operation. The surgeon performs the surgery while
looking at a TV monitor. The laparoscopic method allows
the physician to make a series of much smaller incisions. Laparoscopic
gastric bypass can
speed recovery. It also allows for future adjustment of the size of the
pouch, leading to flexiblity for allowing nutrient absorption. Laparoscopic
gastric bypass usually reduces the length of hospital stay, the amount
of scarring, and results in quicker recovery than an open procedure.
Distal Gastric Bypass (Duodenal Switch, Biliopancreatic Division)
During Distal Gastric Bypass a portion of the stomach is removed. The remaining small pouch is then directly connected to the last portion of the small intestine (the jejunum). A distal gastric bypass weight loss procedure (aka biliopancreatic diversion) is both restrictive and malabsorptive, and
is a more complicated procedure than the Roux-en-Y procedure. This can result in higher surgical risk, longer recoveries and greater risk to the patient. The risk for nutritional deficiencies is also highest with this procedure, because the food is completely bypassing the first section of the small intestine (the duodenum). For these reasons this weight loss surgery is not as commonly performed as the other weight loss procedures.
Note, a variation of the biliopancreatic diversion is a procedure called the
duodenal switch. More of the stomach is retained, including the valve
that controls the release of food into the small intestine. A small
part of the duodenum is also retained.
Comparing the Procedures
Risks are similar for both restrictive and gastric bypass procedures. Except the risk of nutritional deficiencies for iron, calcium, and Vitamin B12--are higher in patients who undergo gastric bypass operations.
Patients generally have more success with gastric bypass
operations than restrictive procedures. However for patients with lower
BMIs the lapband surgeries may prove to be the best choice because of
the quicker recover, and less surgical risk.
With gastric bypass operations there is risk of intestinal leaking and potential risk for "dumping syndrome." "Dumping syndrome" refers to when food moves too fast through the small intestine. It causes nausea, weakness, sweating, faintness, and sometimes diarrhea.
Patients often recover quicker with the laparoscopic surgery (e.g., Lapband and Realize Band), however there are risks associated with this surgery as well, such as the regular surgical risks, as well as band slippage.
Caution Needed
Weight loss surgery itself has risks and should not be undertaken
lightly. Because the surgery can have serious side effects, the long-term health
benefits must be considered and found greater than the risk. Despite
the fact that some surgical techniques can be done laparoscopically
with reduced risk, all bariatric surgery is considered to be major
surgery.
Bottom Line
Before considering surgery, you should work with your
weight loss physician to make lifestyle changes to lose weight. Lifestyle changes include
changes to:
- your diet,
- eating habits, and
- level of physical activity.
If
these measures are not sufficient and you decide to have surgery, all
of these healthy lifestyle habits must be maintained after the surgery as well for the surgery to be successful.
Key Words
weight loss procedure, weight loss, weightloss, gastric bypass, gastroplasty, obesity, obese, obesity, Surgical weight loss procedures, Malabsorptive techniques, restriction, restrictive techniques, Gastric banding, Laparoscopy, lapband, minimally invasive, Vertical banded gastroplasty, Roux-en-Y Gastric Bypass, Laparoscopic gastric bypass, Distal Gastric Bypass, Duodenal Switch, Biliopancreatic Division, diabetes, heart disease, weight management, diet, overweight, fat, healthy eating, nutrition, hypertension, cholesterol, high blood pressure, prediabetes
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