OBESITY and SURGERY

If you have obesity and cannot lose weight with recommended healthy diet and exercises, surgery could be an option for you. The surgery is usually recommended for women who are at least 80 pounds overweight and for men who are at least 100 pounds overweight. The surgery could be also recommended to people with less overweight if obesity is a cause of diabetes, heart disease or sleep apnea.

What means surgery during obesity?

There are several types of surgical interventions during obesity – called “bariatric” (weight-loss surgeries). Each procedure decreases the shape and size of the stomach to reduce the amount of food you can take in and/or consume. Some operations also restrict the amount of food you can digest.

Some operations are rarely performed, while others are meant only for the severely obese. Each type of bariatric surgery has its own advantages, disadvantages and side effects which should be discussed with your doctor before making any decisions.

The bariatric surgery has risks and complications including infections, hernias and blood clots.

In general most clients who have the obesity surgery lose weight quickly. If you follow diet and exercises recommendations, you can keep most of the weight off.

OBESITY SURGERY types

Gastric Balloon

Gastric balloon is a tried and tested solution to failed diets and weight loss programs. It avoids surgery and drugs that would otherwise be needed. If you are overweight and have a Body Mass Index (BMI) around 35 and/or less 35 - you can be considered for a gastric balloon. Gastric balloon is a silicone balloon that is inserted into the stomach via mouth and filled with a sterile saline solution once it is in place. The gastric balloon will partially fill your stomach which results in having a feeling of being full and prevent overeating.

In general the balloon should be removed after 6 months via the same method as it was inserted.

Gastric Banding

If you are morbidly obese or if you have Body Mass Index (BMI) between 35 and 40 and have a risk factor for an obesity-related disease, you can be considered for a gastric band.

Gastric banding is among the least invasive weight loss treatments. Gastric banding limits the capacity of the stomach. Made of inflatable silicone, gastric bands restrict the stomach - the surgeon wraps a band around the top section of a patient's stomach by means of laparoscopic surgery. This surgery uses an inflatable band to squeeze the stomach into two sections: a smaller upper pouch and a larger lower section. The two sections are still connected; it's just the channel between them is very small, which slows down the emptying of the upper pouch. Gastric banding physically restricts the amount of food you can take in at a meal. Most people can only eat a half to one cup of food before feeling too full or sick. The food also needs to be soft or well-chewed.

The band is injected with saline, causing the patient to feel full sooner and eat less. This means that after eating a small amount of food, you feel full. Gastric banding limits the amount of food the stomach can hold. Food then slowly passes from the pouch into the lower part of the stomach and on into digestive system.

Gastric banding is a less invasive surgery and can often be performed on an outpatient basis. The bands can also be tightened or loosened as needed. The operation is quite simple to reverse but does require further surgery.

There are several brands of adjustable gastric bands available. They include LAP-BAND and REALIZE.

In general Gastric banding is simpler to do and safer than gastric bypass and other obesity operations. This procedure can be performed through laparoscope, it is minimally invasive (using small incisions) and recovery is usually fast. You can also have it reversed by surgically removing the band.

Thanks to flexible methodology, Gastric banding can be easily loosened or tightened - to tighten the band and further restrict the stomach size, more saline solution is injected into the band. To loosen it, the liquid is removed with a needle.

The most common side effect of gastric banding is vomiting - the result of eating too much too quickly.

Duodenal Switch

Duodenal switch combines two surgical approaches. First, a surgeon removes about 85 percent of the stomach. What is left is shaped like a banana, about 6 ounces in size. Next, a large section of the small intestine, the section where most digestion occurs, is cut out and bypassed. With a smaller remaining section of the intestines involved in digestion, not as many nutrients and calories can be absorbed, so patients lose weight.

Sleeve Gastrectomy - Gastric Sleeve Surgery

Gastric sleeve surgery is a newer type of weight-loss surgery. The laparoscopic procedure is typically used to kick-start weight loss for the extremely obese people who are too overweight to withstand more invasive surgeries. During a gastric sleeve operation, a surgeon removes more than half (about 75%) of the patient's stomach. What remains of the stomach is a narrow tube or sleeve, which connects to the intestines. What's left takes a sleeve- or tube-like shape, and it is sealed with staples. When the patient has lost enough weight, he or she may then undergo gastric bypass or another type of weight-loss surgery.

Usually, a sleeve gastrectomy is a first step in a sequence of weight loss surgeries. It's typically followed up by gastric bypass or biliopancreatic diversion, which will result in greater weight loss. However, in some cases, it might be the only surgery you need.

For people who are very obese or sick, standard gastric bypass or biliopancreatic diversion may be too risky. A sleeve gastrectomy is a simpler operation that allows them a lower-risk way to start losing weight. Afterwards, once they've lost weight and their health has improved (usually after 12-18 months), they can go on to have a second surgery, such as gastric bypass. In people with high BMIs, sleeve gastrectomies result in an average weight loss of 40% to 50% of excess weight after three years. People with lower BMIs tend to lose even more of their excess weight. The preliminary evidence suggests that sleeve gastrectomy works about as well as adjustable gastric banding.

Sleeve gastrectomy is irreversible. Typical surgical risks include infection, leaking of the sleeve, and blood clots.

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

Gastric bypass is the most common type of weight loss surgery. During operation the surgeon divides the stomach into two parts, sealing off the upper section from the lower. The surgeon then connects the upper stomach directly to the lower section of the small intestine. Essentially, the surgeon is creating a shortcut for the food, bypassing a section of the stomach and the small intestine. Skipping these parts of the digestive tract means that fewer calories get absorbed into the body.

After Gastric Bypass Surgery weight loss tends to be swift and dramatic - happens mainly during first six months. It may continue for up to two years after the operation. Because of the rapid weight loss, health conditions affected by obesity (diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, heartburn, others) often improve quickly. At the same time after Gastric Bypass Surgery clients feel dramatic improvement in their quality of life.

Gastric Bypass Surgery also has good long-term results; studies have found that many people keep most of the weight off for 10 years or longer.

Side effects of the Gastric Bypass Surgery include some nutritional deficiencies - loss of calcium and iron which could lead to osteoporosis and anemia. Another risk of gastric bypass is dumping syndrome, in which food is "dumped" from the stomach into the intestines too quickly, before it's been properly digested. About 85% of people who get a gastric bypass have some dumping. Symptoms include nausea, bloating, pain, sweating, weakness, and diarrhea. Dumping is often triggered by sugary or high-carbohydrate food.

Gastric Bypass is generally considered irreversible. In has been reversed in very rare cases.

Biliopancreatic Diversion

Biliopancreatic Diversion is essentially a more drastic version of a gastric bypass, in which part of the stomach (about 70%) is removed, and even more of the small intestine is bypassed.

Less extreme version of this weight loss surgery is called biliopancreatic diversion with a duodenal switch. While still more involved than a gastric bypass, this procedure removes less of the stomach and bypasses less of the small intestine. It also reduces the risk of dumping syndrome, malnutrition, and ulcers, which are more common with a standard biliopancreatic diversion.

Biliopancreatic diversion can result in even greater and faster weight loss than a gastric bypass. Studies show an average loss of 75%-80% of excess weight. Although much of the stomach is removed, the remainder is still larger than the pouches formed during gastric bypass or banding procedures. So you can actually eat larger meals with this surgery than with others.

Biliopancreatic diversion is known as one of the most complicated and high-risk weight loss surgeries. Side effects include nutritional deficiencies, dumping syndrome and hernia.

Gastroplasty

Gastroplasty, also known as "stomach stapling," was once a popular type of weight-loss surgery. The original gastroplasty debuted in the 1970s. It involved stapling the stomach into a smaller section, so only a small opening was left for food. Surgeons eventually began performing Vertical Banded Gastroplasty (VBG). In this type of surgery, both staples and a band are used to reshape the patient's stomach into a small pouch. Like regular gastroplasty, only a small hole is left for food to travel into the rest of the stomach. Today, gastroplasty is not performed as often, as studies indicate many patients regain weight.

OBESITY SURGERY - Important to know

Weight loss surgery is recommended to clients who:

Have a body mass index (BMI) of 40 or more. This would be about 100 pounds overweight for men or 80 pounds for women.
Have a lower BMI (between 35 and 40) but also have a serious health problem related to obesity, like heart disease, type 2 diabetes, severe sleep apnea, or high cholesterol.
Have tried and failed to lose weight by other means.
Fully understand all risks.