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Which Is Right for You?
The most important step in weight loss surgery is getting
all of the information you need about the various surgical
options. Ultimately your surgeon and other physicians are
your best resource for information about the procedure they
will recommend to you. When you ask a question, make sure
you understand the answer. Do not hesitate to ask for a clearer
explanation given in simpler language. The decision to have
a weight loss surgical procedure may take several visits to
their office and consultation with more than one doctor.
You may choose
to research weight loss surgery on your own via the Internet
or through your local library. As with any search for medical
information, be sure that your sources are responsible recognized
experts in the field you are investigating. An excellent resource
for weight loss surgery is the American Society for Bariatric
Surgery.
Although
the results of weight loss surgery can be drastic, there are
potential risks and complications. Before making your decision,
you should be well informed. These steps are necessary if
you are to give what is called "informed consent"
for the procedure. Informed consent is a legal term meaning
that a patient agrees that they have received and understood
enough information about a procedure's benefits and risks
to allow them to make a decision that is right for them. Your
surgeon will require you to sign a consent form before performing
your procedure. Before you sign a consent form, you should
have a solid understanding of what is about to take place.
You should know what you would need to do to live well after
the operation. And you should be aware of the signs or symptoms
of complications to look for which may occur after your surgery.
Important Considerations
Surgery should not be considered until you
and your doctor have evaluated all other options. The proper
approach to weight-loss surgery requires discussion and careful
consideration of the following with your doctor:
| 1. |
These
procedures are in no way to be considered as cosmetic
surgery. |
| 2. |
The surgery does not involve the removal
of adipose tissue (fat) by suction or excision. |
| 3. |
A decision to
elect surgical treatment requires an assessment of the
risk and benefit to the patient and the meticulous performance
of the appropriate surgical procedure. |
| 4. |
These weight
loss surgical procedures (approved in the United States)
are reversible. |
| 5. |
The success of weight loss surgery is
dependent upon long-term lifestyle changes in diet and
exercise. |
| 6. |
Problems may
arise after surgery that may require re-operations. |
Success of surgical treatment must begin
with realistic goals and progress through the best possible
use of well-designed and tested operations.
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The American Society for Bariatric Surgery describes two basic
approaches that weight loss surgery takes to achieve change:
| 1. |
Restrictive procedures that
decrease food intake. |
| 2. |
Malabsorptive procedures that alter
digestion, thus causing the food to be poorly digested
and incompletely absorbed so that it is eliminated in
the stool. |
Gastric
Restrictive Procedure – Adjustable Gastric Banding System
Combined Restrictive
& Malabsorptive Procedure - Gastric Bypass Roux-en-Y
Laparoscopic or Minimally
Invasive Surgery
Gastric Restrictive
Procedure – Adjustable Gastric Banding System
Lap-Band System is a purely restrictive procedure. This option
restricts how much the stomach can hold by placing an adjustable
band around the upper part of the stomach. The result is you
take in less food. The LAP-BAND® can be adjusted to suit
your situation, and can be removed if necessary. The success
of this process, however, also depends on how motivated you
are and how committed you are to your goal of long lasting
weight loss.
Advantages
| • |
The primary advantages
of this restrictive procedure is that a reduced
amount of well-chewed food enters and passes through
the digestive tract in the usual order. That allows
the nutrients and vitamins (as well as the calories)
to be fully absorbed into the body. |
|
Possible complications
| • |
Slippage
of band |
| • |
Erosion |
| • |
Pulmonary Embolism/DVT |
| • |
Port Problems |
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Combined
Restrictive & Malabsorptive Procedure - Gastric Bypass
Roux-en-Y
In recent years, better clinical understanding of procedures
combining restrictive and malabsorptive approaches has increased
the choices of effective weight loss surgery for thousands
of patients. By adding malabsorption, food is delayed in mixing
with bile and pancreatic juices that aid in the absorption
of nutrients. The result is an early sense of fullness, combined
with a sense of satisfaction that reduces the desire to eat.
In this procedure, stapling creates a small
(15 to 20cc) stomach pouch. The remainder of the stomach is
not removed, but is completely stapled shut and divided from
the stomach pouch. The outlet from this newly formed pouch
empties directly into the lower portion of the jejunum, thus
bypassing calorie absorption. This is done by dividing the
small intestine just beyond the duodenum for the purpose of
bringing it up and constructing a connection with the newly
formed stomach pouch. The other end is connected into the
side of the Roux limb of the intestine creating the "Y"
shape that gives the technique its name. The length of either
segment of the intestine can be increased to produce lower
or higher levels of malabsorption.
Advantages
| • |
Quicker
weight loss initially. |
| • |
Adjustments
not necessary or possible. |
| • |
Can
be done laparoscopically. |
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Risks
| • |
Because the duodenum is bypassed,
poor absorption of iron and calcium can result in the
lowering of total body iron and a predisposition to iron
deficiency anemia. This is a particular concern for patients
who experience chronic blood loss during excessive menstrual
flow or bleeding hemorrhoids. Women, already at risk for
osteoporosis that can occur after menopause, should be
aware of the potential for heightened bone calcium loss. |
| • |
Bypassing the duodenum has caused metabolic
bone disease in some patients, resulting in bone pain,
loss of height, humped back and fractures of the ribs
and hip bones. All of the deficiencies mentioned above,
however, can be managed through proper diet and vitamin
supplements. |
| • |
A chronic anemia due to Vitamin B12
deficiency may occur. The problem can usually be managed
with Vitamin B12 pills or injections. |
| • |
A condition known as "dumping syndrome
" can occur as the result of rapid emptying of stomach
contents into the small intestine. This is sometimes triggered
when too much sugar or large amounts of food are consumed.
While generally not considered to be a serious risk to
your health, the results can be extremely unpleasant and
can include nausea, weakness, sweating, faintness and,
on occasion, diarrhea after eating. Some patients are
unable to eat any form of sweets after surgery. |
| • |
In some cases, the effectiveness of
the procedure may be reduced if the stomach pouch is stretched
and/or if it is initially left larger than 15-30cc. |
| • |
The bypassed portion of the stomach,
duodenum and segments of the small intestine cannot be
easily visualized using X-ray or endoscopy if problems
such as ulcers, bleeding or malignancy should occur. |
| • |
Leak of connection can occur
resulting in death. |
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Laparoscopic
or Minimally Invasive Surgery
When a laparoscopic operation is performed, a small video
camera is inserted into the abdomen. The surgeon views the
procedure on a separate video monitor. Most laparoscopic surgeons
believe this gives them better visualization and access to
key anatomical structures.
The camera and surgical instruments are inserted
through small incisions made in the abdominal wall. This approach
is considered less invasive because it replaces the need for
one long incision to open the abdomen. A recent study shows
that patients having had laparoscopic weight loss surgery
experience less pain after surgery resulting in easier breathing
and lung function and higher overall oxygen levels. Other
realized benefits with laparoscopy have been fewer wound complications
such as infection or hernia, and patients returning more quickly
to pre-surgical levels of activity.
Laparoscopic procedures for weight loss surgery
employ the same principles as their "open" counterparts
and produce similar excess weight loss.
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The actual weight a patient will lose after the procedure
is dependent on several factors. These include:
| • |
Patient's
age |
| • |
Weight
before surgery |
| • |
Overall
condition of patient's health |
| • |
Surgical
procedure |
| • |
Ability
to exercise |
| • |
Commitment
to maintaining dietary guidelines and other follow-up
care |
| • |
Motivation
of patient and cooperation of their family, friends
and associates |
|
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In general, weight
loss surgery success is defined as achieving loss of 50% or
more of excess body weight and maintaining that level for
at least five years. Clinical data will vary for each of the
different procedures mentioned on this site. Results may also
vary by surgeon. Ask your doctor for the clinical data stating
their results of the procedure they are recommending.
Studies show that at 5 years the Lap Band®
achieves approximately 60-65% excess weight loss, which
is comparable to the Gastric Bypass. Patients with initial
higher BMIs tend to lose more total weight. Patient with
lower initial BMIs will lose a greater percentage of their
excess weight and will more likely come closer to their
ideal body weight. Patients with Type 2 Diabetes tend to
show less overall excess weight loss than patients without
Type 2 Diabetes. The surgery has been found to be effective
in improving and controlling many obesity related health
conditions. A 2000 study of 500 patients showed that 96%
of certain associated health conditions (back pain, sleep
apnea, high blood pressure, diabetes, and depression) were
improved or resolved. For example, many patients with Type
2 Diabetes while showing less overall excess weight loss,
have demonstrated excellent resolution of their diabetic
condition, to the point of having little or no need for
continuing medication.
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