Obesity Surgery
Surgical Treatment Options:
Laparoscopic Gastric Banding
The surgeon surgically places a biocompatible adjustable band around the upper part of the stomach, when locked, creates a small stomach and a large stomach. The band is attached by tubing to an access port that is placed under the skin on the abdominal wall, where it can be inflated or deflated. Where the band is placed on the stomach, now looks like an hourglass, resulting in the small upper stomach only being able to handle a small amount of food. As the food digests, it passes to the larger stomach. This modification will allow you to feel full on a small amount of food, thus creating the weight loss process, as you follow the recommended/required diet.
Advantages of the gastric band:
- Least invasive surgery
- Purely restrictive procedure
- No stomach stapling or rerouting of the intestines
- Procedure is reversible
- Low malnutrition risk
- Adjustable for nutrition needs of pregnancy
Disadvantages/risks/complications of the gastric band:
- Slower weight loss
- May feel “hungry”
- Physician follow up is crucial for optimal results
- Nausea/vomiting/reflux
- Outlet obstruction
- Band prolapsed/slippage
- Band erosion
Laparoscopic Sleeve Gastrectomy
Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.
The sleeve gastrectomy is a surgical procedure in which a large portion of the stomach is removed, leaving a 100-150ml gastric tube. The greater curvature of the stomach is removed during the procedure. The small residual stomach tube (looks like a banana) prevents overeating by creating a feeling that the stomach is full after a small meal. The operation is purely restrictive and does not produce malabsorption of nutrients. It is relatively easy to perform compared with other forms of bariatric surgery.
Advantages of the sleeve gastrectomy:
- Improved co-morbid conditions associated with obesity such as:
- Type II diabetes
- Hypertension
- Sleep apnea
- Reduced stomach volume increases feeling of fullness
- Stomach functions normally allowing most food to be eaten
- The hunger stimulating hormone that is produced in this part of the stomach is removed
- There is no dumping syndrome
- No intestinal re-routing
- Simpler procedure than the gastric bypass
- No foreign bodies, such as the gastric band
Disadvantages/risks/complications:
- Staple leak
- Less weight loss than the gastric bypass/BPD
- Irreversible
- Potential for stretching of stomach, resulting in weight regain
- Vomiting if eat too much food
- Reflux/GERD
- Intolerance of some foods
Roux-en-Y Gastric Bypass
The “gold standard” of weight loss surgery is the Roux-en-Y gastric bypass. In this surgery, a small stomach pouch is created by stapling along the upper part of the stomach. A new opening from this pouch is created as well. The first part of the small intestine, called the duodenum, is separated from the second part of the small intestine, called the jejunum. The jejunum is then brought up and connected to the newly created small stomach pouch and the duodenum is reconnected to the small intestine. This creates two pathways, one for food and one for digestive enzymes, and digestion happens downstream. This is a restrictive procedure because there is a newly created small stomach (to hold less food) and with the bypassing of the first part of the small intestines, there is malabsorption, thus creating a 70-75% excess body weight loss within the first twelve to eighteen months.
Advantages of the gastric bypass:
- Quick and dramatic weight loss
- Continued weight loss for 18-24 months
- Many patients maintain a weight loss of 60-70% of excess weight loss
- Improved co-morbid conditions associated with obesity such as:
- Type II diabetes
- Hypertension
- Sleep apnea
- GERD
- Improved quality of life
Disadvantages/risks/complications:
- Staple leak
- Dumping syndrome
- Risk of temporary hair loss
- Vitamin, protein, iron deficiencies
- Malnourishment if required diet is not followed
- Increased risk of gall stones due to rapid weight loss
- Long term complications such as internal hernia, obstructions, etc
Obesity
Obesity is no longer considered a cosmetic issue that is caused by overeating and a lack of self control. The World Health Organization along with National and International medical and scientific societies, now recognize obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.
The disease of obesity is characterized by an excessive accumulation of body fat.
The Body Mass Index is one measure used to define overweight and obesity and considered a more accurate estimate of body fatness.
Do I qualify for surgery?
Overweight is defined as a Body Mass Index (BMI) of 30 or higher and extreme Obesity is a BMI of 40 or greater. Extreme obesity is often referred to as Morbid Obesity due to associated health risks. Most insurance companies will require documentation of a co-morbid condition for a BMI of 35 – 39.9 to qualify for bariatric surgery.
Comorbid conditions include, but not limited to:
- Type II diabetes
- Hypertension
- Sleep apnea
| Very severely underweight | 15 |
| Severely underweight | 15 – 16 |
| Underweight | 16 – 18.5 |
| Normal (healthy weight) | 18.5 – 25 |
| Overweight | 25 – 30 |
| Obese Class I (moderately obese) | 30 – 35 |
| Obese Class II (severely obese) | 35 – 39.9 |
| Obese Class III (very severely obese) | 40 |
Obesity and Prevalence and Rate of Occurrence
According to the WHO, 65% of the world’s population lives in countries where overweight and obesity kills more than underweight. Approximately 500 million adults in the world are affected by obesity and one billion are affected by overweight along with 48 million children.
In the US, epidemiological data from an ongoing study show that 34% of adults more than 20 years old are affected by obesity and 68% are overweight. Obesity affects 10% of children between 2 and 5 years of age, 2% between 6 -11 years old and 18% of adolescents.
Throughout the last 20-25 years, the prevalence of obesity has been increasing at an alarming rate.
Complications of Obesity
Obese patients have more risk for:
• Type II diabetes
• Joint problems
• Hypertension
• Heart disease
• Gallbladder problems
• Psychological issues
• Infertility problems
• Incontinence
• Certain types of cancer
• Digestive disorders, such as GERD
• Breathing difficulties, such as sleep apnea or asthma
Risks to psychological and social well-being:
• Discrimination
• Social isolation
• Negative self-image
• Difficulty with day to day living
• Body movements are more difficult
• May become short of breath with minimal exertion
• Public transportation
• Difficulty maintaining personal hygiene
• May avoid medical care
Treatment Option
The non-surgical treatments that have been regarded as the conventional methods to achieve weight loss, are:
• Diet
• Medication
• Exercise
Unfortunately, research has shown that people with a BMI greater than 35 generally fail to produce permanent weight loss. With the above mentioned methods, several studies have shown that weight loss is approximately 10% of their body weight, and tend to regain two-thirds of it back within one year and almost all of it within five years.
