Weight Loss Surgery Options
The American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:
Restrictive procedures that decrease food intake.
Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.
Roux-en-Y Gastric Bypass:
(Combined Restrictive & Malabsorptive Procedure)
According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the most effective method of weight loss and weight maintenance of all surgical and medical techniques available. It is the most frequently performed weight loss procedure in the United States. 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 or decreased to produce lower or higher levels of malabsorption.
Advantages
The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
One year after surgery, weight loss can average 77% of excess body weight.
You should be aware that weight loss among a large patient population is highly variable and is due to many reasons aside from the surgery alone.
A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved with weight loss surgery.
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, fat, 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.
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.
Laparoscopic Adjustable Gastric Banding:
The Lap Band was recently approved by the FDA and is an option for patients who need to lose a significant amount of weight but want a less invasive procedure, other than gastric bypass surgery.
The Lap Band is an adjustable silicon band with a balloon at the end. Surgeons wrap the Lab Band around the top part of the stomach and fill the balloon with saline solution that will help make the patient feel full more quickly. The operation can be tailored to the individual patient's symptoms and weight loss. By adding saline to the band, the person will feel full and lose weight faster. If they are not eating enough or have problems with nausea and vomiting, the band can be deflated.
Because the entire procedure is performed laparoscopically, using only a few, very small incisions, the patient's recovery from surgery is quicker than traditional surgery. The procedure is usually less than an hour and requires an overnight stay.
Advantages:
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Laproscopic Gastric banding is presently the most commonly preformed weight loss operation outside of the United States (in Australia and Europe) and was recently approved by the FDA.
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Gastric banding is the safest operation available with a rapid recovery time.
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Weight loss ranges from 50% to 65% of excess body weight over the first 2 years and is maintained up to five years. This equals roughly 50-100 lbs. depending on your original weight. Although observed weight loss was lower in the FDA clinical trials, resulting in only 35% excess weight loss, there were significant differences in surgical and clinical technique.
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It is the least invasive surgery of all the surgeries available. Since there is no cutting or re-connecting of stomach or intestines, there is no risk of intestinal leak, dumping or food intolerance.
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Patients who have the LapBand in place do not feel hungry. This appears to be due to the stretching ot the uppermost part of the stomach.
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There is no malabsorbtion of medication or protein. This is particularly important to young women who want to get pregnant. Although you do not need any vitamin or mineral supplements, we recommend a multivitamin once a day.
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The Majority of existing co-morbidities are improved, or even cured, such as diabetes, high blood pressure, sleep apnea, and high cholesterol.
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Since the band is an implantable device, it is 100% reversible just by taking it out.
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The Surgery takes approximately 1 hour to perform and an overnight stay in the hospital. You can be back at work in 3-5 days.
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It is adjustable. This does not require more surgery, but instead, a 10 minute visit to your surgeon's office. As you lose weight, you will need the band tightened, therefore you must be committed to see your surgeon frequently during the first 1-3 years. In certain circumstances, you will need to eat more (ie. pregnancy, illness) so the band can be loosened.
Disadvantages:
- You must re-learn how to eat. Therefore, if you eat too fast, too much or don't chew your food enough, you will vomit. Some foods will not pass through such as steak, white meat chicken and doughy bread.
- Success of weight loss with the LapBand is 70% dependent on your commitment to follow up with your surgeon every 6-8 weeks for at least the first year. Close monitoring of weight, eating habits and various symptoms will determine whether you need an adjustment of your band. This is the only way to assure significant long-term weight loss. If you do not follow-up with your surgeon, you will not lose weight.
- Because the LapBand is an implantable device, it does carry the risk of slippage (causing complete blockage of the gastric pouch) or erosion into the stomach ( causing weight loss to stop ). In either of these cases, another laparoscopic surgery would be required to either re-position the band if it has slipped, or remove the band if it has eroded. This occurs rarely, but is a possibility.
- The LapBand is not a perfect solution and will not result in weight loss if you start eating an excess of chocolate or high calorie drinks ( such as ice cream shakes and soda).
- Although rare, there can be technical problems with the tube kinking or leaking, or the reservoir twisting. This may require a minor operation to correct.
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