Surgery

                                                                                                                                                                                                                                                                                                                                                                                                                                                                            When Diet, Exercise, And Medications Aren’t Enough                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       There are a variety of surgical procedures available for weight loss.  Other websites cover these porcedures in detail.  This is to give you an overview of the available weight loss procedures.  These procedures are usually reserved for the morbidly obese or the super morbidly obese.  The Centers for Disease Control estimate that more than one third of Americans are obese which translates to approximately 78.6 million people.  As with any surgical procedure, there are potential complications which include, but are not limited, to hemorrhage, infection, injury to another organ system and death.  Other complications which can accompany these surgeries include sagging skin and digestion issues.  Therefore, the decision to have one of these surgical procedures is not entered into lightly either by the physician or the patient.  The bariatric surgeries consist of several main procedures including the lap band, gastric sleeve, gastric balloon, gastric bypass, duodenal switch, gastric plication, and the roux-en-Y among others.

With the lap band, the surgeon places a band around the upper part of the stomach to create a small pouch to hold food making the patient feel full even after eating small amounts of food.  This procedure can be done through the laparoscope which reduces the amount of time spent in the hospital, and also reduces the recovery time from the surgery.

A laparoscopy consists of making four to six small incisions on the abdominal wall, and then passing a camera through one of the incisions to view the abdominal structures.  The rest of the small incisions are used to pass surgical instruments into the abdomen.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        The gastric sleeve can also be placed through the laparoscope.  The sleeve is placed around the stomach reducing the stomach by 80%.  The patient will feel fuller sooner, and will therefore eat less.

The gastric balloon is inserted in a deflated state through the mouth and esophagus into the stomach.  The balloon is made of silicone, and gives the patient a feeling of fullness when the balloon is inflated in the stomach.

Gastric bypass surgery divides the stomach into a small upper pouch, and a larger “remnant” lower pouch.  The small intestine, called the jejunum, is then rearranged to connect to both pouches.  Like the other bariatric surgeries, this procedure effectively causes weight loss.  Also, like the other surgeries, this procedure can cause poor nutrition from malabsorption.

The duodenal switch removes 70% of the stomach and reroutes a lengthy portion of the small intestine to reduce caloric absorption and limit fat absorption.  Most of the hunger hormone, called ghrelin is removed when the greater curvature of the stomach is removed.  The removal of this hormone also helps in controlling hunger.

The gastric plication surgery shrinks the stomach size by creating folds in the stomach lining thereby shrinking the stomach to a small fraction of its former size.  This causes the patient to feel fuller sooner.  This procedure is still considered investigational, but the preliminary results of its efficacy are promising.

Finally, the Roux-en-Y procedure creates a small stomach pouch about the size of an egg.  The stomach is then connected to the middle portion of the small intestine (jejunum) thereby bypassing the rest of the stomach and upper part of the small intestine (duodenum).  This reduces the amount of fat and calories absorbed, but it also decreases the amount of vitamins and minerals absorbed.  This can lead to low levels of iron, calcium, and protein.  The procedure can also cause dumping syndrome which is manifested by fast heartrate, abdominal cramping, diarrhea, fainting and nausea after eating.

As you have no doubt figured out by now, the weight loss surgeries can be a risky undertaking, but for some people this is the only answer.  Many of the candidates for these surgeries meet the same criteria as those patients who are placed on appetite suppressants.  The criteria include at least 100 pounds over the ideal weight, a BMI of 40 or a BMI of 35 with existing comorbidities like hypertension and diabetes mellitus.

I hope you learned something about bariatric surgery.  Please feel free to e mail your questions or comments to weightlossbootcamp@gmail.com.

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