Surgery in the Treatment of Obesity (cont.)

Like all surgical procedures, weight-loss operations have benefits and risks. No one should decide to have surgery without being completely informed of both the pros and cons. This is a decision that you make with your family members, your health care provider, and your surgeon.

Benefits of weight-loss surgery

• Weight loss: Most patients begin to lose weight right away. Some gain some of the weight back, but most are able to keep the weight off for long periods.
  
  
  • In general, combined restrictive and malabsorptive procedures (like gastric bypass) are more successful than restrictive procedures (like adjustable gastric banding) at promoting weight loss.
    
    
    • Gastric bypass is the most successful procedure. In the first 2 years after gastric bypass, average weight loss is 65% of excess weight. On the other hand, average weight loss with AGB is 35% of excess weight.
    
    
    
    • With gastric bypass, no band is introduced into the body. Also, it is a good operation for a sweet eater because eating sugar makes the patient feel ill (referred to as "dumping").
    
    
    
    • The lap-band system has the advantages of being less invasive, providing a faster recovery, and avoiding alteration of anatomy of the gastrointestinal tract. It is adjustable and reversible with normal stomach restoration. No opening of the stomach or intestines occurs that could cause a leak.
       
  • People who undergo one of these procedures are much more likely to reach their goal and keep weight off if they also adopt a plan of healthy eating and regular exercise.
     
• Improved health: Most obesity-related medical conditions improve drastically after surgery, especially diabetes, sleep apnea, and hypertension.
  
  
  • After surgery mortality rate is reduced and improvements are seen in many of the health risks associated with obesity.
  
  
  
  • Overall, quality of life, self image, and mobility are reported to be better.

Risks of weight-loss surgery

All surgical procedures have complications. Talk to your surgeons about this and make sure that your surgeons are specialists in bariatric surgery.

• Disadvantages of gastric bypass - A patient who has gastric bypass may develop the following complications:
  
  
  • "Dumping syndrome" - Patients experience nausea, abdominal cramping, and diarrhea after eating sugar. Other symptoms include weakness or faintness.
  
  
  
  • Narrowing or ulcer formation or leak at the stomach to intestine connection - These may require reoperation.
  
  
  
  • Incisional hernia - This is more common in open bariatric surgery.
  
  
  
  • Blood clot in the leg - This may migrate to the lung.
  
  
  
  • In addition to surgical complications, long-term consequences of the malabsorption arise if patients with gastric bypass do not take supplemental vitamins, iron, and calcium. These nutritional deficiencies include the following:
    
    
    • Vitamin deficiencies (A, B-12, D, E, and K)  - Deficiencies of vitamin B-12, folate, and iron can cause anemia.
    
    
    
    • Mineral deficiencies (calcium, iron, and folic acid) - Calcium deficiency is a concern because it may lead to osteoporosis and other bone disorders.
       
• Disadvantages of adjustable gastric band
  
  
  • The lap-band system is not the operation of choice in sweat eaters or patients with severe gastroesophageal reflux disease (GERD).
  
  
  
  • There is a low possibility of port leak or infection, as well as slippage, erosion, or migration of the band. This may require reoperation. High conversion rates of band to gastric bypass have been reported in American studies. However, this may represent the surgeon's learning curve.

In experienced hands, the benefits of surgery are typically viewed to outweigh the risks. The immediate operative mortality rate for both adjustable gastric band and Roux-en-Y gastric bypass is about 1%.

Weight regain after bariatric surgery

Some patients may regain weight after bariatric surgery. This may be due to many factors, among them the following:

• Noncompliance with postoperative diet



• Noncompliance with postoperative exercise



• Stretching of the stomach pouch



• Communication between the pouch and the rest of the stomach



• Band problems

Costs of weight loss surgery

Surgery seems to be much more expensive than other treatments for obesity; however, rates vary depending on choice of surgeon and hospital and region in which you live. Insurance coverage of weight-loss surgery varies by state and insurance carrier. Check with your carrier to see whether such operations are covered. Surgery may be covered by Medicare or Medicaid; check with your regional office.