Surgery in the Treatment of Obesity (cont.)
IN THIS ARTICLE
Operative Procedures for Bariatric Surgery
Gastric bypassRoux-en-Y gastric bypass is the most commonly performed weight loss procedure in the United States. This operation both restricts food intake and limits absorption of food. A part of the stomach is closed off, creating a small pouch. This restricts the amount of food that you can eat at one time. The small pouch of the stomach is connected directly to the small bowel. As the name implies, food bypasses the stomach and the first portion of the small intestine. Because a part of the small bowel is bypassed, less food is absorbed. Most people find they can eat less than 1 cup of food at a time after the operation. Food must be chewed very well. Overeating or not chewing food finely will result in cramping, nausea, and vomiting.
Laparoscopic adjustable gastric bindingThis is a purely restrictive procedure. It involves placing an inflatable silastic band around the uppermost part of the stomach. This results in a smaller upper stomach pouch and a narrow opening between the upper and lower parts of the stomach. This induces and early feeling of fullness and thereby decreases food intake. It is adjustable by changing the volume of saline in a surgically placed subcutaneous reservoir, thereby tightening or loosening the band.
Biliopancreatic diversion Biliopancreatic diversion (BPD) is a malabsorptive procedure with some restrictive component. A part of the stomach is removed and the remaining part is attached directly to the small intestine near its end. BPD is used much less often than Roux-en-Y because it has a greater risk of complications.
Vertical banded gastroplastyVertical banded gastroplasty (VBG, stomach stapling) is a restrictive procedure that traditionally was done by applying bands or staples to the stomach. This procedure is rarely performed today due to the high failure rate. More information about these procedures can be obtained by visiting the American Society for Bariatric Surgery or the Bariatric Multidisciplinary Institute.
Benefits and Risks of Weight-Loss Surgery
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
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.
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:
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.
Postoperative Care for Bariatric Surgery
If you undergo weight loss surgery, you will continue to receive close medical care for the rest of your life. Laparoscopic adjustable gastric banding will require more frequent visits for band adjustment. Postoperative dietary (including vitamin, mineral, and possibly liquid protein supplementation), exercise, and lifestyle changes should be reinforced by counseling, support groups, and working with your primary care physician. Postoperative care may include planning for reconstructive operations after weight stabilization for certain patients.
Medically reviewed by Donald Lee, DO; Board Certified Family Practice
Medically Reviewed by a Doctor on 1/28/2016
Kathryn L Hale, MS, PA-C
Michel M Murr, MD
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