Weight Loss Surgery

Having weight loss surgery is a very significant decision for someone make. It is a very expensive operation and requires a lot of post-operative commitment to lifestyle and behavior changes in order the operation to be a long term success.  Weight loss surgery has been growing in popularity with over 175,000 Americans having operations each year.  This is mainly because weight loss surgery has proven to be the most effective over a sustained period of time compared to other weight loss therapies.  However, like any serious medical operations, there are risks.  Let's take a further look into the world of bariatric surgery so you can have as much information as possible before making your decision....

What to know before getting weight loss surgery

 

Considering Weight Loss Surgery

If you are considering weight loss surgery for yourself it is essential that you know as much information as possible before making any final decisions.  This is mainly because there are several different options for weight loss surgery.  These options are directly related to your specific body type and desired weight loss.  Different people will require different variations of weight loss surgery.   In order to learn more about the different options for this medical procedure and which is best for you, it is best to consult your physician or local bariatric surgeon.  It is also reccommended that you have more than one visit to different doctors in order to get second or third opinions.  Another smart thing to do is talk to these doctors' previous patients and see how their operations turned out; what they liked, what they didn't like etc.  After taking these initiatives, you will be more confident in making the right decision before its too late.  Let's take a further look into the field of weight loss surgery...

It is also important to be aware of the potenial risks invloved with weight loss surgery before making your final decision.  This mainly has to do with the post-operative period.  Most patients do come out of these surgeries more mobile, and with more self confidence, but the most important thing is to live a long and healthy life.  Like any surgery, there are no guarantees for outcomes.  Unexpected things can happen in even the smallest operations.  With weight loss surgery, the success of the operation is almost always dependent on the commitment of the patient after the operation is complete.  An experienced bariatric surgeon can inform you on all the apects of the post operative recovery period and the follow up care that is needed for the operation to be successfull in the short and long term.  If the proper actions are not taken, post operative effects can be physical, emotional and often unexpected.  The actual surgery is only the begginning.  After that, you will have to change your diet, excersise, and lifestyle habits according to the type of procedure that you undertake.  Make sure you know everything you need to know about the requirements of this post operative period to ensure the success of your operation.

How does weight loss surgery work?

There are two general procedures of weight loss surgery

  • Restrictive procedures that are designed to reduce food intake
  • Malabsorptive procedures which are meant to change digestions habits

The basic theory behind restrictive weight loss procedures is that when a person feels "full", they will not have the desire to consume as much.  Therefore, restrictive procedures will decrease the amount of food a person will eat at once.  The restrictive procedure invloves the surgeon creating a separate pouch in the upper part of the stomach.  This pouch will be connected to the rest of the stomach through a passage called the "stoma."  This combination of a reduced stomach size with behavioral changes can result in steady weight loss.   The success of this restrictive procedure is dependent on the eating habits of the patient after the operation.  Each bariatric surgeon will recommend different post-operative plans in regards to eating habits.  In general, this involves eating no more than a cup of food at once, and not drinking to many liquid- especially carbonated drinks.  The patients that have the most success with restrictive procedures are the ones that eat less, eat slower, and follows all of their doctors instructions.  If not, the new stomach pouch will be stretched thus defeating the whole purpose of the operation.

Malabsorptive procedures are designed to alter digestion in order to cause weight loss.  This mainly invloves an operation that will bypass your small intestine where food would travel.  This reduces the amount of calories that your body will absorb.  Malabsorptive procedures general invlove more risks and complications than restrictive procedure can often be more effective.  It is also possible to have both types of procedures done which are know as combination operations. You should consult your doctor too see which method of weight loss surgery is best for you. 

Different kinds of weight loss procedures

Within these two major categories of procedures (restrictive and malabsorptive) there are multiple variation.  Of course, you bariatric surgeon will be able to determine which is best for you. 

Gastric Restrictive Procedure – Vertical Banded Gastroplasty (VBG)

VBG is a type of restrictive procedure.  What happens here is that the upper part of the stomach near the esophagus is stapled in vertical position for about 6cm.  This creates the smaller stomach pouch as mentioned above.  The outlet is then pinched in by a band which makes it more narrow thus slowing the passage of food.  This is supposed to make you feel more full from eating.  Therefore, you won't feel the need to eat as much.  One adavantage of this procedure is that the reduced amount of food going through the digestive track allows the body to absord the maximum amount of vitamins and nutrients with less consumption.  This allows you to feel satisfaction while still eating less.  In the past 10 years, studies show that patients under this procedure have been able to maintain 50% of their desired weight loss.  

Biliopancreatic Diversion

This is a type of malabsorptive weight loss procedure which alters digestion habits.  A smaller stomach is invloved here as well but not to the same degree.  This procedure also removed a large portion of the stomach to reduce food intake but biliopancreatic diversion is heavily focused on the small intestine.  The structure of the small intestine will be changed so that the pancreatic juices and bile will meet the incoming food near the middle or the end of the small intestine rather than the beginning.  The small intestine will then be divided with one end attached to the stomach pouch. This makes what is known as an "alimentary limb." All the food travels through this part but very little is absorbed here. The pancreatic juices and bile travel through the "biliopancreatic limb," which is attached to the side of the intestine close near the end. This produces more of the digestive juices in the sections of the intestine now called the "common limb." The surgeon is able to change how long the common limb is in order to control the amount of absorption of, fat, protein, vitamins.

Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E )

RYGBP-E is an another variation of malabsorption which makes a divided small gastric pouch, leaving the rest of stomach as is.  A long section of the small intestine is connected to the stomach to alter the direction of the pancreatic juices and bile.  RYGBP-E has less operative risks invlolved because there is no removal of the lower 3/4 of the stomach.  The size of the gastric pouch and the length of the bypassed intestine dictate the level of risks for malnutrition, stomoach problems and other post-operative effects.

Combining Restrictive and Malabsorptive Procedures

Gastric Bypass Roux-en-Y

Another option is to have a combination of restrictive and malabsorptive methods.  This type of weigh loss surgery is called Gastric Bypass Roux-en-Y.  In recent years, this has been the most common choice among weight loss patients.  In this procedure, a small  stomach pouch (about 15 to 20cc in size) is stapled out.  The rest of the stomach isn't removed, but instead, it is  stapled entirely shut and divided from the stomach pouch. The outlet from the new pouch flows right into the lower section of the jejunum which, in effect, takes away the absorption of calories. This is done by dividing the small intestine just beyond the duodenum do that it can connect with newly stapled samller stomach pouch. The other end of the small intestine is connected into the side of the Roux limb of the intestine which creates a "Y" shape that gives the procedure its name. The length of each part of the small intestine can be lengthended or shortened for the purpose of produceing higher or lower amounts of malabsorption.

Is Weight Loss Surgery Effective?

The amount of weight that you have the potential to lose after weight loss surgery relies on the following major factors

  • The amount of excess weight you had before surgery
  • your overall health
  • The type of weight loss procedure you decide to have
  • your age
  • willingness to follow your doctor's post operative diet plan and other follow up guidlines
  • willingness to get at least some exercise
  • support of friends and family

As a general rule, weight loss surgery is considered a success if you lose at least 50% of your excess body weight and are able to keep it that way for a minimum of 5 years.  Studies have shown that most weight loss surgery patients lose weight at a very fast rate in the first 20 months or so after the operation.  Usually, patients will lose around 40% of their excess weight in the first 6 months, and then around 60-70% by the 1 year mark.  Studies have also shown that patients have been able to successfully keep away 50-60% of excess body weight for 12-15 years after surgery.  Again, it is important to remind yourself that the oprtation can be successfull only if you do everthing required in the post-operative period.  This notion is what makes weight loss surgery unique.  It is a lifelong commitment.