How does Surgery Promote Weight
- Gastrointestinal surgery is the best option for
people who are severely obese and cannot lose weight
by traditional means or who suffer from serious obesity-related
- The surgery promotes weight loss by restricting
food intake and, in some operations, interrupting
the digestive process.
- However, the best results are achieved with healthy
eating behaviors and regular physical activity.
Who can consider Weight Loss Surgery (WLS)
- People who may consider gastrointestinal surgery
include those with a body mass index (BMI) above 40-about
100 pounds of overweight for men and 80 pounds for
- People with a BMI between 35 and 40 who suffer
from type 2 diabetes or life-threatening cardiopulmonary
problems such as severe sleep apnea or obesity-related
heart disease may also be candidates for surgery.
Choose the surgery option best suited to you:
- The most important step in weight loss surgery is
to know about the various surgical options.
- The best source of information will be your bariatric
surgeon and other physicians who will recommend the
best option to you for weight loss.
- Make sure you understand well about the option being
- The decision to have a weight loss surgical procedure
may take several visits to their office and consultation
with more than one doctor.
- Ask your doctor for names of other patients who
have had similar weight loss surgeries and who are
willing to discuss their experiences, good and bad,
- Although the results of weight loss surgery can
be drastic, there are potential risks
and complications. Before making your decision, you
should be well informed.
- Before you sign a consent form, you should have
a solid understanding of what the complications involved.
What are options of Weight
Gastrointestinal surgery for obesity is also
called bariatric surgery. It alters the digestive process.
The operations promote weight loss by closing off parts
of the stomach to make it smaller. Operations that only
reduce stomach size are known as "restrictive operations"
because they restrict the amount of food the stomach
Some operations combine stomach restriction with a
partial bypass of the small intestine. These procedures
create a direct connection from the stomach to the lower
segment of the small intestine, literally bypassing
portions of the digestive tract that absorb calories
and nutrients. These are known as malabsorptive operations.
Weight Loss Surgery is an expensive option
to lose weight.
There are several types of restrictive
and malabsorptive operations. Each one carries its own
benefits and risks.
- Right after surgery, most patients lose
weight quickly and continue to lose for 18 to
24 months after the procedure. Although most patients
regain 5 to 10 percent of the weight they lost, many
maintain a long-term weight loss of about 100 pounds.
- Surgery improves most obesity-related conditions.
For example, in one study blood sugar levels of 83
percent of obese patients with diabetes returned to
normal after surgery.
- Patients who have weight-loss surgery require follow-up
operations to correct complications.
- Abdominal hernia is the most common complication
requiring follow-up surgery
- Less common complications include breakdown of the
staple line and stretched stomach outlets.
- During rapid or substantial weight loss, a person's
risk of developing gallstones increases.
- Nearly 30 percent of patients who have weight-loss
surgery develop nutritional deficiencies such as anemia,
osteoporosis, and metabolic bone disease. These deficiencies
usually can be avoided if vitamin and mineral intakes
are high enough.
- Women of childbearing age should avoid pregnancy
until their weight becomes stable because rapid weight
loss and nutritional deficiencies can harm a developing
Restrictive operations serve only to restrict
food intake and do not interfere with the normal digestive
process. To perform the surgery, doctors create a small
pouch at the top of the stomach where food enters from
the esophagus. Initially, the pouch holds about 1 ounce
of food and later expands to 2-3 ounces. The lower outlet
of the pouch usually has a diameter of only about ¾
inch. This small outlet delays the emptying of food
from the pouch and causes a feeling of fullness.
As a result of this surgery, most people lose the ability
to eat large amounts of food at one time. After an operation,
the person usually can eat only ¾ to 1 cup of
food without discomfort or nausea. Also, food has to
be well chewed. Restrictive operations for obesity include
adjustable gastric banding (AGB) and vertical banded
- Adjustable gastric banding (AGB).
In this procedure, a hollow band made of special material
is placed around the stomach near its upper end, creating
a small pouch and a narrow passage into the larger
remainder of the stomach. The band is then inflated
with a salt solution. It can be tightened or loosened
over time to change the size of the passage by increasing
or decreasing the amount of salt solution.
- Vertical banded gastroplasty(
VBG) This has been the most common restrictive operation
for weight control. In this, both a band and staples
are used to create a small stomach pouch.
- Successful results depend on the patient's willingness
to adopt a long-term plan of healthy eating and regular
- Restrictive operations are less successful than
malabsorptive operations in achieving substantial,
long-term weight loss.
- However, some patients regain weight.
- Others are unable to adjust their eating habits
and fail to lose the desired weight.
- A common risk of restrictive operations is vomiting,
which is caused when the small stomach is overly stretched
by food particles that have not been chewed well.
- Band slippage and saline leakage have been reported
- Risks of VBG include wearing away of the band and
breakdown of the staple line.
- In a small number of cases, stomach juices may
leak into the abdomen, requiring an emergency operation.
- In less than 1 percent of all cases, infection
or death from complications may occur.
Malabsorptive operations are the most common gastrointestinal
surgeries for weight loss. They restrict both food intake
and the amount of calories and nutrients the body absorbs.
- Roux-en-Y gastric bypass (RGB).
This operation, is the most common and successful
malabsorptive surgery. First, a small stomach pouch
is created to restrict food intake. Next, a Y-shaped
section of the small intestine is attached to the
pouch to allow food to bypass the lower stomach, the
duodenum (the first segment of the small intestine),
and the first portion of the jejunum (the second segment
of the small intestine). This bypass reduces the amount
of calories and nutrients the body absorbs.
- Biliopancreatic diversion (BPD).
In this more complicated malabsorptive operation,
portions of the stomach are removed. The small pouch
that remains is connected directly to the final segment
of the small intestine, completely bypassing the duodenum
and the jejunum. Although this procedure successfully
promotes weight loss, it is less frequently used than
other types of surgery because of the high risk for
nutritional deficiencies. A variation of BPD includes
a "duodenal switch" which leaves a larger portion
of the stomach intact, including the pyloric valve
that regulates the release of stomach contents into
the small intestine. It also keeps a small part of
the duodenum in the digestive pathway.
- Malabsorptive operations produce more weight loss
than restrictive operations.
- They are more effective in reversing the health
problems associated with severe obesity.
- Patients who have malabsorptive operations generally
lose two-thirds of their excess weight within 2 years.
- In addition to the risks of restrictive surgeries,
malabsorptive operations also carry greater risk for
nutritional deficiencies. This is because the procedure
causes food to bypass the duodenum and jejunum, where
most iron and calcium are absorbed.
- Menstruating women may develop anemia because not
enough vitamin B12 and iron are absorbed.
- Decreased absorption of calcium may also bring
on osteoporosis and metabolic bone disease.
- RGB and BPD operations may also cause "dumping
syndrome." This means that stomach contents move too
rapidly through the small intestine. Symptoms include
nausea, weakness, sweating, faintness, and sometimes
diarrhea after eating.
Source : http://www.nlm.nih.gov
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