Bariatric SurgeryAbout The Procedure
Millions of individuals in the United States and around the world are overweight. When weight increases to an extreme level, it is referred tp as morbid obesity. Obesity is associated with diabetes, heart disease, high blood pressure, some types of cancer, and other medical problems. Bariatrics is the field of medicine that specializes in treating obesity. Bariatric surgery is the term for operations to help promote weight loss. Bariatric surgical procedures are only considered for people with severe obesity and not for individuals with a mild weight problem.
There are several different types of Bariatric Surgery procedures, but they are known collectively as Bariatric Surgery.
According to the American Society for Bariatric Surgery, Roux-en-Y or RYGBP is the most commonly performed operation for weight loss in the United States, with approximately 140,000 gastric bypass proceduress performed in 2005.
Procedure Description
In Bariatric Surgery, the surgeon creates a small pouch at the top of the stomach and adds a bypass around a segment of the small intestine.
The surgeon staples the stomach across the top, sealing it off from the rest of the stomach. The resulting pouch is about the size of a walnut and can hold about one ounce of food. The pouch is physically separated from the rest of the stomach. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch.
This redirects food, bypassing most of your stomach and the first section of your small intestine, the duodenum. Food enters directly into the second section of your small intestine, the jejunum, limiting your ability to absorb calories. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in your small intestine.
Some surgeons perform this operation by using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen, which is known as a Laparoscopic Gastric Bypass. The tiny camera on the tip of the scope allows the surgeon to see inside the abdomen.
Best Candidates for Bariatric Surgery
To qualify for Bariatric Surgery, most patients must be morbidly obese, which usually means being overweight by 100 pounds (males) or 80 pounds (females) with a Body Mass Index or BMI of over 40.
Bariatric Surgery may be appropriate if you are 80 pounds overweight and have a serious obesity-related condition like type 2 diabetes or life-threatening cardio-pulmonary problems such as severe sleep apnea or obesity-related heart disease.
The higher the motivation of patients to lose weight, and manage the post-operative requirements of dietary modification and behavioral therapy, the more successful Bariatric Surgery is likely to be, in solving their obesity and weight problems. This may influence the selection of candidates for Bariatric Surgery.
Compared with traditional "open" gastric bypass, the laparoscopic technique usually shortens your hospital stay and leads to a quicker recovery. Fewer wound-related problems also occur.
Length of the Procedure
Bariatric Surgery takes 4 to 5 hours, depending on the extent of the procedure.
Anesthesia
Bariatric Surgery is performed under a general anesthesia
Inpatient or Outpatient?
Bariatric Surgery is performed on an inpatient basis. Most people typically stay in the hospital for a few days or less after surgery.
Possible Side Effects
If a patient consumes sugar after a gastric bypass (ice cream, chocolate candy, soda, etc.), the presence of the sugar in the intestine will create a reaction called dumping syndrome, which affects the whole body.
An episode of dumping shows up as palpitations (heart racing), a sweaty and clammy feeling, cramping, abdominal pain, diarrhea, and then a feeling of weakness during which the patient must lay down for an hour or so until it passes. Dumping syndrome is not dangerous, but it feels awful.
Recovery
Most people typically stay in the hospital for a few days or less after gastric bypass surgery. Some may need to stay 4 to 5 days.
Patients remain on liquid or pureed food for several weeks after the surgery. Even after that time, they will feel full very quickly, sometimes only being able to take a few bites of solid food. This is because the new stomach pouch initially only holds a tablespoonful of food. The pouch eventually expands. However, it will hold no more than about one cup of thoroughly chewed food (a normal stomach can hold up to one quart).
Upon follow up, the doctor will determine if the patient will need replacement of iron, calcium, vitamin B12, or other nutrients. Supplements, such as a multivitamin with minerals, will be prescribed to provide any nutrients that the patient may not be getting from their diet. This lack of nutrients can occur because they are eating less and because the food moves through their digestive system more quickly.
Patients generally resume exercise 6 weeks after the operation. Even sooner than that, they are able to take short walks at a comfortable pace, with the approval and guidance of the doctor. Exercise improves metabolism, while both exercise and attending a group support can boost self-esteem and help the patient stay motivated.
Duration of Results
In adults, Bariatric Surgery results in significant and sustained weight loss, which, in turn, has reversed or reduced the severity of many obesity-related disorders.
Risks
Bariatric Surgery is serious surgical intervention and carries all the usual risks of a major surgical procedure.
The risks associated with Bariatric Surgery include bleeding; infections; follow-up surgeries to correct complications or to remove excess skin; gallstones due to significant weight loss in a short amount of time; gastritis or inflammation of the lining of the stomach; vomiting from eating more than the stomach pouch can hold; Iron or Vitamin B12 deficiencies that can lead to anemia; and calcium deficiency that can contribute to the development of early osteoporosis or other bone disorders. Follow up surgeries may be less likely if gastric bypass is performed with a laparoscope.
Cost
Bariatric Surgery costs $25,000 or more, although insurers are slowly beginning to accept that this kind of weight loss surgery can deliver powerful medical benefits that will save them money in the long run, especially where conventional weight loss remedies have consistently failed to reduce obesity.
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