Obesity Surgery


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Obesity Surgery

 

Definition

Obesity surgery is an operation that reduces or bypasses the stomach or small intestine so that severely overweight people can achieve significant and permanent weight loss.

Purpose

Obesity surgery, also called bariatric surgery, is performed only on severely overweight people who are more than twice their ideal weight. This level of obesity often is referred to as morbid obesity since it can result in many serious, and potentially deadly, health problems, including hypertension, Type II diabetes mellitus (non-insulin dependent diabetes), increased risk for coronary disease, increased unexplained heart attack, hyperlipidemia, and a higher prevalence of colon, prostate, endometrial, and, possibly, breast cancer. In 2003, researchers concluded that obesity surgery could cure Type II diabetes in many people who were not yet morbidly obese. Therefore, this surgery is performed on people whose risk of complications of surgery is outweighed by the need to lose weight to prevent health complications, and for whom supervised weight loss and exercise programs have repeatedly failed. Obesity surgery, however, does not make people thin. Most people lose about 60% of their excess weight through this treatment. Changes in diet and exercise still are required to maintain a normal weight.
The theory behind obesity surgery is that if the volume the stomach holds is reduced and the entrance into the intestine is made smaller to slow stomach emptying, or part of the small intestine is bypassed or shortened, people will not be able to consume and/or absorb as many calories. With obesity surgery the volume of food the stomach can hold is reduced from about four cups to about 1/2 cup.
Insurers may consider obesity surgery elective surgery and not cover it under their policies. Documentation of the necessity for surgery and approval from the insurer should be sought before this operation is performed.

Precautions

Obesity surgery should not be performed on people who are less than twice their ideal weight. It also is not appropriate for people who have substance addictions or who have psychological disorders. Other considerations in choosing candidates for obesity surgery include the general health of the person and his or her willingness to comply with follow-up treatment.

Description

Obesity surgery is usually performed in a hospital by a surgeon who has experience with obesity surgery or at a center that specializes in the procedure. General anesthesia is used, and the operation takes 2-3 hours. The hospital stay lasts about a week.
Three procedures are currently used for obesity surgery:
  • Gastric bypass surgery. Probably the most common type of obesity surgery, gastric bypass surgery has been performed in the United States for about 25 years. In this procedure, the volume of the stomach is reduced by four rows of stainless steel staples that separate the main body of the stomach from a small, newly created pouch. The pouch is attached at one end to the esophagus. At the other end is a very small opening into the small intestine. Food flows through this pouch, bypassing the main portion of the stomach and emptying slowly into the small intestine where it is absorbed.
  • Vertical banding gastroplasty. In this procedure, an artificial pouch is created using staples in a different section of the stomach. Plastic mesh is sutured into part of the pouch to prevent it from dilating. In both surgeries the food enters the small intestine farther along that it would enter if exiting the stomach normally. This reduces the time available for absorption of nutrients. The procedure is normally done laparoscopically, meaning that the surgeon makes one or more small incisions in the abdomen and inserts the necessary tools and instruments through the tiny holes. He or she can view the patient's organs via an inserted camera that displays pictures on a monitor. This method makes for a faster and easier recovery than a large incision.
  • Jejunoileal bypass. Now a rarely performed procedure, jejunoileal bypass involves shortening the small intestine. Because of the high occurance of serious complications involving chronic diarrhea and liver disease, it has largely been abandoned for the other, safer procedures

Preparation

After patients are carefully selected as appropriate for obesity surgery, they receive standard preoperative blood and urine tests and meet with an anesthesiologist to discuss how their health may affect the administration of anesthesia. Pre-surgery counseling is done to help patients anticipate what to expect after the operation.

Aftercare

Immediately after the operation, most patients are restricted to a liquid diet for 2-3 weeks; however, some may remain on it for up to 12 weeks. Patients then move on to a diet of pureed food for about a month, and, after about two months, most can tolerate solid food. High fat food is restricted because it is hard to digest and causes diarrhea. Patients are expected to work on changing their eating and exercise habits to assist in weight loss. Most people eat 3-4 small meals a day once they return to solid food. Eating too quickly or too much after obesity surgery can cause nausea and vomiting as well as intestinal "dumping," a condition in which undigested food is shunted too quickly into the small intestine, causing pain, diarrhea, weakness, and dizziness.

Risks

As in any abdominal surgery, there is always a risk of excessive bleeding, infection, and allergic reaction to anesthesia. Specific risks associated with obesity
The purpose of obesity surgery is to reduce the size of the stomach and slow the stomach emptying process by narrowing the entrance into the intestine. With this surgery, the volume of food the stomach can hold is reduced from approximately 4 cups to approximately one-half cup. There are two types of procedures used for obesity surgery: gastric bypass surgery and vertical banded gastroplasty, as shown in the illustration above.
The purpose of obesity surgery is to reduce the size of the stomach and slow the stomach emptying process by narrowing the entrance into the intestine. With this surgery, the volume of food the stomach can hold is reduced from approximately 4 cups to approximately one-half cup. There are two types of procedures used for obesity surgery: gastric bypass surgery and vertical banded gastroplasty, as shown in the illustration above.
(Illustration by Electronic Illustrators Group.)
surgery include leaking or stretching of the pouch and loosening of the gastric staples. Although the average death rate associated with this procedure is less than one percent, the rate varies from center to center, ranging from 0-4%. Long-term failure rates can reach 50%, sometimes making additional surgery necessary. Other complications of obesity surgery include an intolerance to foods high in fats, lactose intolerance, bouts of vomiting, diarrhea, and intestinal discomfort
Studies on the risks of these surgeries continue. A 2003 report showed that gastric bypass surgery risk increases with age, weight and male gender. Patients age 55 and older experienced more complications than did younger patients and male patients had more life-threatening complications than female patients, particularly those who were more severely obese.

Normal results

Many people lose about 60% of the weight they need to reach their ideal weight through obesity surgery. However, surgery is not a magic weight-loss operation, and success also depends on the patient's willingness to exercise and eat low-calorie foods. A 2003 report showed that super obese patients had a lower success rate with laparoscopic vertical banding gastroplasty than those considered morbidly obese. However, the overall success rate was nearly 77% of patients carrying less than 50% excess weight four years after the procedure.

Resources

Periodicals

"Gastric Bypass Surgery Risk Increases with Age, Weight, and Male Gender." Medical Devices and Surgical Technology Week January 19, 2003: 29.
"Laparoscopic Vertical Banding Gastroplasty Safe and Effective for Morbid Obesity." Medical Devices and Surgical Technology Week January 19, 2003: 2.
Sadovsky, Richard. "Obesity Surgery May Cure Diabetes in Nonobese Patients." American Family Physician 56 (February 15, 2003): 866.
References in periodicals archive ?
If Hospital doctors understand that obese do not represent chances for gaining money through obesity surgery and obesity drugs, then real hope might appear in practice.
Obesity surgery is on the rise, in part, because in most cases, diets may help obese people lose weight, but they don't keep the weight off.
Arun Prasad, President, Obesity Surgery Society of India (OSSI), said, "There is growing need to understand the developing obesity and type 2 diabetes crises in India.
Christou, "Validation of obesity surgery mortality risk score in patients undergoing gastric bypass in a Canadian center," Surgery for Obesity and Related Diseases, vol.
Junginger, "Is routine preoperative upper endoscopy in gastric banding patients really necessary?," Obesity Surgery, vol.
Recent preliminary results indicates that decreased experiential avoidance during behavioral interventions, is associated with healthier eating patterns, less body dissatisfaction, and enhanced quality of life among both obese patients (Hayes, Strosahl, & Wilson, 2011) and obesity surgery patients (Weineland, Hayes, & Dahl, 2012).
Professor Naveed Sattar, professor of metabolic medicine at Glasgow University, said: "The number of cases of obesity said: "The number of cases of obesity surgery we do in the UK is tiny.
The Primary Obesity Surgery Endoluminal (POSE) where the doctor uses an endoscope to reach the stomach and stitch up parts related to the hunger receptors that secrete hunger hormones like ghrelin, reduces its secretion and the urge to eat more.
New York, NY, August 14, 2014 --(PR.com)-- Persistence Market Research Released New Market Report on “Global Market Study on Obesity Surgery Devices: Asia-Pacific to Witness Highest Growth by 2020” the global obesity surgery devices market was valued at USD 1,432.4 million in 2014 and is expected to grow at a CAGR of 9.6% from 2014 to 2020, to reach an estimated value of USD 2,489.5 million in 2020.
And to top it all, their problems are compounded because health insurance does not cover obesity surgery.
Schernthaner, "Ghrelin and obestatin levels in severely obese women before and after weight loss after Rouxen-Y gastric bypass surgery," Obesity Surgery, vol.
The study offers reassuring evidence that obesity surgery is generally safe for teens, echoing previous short-term research.

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