Surgical Treatment for Severe Obesity
It is estimated that more than 10 million Americans suffer from severe obesity. For these people, weight management is much more than carrying a few extra pounds. It can be a matter of life and death.
Many have struggled with weight loss for years trying various diets, medications and professional weight-loss services without long-term success. For these individuals, weight-loss surgery, also called bariatric surgery, may produce long-term weight loss.
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Is Weight Loss Surgery for You?
To qualify for gastric bypass surgery, you must meet the following criteria:
- 100 lbs over ideal weight or a BMI of more than 40, with or without co-morbid conditions
- A BMI between 35 and 40 also may qualify with associated comorbid conditions such as high blood pressure, sleep apnea, heart disease or diabetes
- Previous weight-loss efforts including medically supervised diet plans, exercise and behavioral modification programs have been unsuccessful
- Understand and be committed to the behavioral changes that will be required after surgery
Before deciding whether or not you are a candidate for bariatric surgery, your doctor will conduct a comprehensive medical evaluation that may include blood tests, EKG, chest x-ray, pulmonary function test, upper gastrointestinal x-ray, gall bladder ultrasound and/or a psychiatric evaluation.
You may not qualify for surgery if you have pre-existing conditions such as alcoholism, hepatic cirrhosis with impaired liver functions, serious psychiatric disability and/or correctable hormonal causes of obesity.
Preparing for Weight Loss Surgery
Prior to admission to the hospital, your surgeon will refer you for pre-operative tests and lab work. You may be asked to stop smoking or drinking alcohol as early as one month prior to surgery. In addition, you may be told to stop taking aspirin or arthritis medications as they can slow the clotting of blood. We recommend you discuss blood donation options with your surgeon in case a blood transfusion becomes necessary. Your surgeon may recommend that you donate your own blood weeks in advance.
Gastric Bypass and Gastric Banding
The choice of which type of weight-loss surgery to have is an important and serious decision. While the majority of patients who undergo these procedures are very successful, no procedure is perfect. You are encouraged to discuss the benefits and risks of each type of surgery in detail with your surgeon.
- Roux-en-Y Procedure (Gastric Bypass)
In this procedure, the surgeon staples across the top portion of the stomach to create a very small stomach pouch. The surgeon then connects the new stomach pouch to the small intestine, bypassing some of the upper and more absorptive part of the small intestine. This reduces the amount of food eaten as well as decreases absorption of the food and calories consumed. Results vary but the average patient usually can expect to lose 50 to 90 percent of excess weight in 12 to 18 months after surgery.
- Laparoscopic Gastric Bypass Surgery
In a conventional procedure, the surgeon operates through an abdominal incision, usually four to five inches for the majority of patients. Laparoscopic procedures involve small incisions in the abdomen. The surgeon operates through these incisions using a laparoscope (a fiber-optic tube and a small video camera which shows the abdominal organs on a TV monitor). The surgeon staples the stomach to create a pouch as is done in traditional gastric bypass surgeries.
- Laparoscopic Adjustable Gastric Band
Surgeons use a silicone band to create a small pouch using the top part of the existing stomach. Using thin surgical instruments and a small internal camera to monitor the operation, the surgeon places a laparoscopic adjustable gastric band around the top portion of the stomach creating a small pouch, without cutting or stapling. This pouch later limits the patient's food consumption without disrupting the normal progression of food through the digestive tract. In some cases, the gastric band is connected via a small tube to a small reservoir that contains saline. This reservoir is placed under the skin of the upper abdomen. After surgery, the surgeon will examine the patient to ensure that the band contains enough saline. It needs to be tight enough to allow for gradual weight loss while ensuring that the patient eats enough food for proper nutrition. Adjustments typically are made to the band one month after the procedure. Using a fine needle, the surgeon can add or remove saline to enlarge or shrink the band. This results in allowing more or less food to pass between the two parts of the stomach. The number of adjustments varies from person to person, but most patients usually need three to five before the band is at the ideal tightness. This procedure allows for pregnancy since the stomach outlet size can be opened to increase nutritional uptake. With the laaroscopic adjustable gastric band procedure, patients can experience weight loss of one to three pounds a week in the first year after surgery. The amount usually decreases after 12 to 18 months.
- Laparoscopic Sleeve Gastrectomy
Laparoscopic sleeve gastrectomy, an alternative to laparoscopic banding or Roux-en-Y, restricts the amount of food consumed by the stomach. During this procedure, the surgeon removes 85 percent or more of the stomach without bypassing the intestines. The stomach is not bypassed as in Roux-en-Y procedures. In addition to the reduced stomach volume, this procedure decreases Ghrelin blood levels (a hunger hormone) so patients may feel less hungry while they lose weight.
GW Hospital has a dedicated bariatric unit for patients who undergo surgical weight-loss procedures. Specialized nursing care and monitoring are provided in the bariatric unit. Patients are encouraged to participate in a preoperative education class and tour of the unit prior to surgery. The unit coordinator will contact you to schedule a class. Patient rooms have been furnished with the larger patient in mind so the beds and chairs comfortably accommodate most individuals. Nurses work closely with the physicians and are well trained to care for patients recovering from weight-loss surgery.
What Results Can You Expect?
Weight-loss surgery has given many individuals a new lease on life. The amount of weight you lose will depend on the type of surgical procedure you have and how committed you are to the required lifestyle changes, including exercise and eating habits. Your age, sex and initial weight at the time of surgery also may affect surgical outcomes.
Even if the ideal weight is not reached, comorbid medical problems are improved in most cases. Many patients find they no longer need medications for diabetes, hypertension, sleep apnea, arthritis and back pain. Most patients report an increase in self-esteem and self-confidence and an improvement in their overall quality of life.
You will be closely monitored throughout your hospital stay. To help manage your pain, special analgesia machines will allow you to self-administer pain medication until you are able to take oral medications.
Postoperative leg exercises may be recommended and/or a compression device may be attached to your legs to help prevent the formation of blood clots and to improve circulation. Your doctor will likely encourage you to be up and walking as soon as possible to help your circulation.
After surgery, you will start on a liquid diet and then transition to a pureed, soft and regular diet, as instructed by your doctor. Your individual progress will determine the length of time needed for each eating phase.
Your surgeon will discuss a postoperative plan with you, which is essential to the long-term maintenance of your weight loss. This may include referrals to nutritionists, exercise programs, psychotherapists and/or support groups.
Patients generally stay in the hospital for two to four days.
After weight-loss surgery, the amount you can eat before feeling full is significantly reduced. Your doctor may recommend eating several (eight to ten) small meals throughout the day to ensure you get proper nutrition. Most patients experience some difficulty tolerating red meat, chicken and sweets after surgery. During the first three to seven months of reduced food intake, some patients experience nausea, vomiting, food intolerance, changes in bowel movements, constipation, transient hair loss and loss of muscle mass. Nearly all patients usually see a significant improvement in how they feel when dietary intake is improved (6 to 12 months).
After many months of losing weight you may have excess skin that did not contract during your weight loss. Once your body has stabilized after 12 to 18 months, you may wish to talk with your surgeon about undergoing plastic or cosmetic surgery to correct the condition.
Risks and Side Effects
As with any abdominal surgery, there are potential risks. However, with bariatric surgery, these risks are further complicated because of the patient's extra weight. Please discuss these risks with your surgeon.
The risk of death is greatly dependent on an individual's personal health and existing risk factors. Nationally, the risk of death is approximately from .5 to 2 percent.
GW Hospital participates in most health and insurance plans. Many insurance plans have coverage for obesity surgery with durational limits, dollar limits, deductibles, co-payments and co-insurance factors that are no less favorable than for physical illness. Because the surgery is done for medical and not cosmetic reasons your doctor will need to substantiate the medical necessity for the gastric bypass procedure. Your physician's office can help you better understand how to work with your insurance carrier.
For phone numbers and office information about gastric bypass surgeons, see the list of gastric bypass surgeons in the right column. Or call the GW Physician Referral Service at 1-888-4GW-DOCS.
Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if bariatric surgery is right for you.