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Bariatric surgery

The decision to undergo bariatric surgery should be well informed. The following information serves as a guide to developing a detailed understanding of the benefits and risks of bariatric surgery as treatment for the disease of morbid obesity. Like so many people who struggle with their weight, you’ve probably made several attempts to take control using diet and exercise. The fact is, more than 95% of people who take part in non surgical weight loss programs will fall to achieve and maintain significant weight loss for a long period of time’. You interested in this information shows that you want to learn more about experiencing life at a healthier weight. Weight loss surgery has been proven to help people achieve and maintain a healthier weight when diet and exercise alone have failed, and it may be right for you. Surgery is a serious decision.
 
Taking certain steps in the right order can help ensure you get all the necessary information to identify the most effective treatment. With these steps you’ll know how to get started and what to do next. The goal is to have everything in place to feel confident with your decision to achieve and maintain a healthier weight.
 
Living with excess weight has been shown to put your health at risk. Serious health problems may also result when dieting leads to ‘weight cycling’(the repeated loss and regain of body weight). Bariatric surgery has helped hundreds of thousands of people discover life at a healthier weight and it may be the answer for you. But it’s critical to have a clear understanding of what this life-changing treatment involves.The starts with gettingreliable information.
 

What is obesity?

The centre for disease control defines obesity as an excessively high amount of body fat in relation to lean body mass. It is commonly measured by body mass index (BMI), which calculates the relationship of weight to height. An adult with a BMI of 30 or more is considered obese. Obesity becomes morbid obesitywhen an adult is 45kgs or more ideal body weight, has a BMI of 40 or more or has a BMI of 35 or more in combination with a health-related conditions such as obstructive sleep apnea or a disease such as type2 diabetes or heart disease.

 

 

Obesity puts your health at risk

Obesity dramatically increases the risk of :

  • High blood pressure
  • High levels of triglycerides (a type of blood fat )
  • Type 2 diabetes
  • Heart disease and stoke
  • Arthritis
  • Obstructive sleep apnea
  • Higher body weights are also associated with cancer and early death.

 

How to evaluate surgical options?

Bariatric surgeons and their patients have a choice of procedures that use different techniques, or combine techniques to achieve weight loss.Restrictive procedure decrease food intake by creating a smaller stomach.Malabsorptive procedure alters the digestive process, causing food to be poorly digested and incompletely absorbed. The following information will help you understand more about available surgical options, including the benefits

 

 

 

 

Gastric banding

How it works to help you lose weight

Gastric banding is a restrictive procedure because it limits the amount of food you can eat at one time. During this procedure, the gastric band is placed around the stomach, dividing it into two parts; a small upper pouch and a lower stomach. The upper pouch holds about 4 ounces (1/2 cup) of food. This helps a person feel full sooner and longer than usual.

Advantages

  • Limits the amount of food that can be eaten at a meal
  • The surgery can be reversed
  • No part of the stomach or digestive system is stapled, cut, or removed; food passes through the digestive tract in the usual order, allowing it to be fully absorbed into the body
  • In a clinical trial, gastric band patients lost an average of 38% of excess weight in 1 year and nearly 43% in 3 years
  • Shown to help resolve other conditions, such as type 2 diabetes, high cholesterol (LDL) and obstructive sleep apnea

 

Risks

The following are in addition to the general risks of surgery

  • Gastric perforation  or tearing in the stomach wall may require additional operation
  • Access port leakage or twisting may require addition operation
  • May not provide the necessary feeling of satisfaction that one has had enough to eat
  • Nausea and vomiting
  • Outlet obstruction
  • Pouch dilatation
  • Band migration/slippage

Talk with your surgeon about the possible surgical risks.

Important safety information

The gastric banding is for adult patients, 18 years of age or older, who have morbid obesity and have failed more conservative weight loss alternatives. The gastric banding is not for patients with medical conditions that may put them at increased risk during or after surgery, or for patients who are unwilling to make significant changes in eating and behavior patterns. If you have a hiatal hernia, it may need to be repaired before or during the gastric banding surgery.

 

The Procedure

  1. The gastric band is placed around the uppermost part of the stomach to create a small upper pouch and a lower stomach.
  2. Small stomach pouch.
  3. Thin, flexible tubing connects the band and the port.
  4. The port is fastened in the abdomen about 2 inches below the rib cage on the left or right side.

 

Why the band is adjustable

Over time, your surgeon adjusts the tightness of the band to help you continually meet your weight loss goals. During an adjustment, saline(a safe fluid) is delivered through the port into the band balloon, making the band fit more snugly around your stomach. Saline can also be removed from the band. After an adjustment, you’ll full sooner, stay satisfied longer and maintain gradual weight loss. Fast and easy band adjustments take place at your surgeon’s office, clinic, or hospital. Your first adjustment will probably be scheduled 4 to 6 weeks after your surgery.

 

Your band adjustment schedule

Your weight, the physical symptoms you report, and other factors help your surgeon decide if a band adjustment is necessary. The timing and number of band adjustments are different for everyone and can only be determined by each patient’s surgeon.

 


 

  Gastric bypass

How it works to help you lose weight

Gastric bypass, which combines restrictive and mal-absorptive surgery technique, is the most frequently performed bariatric procedure in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the lower stomach pouch. The outlet from this newly formed pouch empties directly into lower portion of the jejunum, thus bypassing calorie adsorption and the duodenum. To achieve this, the small intestine is divided just beyond the duodenum and a connection with the new, smaller stomach pouch is constructed. The length of either segment of the intestine can be increased to produce lower or higher levels of mal-absorption.

The procedure

The surgeon creates a small stomach pouch using staples, then attaches a section of the small intestine directly to the pouch.

The remaining stomach area is stapled shut and divided from the smaller pouch.

This allows food to bypass a portion of the small intestine where calories and nutrients are normally absorbed.   

 

 

 

Advantages

    • Limits the amount of food that can be eaten at a meal and reduces the desire to eat
    • Average excess weight loss is generally higher than with gastric banding or sleeve gastrectomy
    • No postoperative adjustments are required
    • An analysis of clinical studies reported an average excess weight loss of 61.6% in 4204 patients
    • Shown to help resolve type 2 diabetes, high blood pressure, and obstructive sleep apnea, and to help improve high cholesterol
    • In a study of 608 gastric bypass patients, 553 maintained contact for 14 years; the study reported that significant weight loss was maintained in 14 years

Risks

The following are in addition to the general’s risks of surgery:

  • Because the duodenum is bypassed, poor absorption of iron and calcium can results in the lowering of total body iron deficiency anemia. Women should be aware of the potential for heightened bone calcium loss.
  • Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back, and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements
  • Chronic anemia due to vitamin B12 deficiency can occur. This can usually be managed with vitamin B12 pills or injections
  • When removing or bypassing the pylorus, a condition known as dumping syndrome can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risks to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness, and, on occasion, diarrhea after long eating
  • In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15 to 30 cc
  • Rerouting of bile, pancreatic and other digestive juices beyond the stomach can cause intestinal irritation and ulcers
  • The lower stomach pouch and segments of the small intestine cannot be easily visualized using x-ray or endoscopy if problems such as ulcers, bleeding, or malignancy should occur

Talk with your surgeon about the possible surgical risks.

 


 

Sleeve gastrectomy

How it works to help you lose weight

A sleeve gastrectomy is a restrictive procedure that limits the amount of food you can eat by reducing the size of your stomach. During this procedure a thin vertical sleeve of stomach is created using a stapling device. This sleeve will typically hold between 50 to 150 ml, and is about the size of a banana. The excised portion of the stomach is removed.

Advantages

    • Limits the amount of food that can be eaten at a meal
    • Food passes through the digestive tract in the usual order, allowing vitamins and nutrients to be fully absorbed into the body
    • No postoperative adjustments are required
    • In clinical studies patients lost an average of 55% of their excess weight
    • Shown to help resolve high blood pressure and obstructive sleep apnea, and to help improve type 2 diabetes and hyperlipidemia

The procedure

A thin vertical “sleeve” of stomach is created using a stapling device. This sleeve is about the size of a banana.

The excised, unused portion of the stomach is removed.

Risks

The following are in addition to the general risks of surgery:

  • Complications due to stomach stapling, including separation of tissue that was stapled or stitched together and leaks from staple lines
  • Gastric leakage
  • Ulcers
  • Dyspepsia
  • Esophageal dysmotility
  • Nonreversible since part of the stomach is removed

Talk with your surgeon about the possible surgical risks.

 

 

The weight loss surgery lifestyle

Bariatric surgery is an effective weight loss treatment. But you have to do your part, too. Understanding and activity engaging in lifestyle that supports achieving and maintaining a healthier weight is vital for success. Staying connected with your bariatric team is just as important.

Preparing for bariatric surgery

Whichever procedure you choose to have, it is important that you begin your new lifestyle preoperatively. Weight loss surgery should be considered one of the tools available to help you loss weight. Making appropriate lifestyle adjustments are crucial to the success of your procedure.

Work with your medical team to understand what changes you will need to make in your daily routine to help ensure the success of your postoperative dietary requirements, exercise needs and any other changes you will be making before you receive surgery. It is a good idea to implement  these changes as well as any other behavior modifications preoperatively to help you transition more easily into your new postoperative lifestyle.

 

 

Life after surgery

Diet

The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Post surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their bariatric surgery. It is Important to remember that every surgeon dose not perform the same bariatric surgery procedure and that the dietary guidelines will be different for each surgeon and each type of procedure. What is most important is that you adhere strictly to your surgeon’s recommended guidelines.

The following are some of the generally accepted dietary guidelines a bariatric surgery patient may encounter:

  • When eating solid food. It is essential that you chew thoroughly. You will not be eat chunks of meat if they are not ground or chewed thoroughly
  • Do not drink fluids while eating
  • Omit sweets and other high calorie foods
  • Omit carbonated drinks, milk shakes, high-fat foods and foods with high fiber content
  • Avoid alcohol
  • Limit snacking between meals

 

Going back to work

Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity, and the type of bariatric surgery you had. Many patients return to full pre-surgery levels activity within 6 weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.

Birth control and pregnancy

It is strongly advised that women of childbearing age use the most effective form of birth control during the first 16 to 24 months after bariatric surgery. The added demands pregnancy place on your body and the potential for feral damage make this a most important requirement.

Long-term follow- up

Although the short-term effects of bariatric surgery are well understood, there are still questions to be answered about the longer-term effects on nutrition and body systems.

Nutritional deficiencies that occur over the course of many years will need to be monitored. Over time, you will need periodic checks for anemia (low red blood cell count) and vitamin B12, folate, iron levels. Follow-up tests will initially be conducted every 3 to 6 months, or as needed, and the every 1 to 2 years. Follow-up care is recommended for life.

Support groups

The widespread use of support groups has provided bariatric surgery patients with an excellent opportunity to discuss their various personal or other issues. Most learn, for example, that bariatric surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have had on their emotional well-being.

Most surgeons have support groups in place to assist you with short-term and long- term questions and needs.Bariatric surgeons who frequently perform bariatric surgery will tell you that ongoing postsurgical support helps produce the greatest level of success for their patients.