weight loss surgery
Weight Loss

Do Weight Loss Surgery Benefits Outweigh the Risks?

Bariatric surgery helps you lose weight by limiting the amount of food the stomach can hold. This will cause malabsorption of some nutrients, or by combining both gastric restriction and malabsorption. These surgical procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch. 

Weight Requirements

The candidate should have:

  • BMI (Body Mass Index) of 40 or more than 100 pounds overweight.
  • BMI of 35 to 40 (about 80 pounds overweight) and the patient is suffering from diabetes or a metabolic syndrome, heart disease, asthma, or obstructive sleep apnea.
  • BMI of 30 to 35 and the patient has a certain type of diabetes, or a combination of other serious health conditions known as metabolic syndrome.

Surgery Preparation

The doctor will help prepare by telling you what exactly you have to do. You will have to avoid aspirin or any product that contain it and herbal supplements, one week before the procedure. You will have to eat or drink only clear liquids for 24 to 48 hours before the procedure.

You will be getting a general anesthesia during the procedure.

After the Surgery

Regardless of the surgery that you will have, your doctor will close any cuts with surgical stitches or staples. You will need to stay in the hospital for some time to ensure that you are okay.

You will be given pain medications and the doctor will closely watch you for any signs of health problems including low blood sugar, blood clots,or dehydration.

What To Eat After Weight Loss Procedure

At first, you will be on a liquid diet and after several weeks, you will be allowed to eat solid foods. You need to be supervised with a nutritionist who knows about weight loss procedure for creating an eating plan. You may not be allowed to eat what you did before. You will have to eat small portions and lesser calories. With the help of your doctor and nutritionist, you need to get enough essential nutrients which may mean taking some supplements.

Lifestyle After the Procedure

It takes a sincere commitment to make results last and keep the weight off. Adapt a lifestyle change that you can live with permanently. You will have to eat smaller portions for the whole day, build good nutrition plan, and exercise into everyday habits.

Common Weight Loss Procedures

Gastric Bypass

image: Coordinated Health

Often called gastric bypass, Roux-en Y Gastric Bypass is the most common weight loss procedure.

The Procedure

A general anesthesia will be given before the surgery.

There are two steps during gastric bypass procedure:

  1. The first step will make your stomach smaller by using staples to divide the stomach into a small upper section and a larger bottom section. The top portion of the stomach, called pouch, is where the food that you eat will go. The pouch will be about the size of a walnut where it holds only about 1 ounce or 28 grams of food. This will make you eat less and lose weight.
  2. Next, is the bypass procedure where the doctor connects a small part of the small intestine, known as jejunum, to a small hole in the pouch. The food that you eat will go from the pouch into the new opening and into the small intestine. This is to allow your body to absorb fewer calories.

Gastric bypass can also be done in 2 ways. One, open surgery where the doctor makes a large surgical cut to open your stomach. Bypass is done by working on your stomach, small intestine, and other related organs.

Secondly, the procedure uses a small camera known as laparoscope where it is placed in the stomach. The procedure is known as laparoscopy where the doctor is allowed to see what is inside your stomach.

The whole procedure will:

  • The surgeon makes 4-6 tiny cuts in your stomach.
  • The scope and surgery instruments required to perform the procedure are inserted through these cuts.
  • The laparoscope, a tiny camera is connected to a video monitor in the operating room so that the surgeon will see what is inside your stomach while doing the surgery.

The operation takes about two to four hours.

And most important, the rerouting of the food stream makes some changes in the gut hormones that promote satiety, curb hunger, and reverse one of the main systems by which obesity induces type 2 diabetes.

Pros

  • Offers remarkable long term weight loss for about 60% to 80% weight loss.
  • Limits the amount of food that can be taken.
  • Produces positive changes in gut hormones that minimize appetite and enhance satiety.
  • May result to conditions that boost energy.
  • Maintenance of about more or less 50% excess weight loss.

Cons

  • Technically a more complex procedure compared to AGB OR LSG and may result to more complication rates.
  • Can result in long term vitamin or mineral deficiencies, especially deficit in vitamiins B12, calcium, iron, and folate.
  • Has a longer hospital confinement compared to AGB.
  • Needs to comply to dietary recommendations, life-long vitamin or mineral supplements, and follow-up compliance.

Sleeve Gastrectomy

image: Atlantic Bariatric

Often called the sleeve, Laparoscopic Sleeve Gastrectomy, is a surgical procedure that stimulates weight loss by limiting food intake. The surgeon removes approximately 75% of the stomach which results in the stomach taking the shape of a tube or “sleeve” that can hold less food.

The Procedure

Originally, sleeve gastrectomy was created as the first phase of a two-stage procedure for superobese or high-risk patients. Now, this is commonly used – and successfully – for weight loss in individuals with a BMI of more than 40.

Reports claim that weight loss for this surgery ranges from 60% of excess weight where better results were achieved with good compliance to dietary and behavioral guidelines. Smart food options with regular exercise and good eating habits, patients who successfully went through a sleeve gastrectomy enjoy and keep the good weight loss.

With this procedure, there is not foreign body that is implanted and there is without complex intestinal rearrangement compared to gastric bypass. Patients find that after a reasonable recovery from the procedure, they are allowed to eat a wide variety of food including meat and fibrous veggies. Unlike the gastric band and gastric bypass, sleeve gastrectomy is a permanent surgery, which means that it cannot be reversed. By removing a part of the stomach minimizes the level of your body’s hormone known as ghrelin or the “hunger hormone.” As a result, patients who went through this procedure find that they are less hungry. Ghrelin also plays a role in blood sugar metabolism, hence people with type II diabetes usually observe an immediate decrease in their need for diabetes medications, particularly oral medications.

Pros

  • Reduces the amount of food the stomach can hold.
  • Promotes fast and significant weight loss.
  • Needs no foreign objects and without bypass or rerouting of food stream.
  • Short hospital stay of approximately two days.
  • Causes positive changes in gut hormones that curb hunger, minimize appetite, and improve satiety.

Cons

  • Non-reversible procedure
  • Has risks for long term vitamin deficiencies.
  • Has higher early complication rates compared to AGB (Adjustable Gastric Band).

Adjustable Gastric Band

image: Asian Bariatrics

Adjustable Gastric Band, also called “Lap Band” or “Realize band”, is considered as the least invasive surgery for weight loss. It involves putting an implant which is a soft silicone ring with expandable balloon in the center around the top portion of the stomach. By doing so, it creates a two-part stomach with smaller top portion above the band. When a person eats enough food, it will only fill the top portion of the stomach. After the meal, the food passes through the opening of the band into the remainder  of the stomach, and digestion happens normally.

The Procedure

The band is connected to an injection port below the skin through a soft tubing that allows adjustment of the tightness of the band by inflating or deflating the balloon in the band. Adjustment to the band is easily done in the office and needs no special preparations. The procedure also involves adding saline to the band will make the orifice between two portions of the stomach smaller. This will allow the passage of food from the top of the stomach to the rest of the stomach slower. By removing saline from the band makes faster passage of larger food particles to pass.

This procedure is presently approved for patients with BMI with more than 35 or 35 with obesity-related conditions like type II diabetes, sleep apnea, and hypertension who failed to attain sustained weight loss with non-surgical procedures. In most cases, the Adjustable Gastric Band is performed as outpatient surgery where the patient goes home on the same day as the surgery.

To be successful in weight loss using this procedure, the patients should commit to major eating habits and lifestyle. The patient should be willing to mindful, planned eating with healthy food options, careful chewing, and not combining solid food and liquid during a meal. Failure to follow these behaviors will lead to adverse symptoms including reflux, pain, or vomiting. There should be a thorough follow-up program which includes dietary counseling and monthly visits for weigh-ins and possible adjustments for successful weight loss goals. Regular exercise is also recommended for a healthy lifestyle.

Reports showed that there was an average excess weight loss in 40%-60% range, depending on the motivation of the patient and compliance. A U.S. study shows that patients with BMI 30-40 have lost at least 30% of their excess weight and have kept the weight off for about one year. There patients who have lost more than 80% of their excess weight, while some have not lost any pounds. It was also reported that the quality of life for patients who joined the study have significantly improved. With rare short term complications of the surgery that has been recorded, latest claims show a significant long term complication rate. There are about 15-50% of patients who went through the surgery need re-operation for implant malposition, erosion, weight loss failure, and frequent vomiting.

Pros

  • Minimizes the amount of food the stomach can hold.
  • Promotes excess weight loss of about 40% to 50%.
  • Entails no cutting of the stomach or rerouting of the intestines
  • Shorter hospital stay, usually less than 24 hours, while other clinics discharge patients the same day as the operation.
  • Lowest early postoperative complication and mortality rates among the approved bariatric surgery.
  • Lowest risks for vitamin or mineral deficiencies.

Cons

  • Gradual and less early weight loss compared to other surgical procedures
  • Higher rate of patients who failed to lose at least 50% of excess body weight.
  • Still needs a foreign device to remain in the body.
  • Possibility of mechanical problems with the bands, tube, or port.
  • Needs strict compliance to postoperative diet plan and to post operative follow-up visits.
  • Record high or re-operation rate.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass

image: Foothills Weight Loss

Also called as Duodenal Switch or BPD-DS is a complex procedure that helps patients to lose weight through a sleeve gastrectomy and intestinal bypass. This procedure results in decreased absorption of food. 

The Procedure

The surgeon removes about 60% to 70% of the stomach, making the stomach takes the shape of a tube. The lower part of intestine is divided much further compared to gastric bypass. This will make two-thirds or more of the intestine is bypassed, leaving a few feet of the intestine where food and digestive enzymes meet. This is the intestinal bypass part of BPD-DS. The term duodenal switch comes from the actual operation that the intestinal bypass begins at the duodenum. The first portion of the intestine – the duodenum – is divided and connected to the lower part of the small intestine (ileum).

The duodenal switch keeps the outlet muscle known as the pylorus that regulates the emptying of the stomach. With sleeve gastrectomy, dumping syndrome is uncommon. Duodenal switch may cause the most reliable and long lasting  weight loss. This procedure may induce a condition of decreased absorption and the patients may tend to experience frequent and loose bowel movements, and increased flatulence. The patient also has to be closely monitored for minerals, vitamins, and protein levels.

With extreme overweight cases, patients undergoing this surgery is done in two phases: sleeve gastrectomy is done first and followed by 9 to 12 months later by intestinal bypass part of the surgery. 

This procedure can also be used as a revision operation for sleeve patients who have not lost enough weight or those who regain significant weight. In these cases, intestinal bypass is added beyond the sleeve instead of dividing the sleeve and changing it to a gastric bypass.

Generally, patients of BPD/DS may expect to lose about 60% to 80% of excess body weight for about two-year period. 

Pros

  • Greater weight loss compared to the RYGB, AGB, OR LSG by about 60 to 70% of excess weight, or even greater, at 5-year follow-up.
  • Allows the patients to gradually eat near “normal” meals.
  • Minimizes the absorption of fats by about 70%, or even more.
  • Results in positive changes in gut hormones to minimize appetite and improve satiety.

Cons

  • High complication rates and risks for mortality compared to RYGB, AGB, and LSG.
  • Longer hospital stay.
  • Higher potential rate for protein deficiencies and long term deficiencies in vitamins and minerals such as iron, zinc, calcium, and many more.
  • Strict adherence to follow-up visits and care, dietary plan, vitamin and supplementation guidelines are crucial to avoid severe complications from protein and other deficiencies.

Adapting to a new life after any of these procedures

image: Metabolism Clinic

You may feel varied emotions after weight loss procedure. You may be happy as you  start seeing some positive results, especially losing weight. Or, you may feel frustrated by the changes that you have to make in your diet, lifestyle, and daily activities.

Consult with your doctor before deciding to undergo any of these weight loss procedures.

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