Bariatric surgery to achieve weight-loss is a very serious decision, not to be taken lightly. Anyone thinking about this kind of surgery must talk to physicians and nutritionists early in the thought process to achieve a full understanding of what is involved, including the associated personal responsibilities, the risks and the probability of success.
The following are some of the most frequently asked questions (FAQ) about weight-loss surgery:
- How does bariatric surgery promote weight loss?
- What are the benefits of weight-loss surgery?
- What are the risks of weight-loss surgery?
- What is laparoscopy?
- What are the surgical options?
- What is body mass index (BMI)?
- What does weight-loss surgery cost?
- LAP-BAND FAQs:
How does bariatric surgery promote weight loss?
Weight-loss surgery for obesity makes large-scale changes in the digestive process. The operations promote weight loss by closing off parts of the stomach so that it holds less food, which means you can only eat very small quantities at a time. Operations that solely reduce stomach size are known as restrictive operations because they restrict the amount of food the stomach can hold.
Another kind of weight-loss surgery combines stomach restriction with a partial bypass of the small intestine. Such procedures create a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that previously absorbed more of the calories and the nutrients in food. These surgeries are known as malabsorptive operations.
Source:
NIDDK: Gastrointestinal Surgery for Severe Obesity
What are the benefits of weight-loss surgery?
A majority of patients lose weight quickly and continue to lose for 18 to 24 months after weight-loss surgery. Although most patients regain 5 to 10 percent of the weight they lost, many maintain a long-term weight loss of approximately 100 pounds or more.
Surgery improves most severe obesity-related conditions. For example, studies have shown that blood sugar levels of 83 percent of obese patients with diabetes returned to normal after surgery. Cases where patients' blood sugar levels did not return to normal involved advanced age or long-term diabetes.
Source:
NIDDK: Gastrointestinal Surgery for Severe Obesity
What are the risks of weight-loss surgery?
Abdominal hernia is the most common complication requiring follow-up surgery, though laparoscopic techniques have reduced this problem. Less common complications include breakdown of the staple line and stretched stomach outlets.
Like anyone who loses a lot of weight or loses weight quickly, some patients who have weight-loss surgery may develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. Taking supplemental bile salts for the first six months after surgery can help prevent gallstones, but be sure to talk to your doctor first.
Some of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. Fortunately, these deficiencies can usually be avoided with sufficient vitamin and mineral intakes. Women of childbearing age who have weight-loss surgery should avoid pregnancy until their weight stabilizes because rapid weight loss or nutritional deficiencies could harm a developing fetus.
What is laparoscopy?
In laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. It is usually less painful and allows for a more rapid recovery.
What are the surgical options?
Weight-loss (bariatric) surgery, surgery on the stomach and/or intestines to help a patient to reduce severe obesity, includes restrictive and malabsorptive operations. While similar, each carries specialized benefits and risks.
Malabsorptive Operations
Malabsorptive operations are the most common weight-loss surgeries. They restrict both food intake and the amount of calories and nutrients the body absorbs.
Roux-en-Y gastric bypass (RGB), illustrated in Figure 1, is the most common and the most successful form of malabsorptive surgery and is the procedure that Dr. Gritsus will perform. A small stomach pouch is created to restrict food intake. Then a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine) and the first part of the jejunum (the second segment of the small intestine). The bypass reduces the amount of calories and nutrients the body absorbs.
Biliopancreatic diversion (BPD) is a more complicated malabsorptive operation than RGB, where portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. Although this procedure successfully promotes weight loss, it is less frequently used than other types of weight-loss surgery because of the high risk for nutritional deficiencies. A variation of BPD includes a "duodenal switch," which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine, as well as a small part of the duodenum.
Malabsorptive operations can produce greater weight loss than restrictive operations, and are considered more effective in reversing the serious health problems associated with severe obesity. Patients who have malabsorptive operations generally lose two-thirds of their excess weight within two years.
In addition to the risks of restrictive surgeries, malabsorptive operations also carry greater risk for nutritional deficiencies because foods bypass the duodenum and jejunum where most iron and calcium are absorbed. Menstruating women may develop anemia because not enough vitamin B-12 and iron are absorbed. Decreased absorption of calcium may also contribute to osteoporosis and metabolic bone disease. Patients are thus required to take nutritional supplements, which will usually prevent these deficiencies. Patients who have the biliopancreatic diversion surgery must also take the fat-soluble vitamins A, D, E and K in supplement form. RGB and BPD operations may also cause something called "dumping syndrome," where stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating and faintness, and sometimes diarrhea after eating. Because the duodenal switch operation keeps the pyloric valve intact, it can reduce the likelihood of dumping syndrome.
In general, the more extensive the bypass, the greater the risk for complications and nutritional deficiencies. Patients with extensive bypasses of the normal digestive process require close monitoring and lifelong adherence to special diets, supplements and medications.
Restrictive Operations
Restrictive operations, or gastric banding, severely limit food intake without otherwise interfering with the normal digestive process. In these procedures, physicians create a small pouch at the top of the stomach where food enters from the esophagus. Initially, the pouch holds about one ounce of food, eventually expanding to hold two to three ounces. The lower outlet of the pouch usually has a diameter of only about ¾ inch. This small outlet delays the emptying of food from the pouch and results in a feeling of fullness.
After such a surgery, the patient loses the ability to eat anything but very small amounts of food at any one time. The person will usually be able to consume only ¾ to 1 cup of food without discomfort or nausea. In order to be properly digested under these conditions, all food has to be very well chewed.
Adjustable gastric banding is where a hollow band made of specialized material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the remainder of the stomach. The band is then inflated with a saline solution. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of solution.
Although restrictive operations lead to weight loss in about 80 percent of patients, they are less successful than malabsorptive operations in achieving substantial, long-term weight loss. Only about 30 percent of those who undergo ABG achieve normal weight and some patients will regain weight. Successful results depend on the patient's willingness to adopt a long-term plan of healthy eating and regular physical activity. Some patients who undergo restrictive operations fail to lose the desired weight because they fail to adjust their eating habits.
Common risks of restrictive operations include vomiting, caused by the small stomach being overly stretched by too much food or food that has not been sufficiently chewed. Band slippage and saline leakage can occur. In a small number of cases, stomach juices can leak into the abdomen, requiring an emergency operation. Infection or death from complications occur in less than one percent of all cases.
Source: NIDDK: Gastrointestinal Surgery for Severe Obesity
What is body mass index (BMI)?
Body mass index (BMI) is a measure of body weight relative to height. BMI can be used to determine if you are at a healthy weight, overweight or obese. To figure out BMI, use the following formula:
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BMI = |
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Weight in pounds X 703 |
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| Height in inches X Height in inches |
A body mass index (BMI) of 18.5 to 25 refers to a healthy weight, a BMI of 25 to 30 refers to overweight and a BMI of 30 or higher refers to obese.
Click here to use our interactive BMI Calculator.
What does weight-loss surgery cost?
Gastric bypass surgical costs vary from one hospital to another. Medical insurance coverage also varies by state and insurance provider. If you are considering weight-loss surgery, you will need to contact your insurance plan to find out if the procedure is covered.
Wherever you choose to have your procedure, the surgeon's office will need to assist you in obtaining insurance authorization for weight-loss surgery.
Fees for Self-Pay patients:
Gastric Bypass $21,000.00
Lap-Band $15,000.00
Source:
NIDDK: Gastrointestinal Surgery for Severe Obesity
Will I be sick a lot after the operation?
The LAP-BAND System limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well or that you are not following the diet rules properly. However, it could also mean that there is a problem with the placement of the band so you should contact us if this problem persists. Vomiting should be avoided as much as possible. It can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band, which would reduce the success of the operation. In some cases, it would also require another operation.
How long will it take to recover after surgery?
If LAP-BAND surgery is performed laparoscopically, patients typically spend less than 24 hours in the hospital. It takes most patients about a week to return to work and a month to six weeks to resume exercising. In the case of open surgery or if there are complications, recovery may take longer.
Q: How much weight will I lose?
Weight-loss results vary from patient to patient, and the amount of weight you may lose depends on several things. The band needs to be in the right position, and you need to be committed to your new lifestyle and eating habits. Obesity surgery is not a miracle cure, and the pounds won't come off by themselves. It is very important to set achievable weight-loss goals from the beginning. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less. Remember that you should lose weight gradually. Losing weight too fast creates a health risk and can lead to a number of problems. Your main goal is to have weight loss that prevents, improves, or resolves health problems connected with severe obesity.
How do the weight-loss results with the LAP-BAND compare to those with the gastric bypass?
You should focus on long-term weight loss and remember that it is important to lose weight gradually while reducing obesity-related risks and improving your health.
Does the LAP-BAND require frequent office visits after surgery?
Check-ups are a normal and a very important part of the LAP-BAND System follow-up.
Does the LAP-BAND limit any physical activity?
The LAP-BAND does not affect or hamper physical activity including aerobics, stretching and strenuous exercise.
How is the band adjusted?
Adjustments are often carried out in the X-ray department. They are done there so the access port can be clearly seen. When X-rays are used, your reproductive organs should be shielded. Sometimes adjustments can be done in an outpatient clinic or office. Local anesthesia may or may not be needed. A fine needle is passed through the skin into the access port to add or subtract saline. This process most often takes only a few minutes. Most patients say it is nearly painless.
Do I have to be careful with the access port just underneath my skin?
There are no restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed it should not cause discomfort or limit your movements or any physical exercise. The only sensation you may have from the port is when you go in for adjustments. If you feel persistent discomfort in the port area, let us know as soon as possible.
Can the band be removed?
Although the LAP-BAND System is not meant to be removed, it can be. In some cases this can be done laparoscopically. The stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight or even gain more.
Will I need plastic surgery for the surplus skin when I have lost a lot of weight?
That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation. Sometimes the skin will mold itself around the new body tissue. You should give the skin the time it needs to adjust before you decide to have more surgery.
Is it true that the LAP-BAND seems "tighter" in the morning?
This is a fairly common feeling, especially for people with bands that are tight or just after an adjustment. During the day the water content in the body changes and this may cause the band to feel "tighter" some of the time. Some women have also noticed that the LAP-BAND feels tighter during menstruation.
Will I feel hungry or deprived with the LAP-BAND?
The LAP-BAND makes you eat less and feel full in two ways - by reducing the capacity of your stomach and increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that the LAP-BAND is a tool to help you change your eating habits.
What will happen if I become ill?
One of the major advantages of the LAP-BAND System is that it can be adjusted. If your illness requires you to eat more, the band can be loosened by removing saline from it. When you have recovered from your illness and want to lose weight again, the band can be tightened by increasing the amount of saline. If the band cannot be loosened enough, it may have to be removed.
What about pregnancy?
Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. If you need to eat more while you are pregnant, the band can be loosened. After the pregnancy, the band may be made tighter again, and you can resume losing weight.
Will I need to take vitamin supplements?
You may. It's possible you may not get enough vitamins from three small meals a day. At your regular check-ups, your specialist will evaluate whether you are getting enough vitamin B12, folic acid, and iron.
What about other medication?
You should be able to take prescribed medication. You may need to use capsules, break big tablets in half or dissolve them in water so they do not get stuck in the stoma and make you sick. You should always ask the doctor who prescribes the drugs about this.
What if I go out to eat?
Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.
What about alcohol?
Alcohol has a high number of calories. It also breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss1.
Can I eat anything in moderation?
After your stomach has healed, you may eat most foods that don't cause you discomfort. However, because you can only eat a little it is important to include foods full of important vitamins and nutrients such as those recommended in the nutrition section of this booklet and as advised by your surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat or drink liquids full of "empty" calories, such as milkshakes, the effect of the LAP-BAND may be greatly reduced or cancelled.
Will I suffer from constipation?
There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fiber. This should not cause you severe problems. If difficulties do arise, let us know as soon as possible.