Articles

Article appeared in To Your Health - January, 2003 and Today’s Woman - March, 2003

Weighing In On Bariatric (Weight Loss) Surgery
By Dr. Dominick Artuso

The numbers are staggering. Approximately 127 million adults in the U.S. – 65% of all Americans – are overweight, and 60 million (30.5%) of all Americans are obese. In fact, the percentage of obese Americans has more than doubled over the past 20 years and the trend is seemingly on the rise. Also rising are the serious health risks resulting from obesity as well as the annual healthcare costs associated with treating patients (approximately $100 billion per year). Equally distressing, is that each year, complications caused by obesity cause approximately 300,000 premature deaths in the U.S.

Questions arise. Can these figures be reduced? Are there relatively safe and effective lifesaving procedures within my specialty of bariatric (weight loss) surgery that are available to those who suffer the physical and emotional consequences of obesity? Can bariatric surgery be a long-term solution for a serious problem? If you or someone you care about falls into the above category, might bariatric surgery be an option? The answers to these questions are, quite simply, an overwhelming, “yes.”

Research reveals that conventional weight loss methods such as diet, exercise programs and medication fail to produce permanent results for those who are markedly overweight. While these patients are able to lose approximately 10% of their body weight, they tend to regain two-thirds of it within one year, and almost all of it within five. As a result, bariatric surgery as a weight loss solution, is being viewed as an important means of inducing long-term weight loss. Several celebrities and high profile individuals who have undergone bariatric surgical procedures, such as gastric bypass (the most widely performed and successful weight-loss surgery) have come forward to share their successful experiences…and their joy. Often, bariatric surgery succeeds where other methods have failed. For patients whose health is failing and whose spirits are falling, these revolutionary procedures, some of which can be performed laparoscopically, virtually offer a new lease of life.

Bariatric surgery…what it is and isn’t. Bariatric surgery reduces the capacity of the stomach and, hence, limits the amount of food intake. Surgical options include laparoscopic and the traditional open Roux-en-Y (RNY) gastric bypass surgery (the most common procedure), and laparoscopic adjustable gastric band. All three surgical procedures have proven to be effective and appropriate alternatives for patients who have tried all conservative measures to control their weigh and have failed.

What bariatric surgery isn’t is a quick fix of a serious, long-term problem. Undergoing any of these procedures requires commitment, determination and lifestyle changes. If you’re up to the challenge, the coupling of bariatric surgery with your individual effort may prove to be the ideal solution for your weight problems and related medical conditions and pyschosocial issues.

Here’s what you might be interested in knowing about the most up-to-date bariatric surgical procedures available. Laparoscopic gastric bypass is an operative procedure performed with the aid of a laparoscope (a fiber-optic tube and light source connected to a small video camera which allows the visualization of the abdominal organs on a closed-circuit TV monitor.) During this procedure, surgical instruments inserted through small incisions are used to divide and staple a “new stomach,” referred to as a “pouch.” This pouch is only about 5-10% of the size of the “old stomach” (a golf ball vs. a football and holds less food. Sections of the small intestine are stapled and sutured to the new stomach, allowing food to “bypass” portions of the small intestine. With a smaller stomach, you feel full after a few bites and fewer calories are absorbed through the altered digestive tract.

Because this specialized procedure is performed laparoscopically, thereby making only tiny incisions, patients can expect better cosmetic results, less pain, shorter hospital stays, quicker recovery times and less chance of wound infection and hernia – two complications that could occur with any major gastrointestinal surgical procedure.

In laparoscopic adjustable gastric banding, surgeons use a silicone band to create a small pouch out of the top of the existing stomach. This limits food consumption without disrupting the normal progression of food through the digestive tract. The procedure does not involve any intestinal connection and there is no malabsorption component with this procedure. Although excellent weight loss can be achieved, it is generally slightly less than that resulting from a gastric bypass procedure. The band has its advantages. In order to accommodate for a patient’s future needs, such as pregnancy, the band is “adjustable.” And hospitalization time is generally limited to approximately 1-2 days, depending upon the individual.

The traditional open Roux-en-Y (gastric bypass) is a combined restrictive and malabsorptive procedure that moderately limits calorie and nutrient absorption and may also alter food choices (approximately 50% of patients have difficulty with foods or liquids high in refined sugar (table sugar). That delicious-looking cheesecake is not what the doctor or your new stomach should order and might be off-limits. The normal amount of sugar is what is not considered desserts or snack food will generally not be a problem post-operatively.

The Roux-en-Y works by decreasing food intake, limiting the amount the stomach can hold and delaying the emptying of the stomach, thereby maintaining a sense of “fullness,” longer. This procedure has shown the best results with the least complications. In this operation, the stomach is divided into two separate compartments using six rows of staples. A newly created stomach “pouch” initially holds approximately 1 oz., but expands over time to hold 2 or 3 ozs. The small intestine is divided, brought up and joined to the new stomach.

Post-operative risks or complications. Any operation, no matter how major or minor, has the potential for complications and there are additional risks if a patient is obese. Anyone undergoing surgery should be aware of operative and post-operative complications that could arise as a result of a specific surgical procedure and discuss them with his/her surgeon. Your choice of a reputable, qualified and experienced bariatric surgeon is an essential part of a successful surgical experience and recuperating without incident. Your surgeon’s and his/her surgical team’s attention to your pre-operative status and post-operative progress further ensure an uneventful recovery.

Bariatric surgery…for me or not for me? If your obesity is already creating health problems like diabetes, high blood pressure, heart disease, respiratory distress and arthritis, the choice to undergo one of the above procedures is one to be taken seriously.

Do your homework. Find a surgeon who is expert at performing bariatric surgical procedures successfully. Consult with him/her, talk to his/her patients or, for that matter, anyone who is willing to share their personal surgical experience with you. Most of all, seriously consider what undergoing bariatric surgery means for you, your family and / or those you care about most. They’ll all love you no matter what, but they can only love you longer if you’re around.

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