Weight Loss Surgery
Weight loss surgery began in the 1950's with bypass of long segments of the bowel to prevent absorption of calories. The jejunoileal bypass is an example of this surgery. These surgeries were effective at weight loss, but had several associated nutritional complications. As a result, restrictive surgeries were developed to attempt to reduce food intake while avoiding nutritional complications.
The vertical banded gastroplasty is an example of this surgery. Combined surgical procedures such as the Roux-en-Y gastric bypass were then developed to take advantage of the best parts of each of these operations. Currently, the Roux-en-Y gastric bypass is the most common bariatric surgery procedure done in the United States.
The Vertical Sleeve Gastrectomy is the newest bariatric procedure available. In this procedure ¾ of the stomach is removed. This surgery was first performed in 1995 and was intended to be the first step or "stage" procedure before eventually having a Biliopancreatic Diversion or a Laparoscopic Roux-en-Y Gastric Bypass. Some of these patients did so well with the first procedure they did not want to continue on to the second procedure. After that time the procedure was changed to a much smaller "sleeve" of the stomach left in the patient. This offers improved weight loss and decreases the chance of stretching the small stomach out causing late weight regain. The sleeve became a one-step only procedure in 2003. The current form of the procedure has been done for over 7 years in the U.S.
Anatomy and Function of Gastrointestinal Tract
It is important to understand how your digestive system works to understand how bariatric surgery results in weight loss.
Food is mechanically broken down by your teeth and passes down your esophagus into your stomach. The stomach stores the food which then mixes with gastric acid. The acid breaks down the complex proteins into more easily absorbed particles. The food then enters the beginning of the small intestine which is called the duodenum. It then mixes with enzymes from the liver and pancreas allowing conversion of the food into a form that can be absorbed. The food then travels along the small intestine and the nutrients and vitamins are absorbed. Water is also absorbed. The final step of the digestion process is the large intestine (colon). Water is absorbed in the colon and the waste products are then passed through the rectum.
Your body converts calories from the food into the energy it needs. This energy is used for physical activity. The excess energy is stored in fat cells. Weight gain occurs when the calories that are absorbed are greater than that needed for your physical activities. Weight will also be affected by your metabolic rate and how efficient your body is at absorbing calories.
Surgical Weight Loss
Surgery has the goal of decreasing your weight by at least 50% of your excess body weight and resolving the diseases that are being caused or worsened by the excess weight.
There are a variety of bariatric surgeries that can be effective and they are divided into groups by how they affect your digestive system:
Limits the amount of food that you can eat
- Laparoscopic Vertical Sleeve Gastrectomy.
Restrictive and Malabsorptive
Limits the amount of food eaten and limits absorption of food
A new start
This is a life changing surgery and the risks and benefits need to be carefully considered prior to making a decision for surgery.
Surgery should be viewed as a method for alleviating the debilitating diseases your obesity is causing. The surgery is a tool that must be used in conjunction with all of the aspects of the bariatric surgery program (diet modification, exercise, psychiatric counseling, lifelong follow up care) to be successful.
Success will require your commitment to the entire program.
You must attend the bariatric surgery seminar to receive education about the different surgical options and the risks of each. Each bariatric team member will educate you about their area of expertise. You will meet individually with the surgeon for a careful history and physical exam. You should also discuss weight loss surgery with your family physician. At that point, you will make a decision with the help of the bariatric team as to whether surgical weight loss is right for you.