Bariatric Surgery: A Last Resort for Weight Loss

Bariatric (or weight loss) surgery, is a complex procedure that involves changing the anatomy of your digestive system in order to limit the amount of food you are able to eat.

The surgery, developed as a treatment for severe obesity, is intended as a final option for individuals who have tried unsuccessfully to manage their weight by other means.

Bariatric Surgery Candidates

Surgeons use the guidelines set forth by the National Institute of Health (NIH) when establishing whether a patient qualifies for bariatric surgery. The guidelines also serve as a basic means to differentiate between medical versus cosmetic weight loss surgery. According to NIH, potential candidates for bariatric surgery have:

1. a BMI of 40 or more or are at least 100 pounds over their ideal body weight.
2. a BMI of 35 or greater, combined with one or more co-morbid conditions. A co-morbid condition is a life-threatening health problem associated with obesity. Examples of such conditions include Type 2 diabetes, heart disease, high blood pressure, cancer and other serious health problems.

Potential candidates for the surgery should also have a history of failed weight loss treatments, be willing to commit to post-op diet and lifestyle changes, and be aware of the risks associated with the surgery.

Bariatric surgery is a serious procedure aimed to treat chronically obese individuals. As such, it should not be considered as an alternative for people looking to lose weight for purely cosmetic reasons.

Types of Bariatric Surgery

There are four basic types of bariatric surgery currently available:

1. The most common and popular form of weight loss surgery in the United States is gastric bypass surgery. In 2005 alone over 140,000 gastric bypass procedures were performed. Most patients and professionals favor this type of operation over alternatives because it's generally considered to be safer and produce fewer complications than other types of weight loss surgery. During gastric bypass surgery, the surgeon forms a small pouch at the top of the stomach and creates a bypass around a segment of the stomach and small intestine. By stapling the section across the top, the pouch gets sealed off from the remainder of the stomach. Next, the surgeon cuts part of the small intestine and sews it onto the pouch. In this way, food is redirected via the new connection, bypassing most of the stomach and part of the small intestine. The procedure limits the body's ability to absorb calories. It takes about four hours and requires a long recovery period in which substances ingested by the patient are strictly limited.
2. In LAP-BAND adjustable gastric banding (LAGB), the surgeon uses an inflatable band to divide the stomach into two sections by wrapping the band around the upper part of the stomach. By pulling it tightly, only a tiny channel is left between the two sections. LAGB is becoming a more popular form of bariatric surgery because it's a simpler procedure and has fewer potential risks than some other surgeries. The downside of LAGB is that it results in less weight loss than the gastric bypass.
3. Vertical banded gastroplasty, also known as "stomach stapling", divides the stomach into two parts, limiting space for food. This results in an inability to eat large quantities of food. While no bypass is involved in this operation, it has become a less favorable option because it does not provide long-term weight loss results.
4. Biliopancreatic diversion with duodenal switch is a procedure that removes approximately 80 percent of the stomach. This surgery offers sustained weight loss, but malnutrition and vitamin deficiencies are more likely in patients who undergo this procedure.

While each of these weight loss surgery options possesses its own benefits and drawbacks, all of them, like any major surgery, entail some degree of risk.

Weight Loss Surgery: Risks and Rewards

Morbid obesity can interfere with basic life functions, such as breathing and walking, and reduce overall quality of life. For individuals suffering from such a condition, the surgery can be a welcome reprieve. Combined with a healthy change in eating habits and lifestyle, weight loss surgery can result in lasting weight loss and decreased susceptibility to co-morbid conditions and diseases.

The procedure, however, is not without its risks. Here are a few of the more serious potential risks to consider before opting for bariatric surgery:

• Blood clots in the legs: Overweight individuals are more likely to develop blood clots. In some cases, blood clots can travel to the lungs and damage tissue or cause death. Smoking is also linked to an increase in blood clot formation in patients who have undergone bariatric surgery.
• Death: There is a risk of death associated with bariatric surgery. Reports indicate that one in every 200 or 300 gastric bypass surgeries (the most popular form of bariatric surgery. See definitions below) results in a death.
• Dumping syndrome: Frequently experienced after eating sweets or high fat foods, this condition results from the stomach contents moving too swiftly through the small intestine. Dizziness, vomiting and nausea are common symptoms of dumping syndrome.
• Incision hernia: An incision hernia usually results from weakening around the line of the incision and generally requires surgical repair.
• Leaks at the staple line in the stomach: In most cases, this problem can be treated with antibiotics. However, if the leak is severe, it can require the patient to undergo emergency surgery.

As with any major surgery, research your options carefully before committing to a procedure. If you or someone you love is suffering from obesity, you can request a diagnostic exam from your doctor to determine whether bariatric surgery is an appropriate option for you.