In 2001 almost 50,000 thousand patients had some type of obesity surgery, with the number rising to 60,000 in 2002 and 120,000 in 2003. It is estimated that during 2005, more than 150,000 patients will undergo gastric bypass surgery, a more than 600% increase over the last decade. It is estimated that in 2002 alone, gastric bypass surgery resulted in hospital revenue of more than two billion dollars. As patient's try to reach a "go, no go" decision, what they are told about risks may be drowned out by dramatic before and after photographs of successful weight losses of 100-150 pounds. It is important that you have an understanding of the surgery and its risks before going into the hospital, and important as well that you understand the mechanics of the surgery should you be the victim of "gastric surgery gone bad."
Obesity surgery attempts to promote weight loss by limiting the amount that the stomach can hold, thus working to reduce food intake and/or by causing food to be poorly digested and absorbed. Restrictive surgeries have in common the creation of a small pouch at the top of the stomach where food enters. At the present time Roux-en-Y gastric bypass is the procedure most often performed.
The preoperative period should be a time for a comprehensive evaluation of the patient contemplating surgery. It is helpful if the patient is evaluated not only by surgeons, but by psychologists, dietitians, physical therapists and the postoperative care team.
Particularly important is a thorough knowledge of the post gastric bypass diet. Given the restrictive nature of the surgery, a post bypass diet must be directed toward allowing a period of adjustment and adaptation. The pouch will expand over time to accommodate a rising, but controlled, level of intake. The initial capacity may be a little as one ounce, with expansion to eight ounces over approximately eighteen months.
Patients should be told to expect that the initial post bypass diet will consist entirely of high protein fluids and vitamin supplements, with eventual progression to solid food.
A 2004 study published in "Pediatrics" suggests that teenagers may benefit from gastric bypass surgery. This study recommended that children should be 1. older than 13; 2. 95% of their expected adult height; and 3. demonstrate obesity related health problems in addition to being severely overweight. The surgical risk appears to be the same for teenagers and adults, however it must be remembered that there is no study that evaluates the long term risks and benefits for teenagers. The study concludes that gastric banding is not an appropriate choice, particularly since there likely will be the need for multiple replacements as the children age.
Given that the number of overweight teenagers has almost tripled over the last twenty years, with a resultant rise in morbidly obese adolescents, it appears that as a response, hospitals nationwide are increasingly offering some type of procedure to adolescents. The conventional wisdom is that children under 15 years of age are not candidates for surgery.
Please be sure that your child undergoes a detailed psychological evaluation before any type of surgery is considered, and that any decision to go forward is theirs, not yours. Be sure that your doctor discusses with you the risk of malnutrition, with a particular emphasis on calcium and protein defeciencies.
Despite the article in "Pediatrics" cited above, gastric banding for teens is becoming quite popular. Please be sure to discuss the pros and cons of this procedure before going forward.
Gastric banding uses a band made of a special, plastic like material to make a small pouch and narrow passage into the stomach. The band is placed by minimally invasive surgery around the upper stomach, and can be adjusted periodically without additional surgery. Two companies, Allergan and Johnson & Johnson, manufacture FDA approved bands, and it is estimated that within a few years half of all weight-loss surgery will be band placement.
Vomiting is a common side effect of this procedure, but more serious complications, such as erosion and slippage have been reported. It is not totally clear whether banding offers the same long-term weight loss as gastric bypass, though some studies from Australia suggest that it does.
Vertical Banded Gastroplasty, or VBG has become the most popular of the various gastroplasty procedures. In VBG a stapled opening in the stomach is combined with the use of plastic mesh to form a small pouch. Silastic ring gastroplasty substitutes silastic plastic tubing for the mesh. Some surgeons are combining Vertical Banded Gastroplasty (VBG) with a Roux-en-Y procedure. This variation remains less common than Roux-en-Y alone.
This procedure utilizes staples to close the stomach and create a small pouch. The small bowel is then directly connected to the pouch and a gastrojejunostomy is created. The surgeon may choose to create a "long-limb" and this procedure is then called a Long-Limbed Roux-en-Y. The rearrangement of the normal anatomy allows food to bypass portions of the small bowel, thus limiting the body's ability to digest food, and allowing undigested food to pass out of the body. Several studies have indicated that weight loss is most effective with Roux-en-Y as compared to gastroplasty or other forms of gastric bypass.
Laparoscopic procedures are by their very nature minimally invasive. The theory behind minimally invasive surgery is to decrease hospital stays and limit postoperative pain, infections, and problems with wound healing. Since 1993, laparoscopic Roux-en-Y gastric bypass and gastric banding has become increasingly popular. It is estimated that in 2003, almost 60% of bariatric surgery will be done by laparoscopic technique. You must be aware that there continues to be a learning curve for surgeons performing this type of specialized surgery; less experience or inadequate training means more complications, including potentially lethal leaks. Some state medical boards are so concerned by this problem that they have opened investigations. It is vital that you make sure that the surgeon is very experienced not only in laparoscopic surgery in general, but in laparoscopic bariatric surgery in particular.
It is becoming increasingly clear that a significant percentage of bypass patients will regain most if not all of their weight. The weight gain occurs in most cases when the patient finds eating stragegies that allow the intake of high calorie foods in multiple, small portions. Doctors often try to wash their hands of these patients, blaming them for being "weak" or "failures". Morbid obesity is a complex problem which is not simply fixed by technically sucessful surgery, so it is not enough to choose a qualified surgeon-make sure that you are given long term access to nutritional and psychological counseling.
Diabetes is a major health problem affecting millions of Americans. A variation of Roux-en-Y gastric bypass surgery shows some real promise in the treatment of diabetes. In this surgery, the stomach is left intact and a portion of the duodenum is bypassed. It is felt that by bypassing this portion of the small bowel, some changes occur which reverses diabetes. More study will be needed before surgery becomes a routine tool in the treatment of diabetes.
Johnson & Johnson, who in September received FDA approval for their lap band, called "Realize," have now created a new website, www.realizemysuccess.com. The site allows patients to interactively chart how they would look after weight-loss, and even permits them to see how they would fit into new clothes from Lands End.
Gastric Bypass surgery when properly performed can save lives. Newly released research has shown that those patients who underwent sucessful surgery has as much as a 40% lower risk of dying over seven to ten years compared to those who did not have the operation.
A warning for post-op patients: Take Your Vitamins.
Brain damge, which in some cases is permanent, can occur in the weeks following surgery if there is a thiamine deficiency. Thiamine is an essential B vitamin which can be taken as a supplement. Advise your doctor immediately if you have vomiting, confusion, lack of coordination, or visual changes.
The Federal Government announced in July of 2006 that 40% of gastric bypass patients develop complications following their surgery. As we have discussed on our site, leaks, infection and respiratory failure are among the most common serious complications.
July 2005: Gastric Bypass surgery may, in some cases, cause the pancreas to go into hyperdive, resulting in increased insulin production and dangerously low levels of blood sugar(hypoglycemia). Patients with this condition typically have a hypoglycemic attack a few hours after eating. If you have unexplained symptoms after eating, contact your doctor immediately.
The risks of surgery may be greater than once thought. The latest data suggest that 20% of weight loss surgery patients suffer some type of complication, with 5% suffering serious problems such as heart attacks and stroke. The death rate in the first 30 days after surgery may be higher than for some types of heart interventions.
Health insurers are increasingly resistant to approving surgery. Some are insisting on further attempts at non-surgical weight loss, despite proof that most weight loss programs fail the morbidly obese.
BariatricEdge.com: Where people struggling with morbid obesity find answers.
www.bariatricedge.com
ObesityHelp.com: Making the Journey Together
http://www.obesityhelp.com
Obesity Surgery Including Laparacopy and Allied Care
http://www.obesitysurgery.com
National Institute of Health Consensus Statement on Gastrointestinal Surgery for Severe Obesity
http://consensus.nih.gov/cons/084/084_statement.htm
National Institute of Health Consensus Statement on Gastrointestinal Surgery for Severe Obesity
http://consensus.nih.gov/cons/084/084_statement.htm
Weight-control Information Network
http://www.niddk.nih.gov/health/nutrit/nutrit.htm
Gastrointestinal Surgery for Severe Obesity
http://www.niddk.nih.gov/health/nutrit/pubs/gastric/gastricsurgery.htm
American Board of Bariatric Medicine
http://www.abbmcertification.org
Consumer Action and Information Center: Medical Malpractice
http://consumerlaw.com/medical.html
Gastric Bypass Surgery
http://www.fresnobee.com/bypass/story/1390673p-1467976c.html
Metroactive News | Gastric Bypass Surgeries
http://www.metroactive.com/papers/metro/11.01.01/bypass-0144.html
GastricBypassProblems.org: Beth Israel Center for Weight Loss Surgery
http://www.gastricbypassproblems.org
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