Fifty million people in the United States are considered obese, which is defined as a BMI (body mass index) equal to, or greater than, 30 kg/m2. Twenty percent of that population is morbidly obese, according to the consensus paper written by Dr. Buchwald for the journal of "Surgery for Obesity and Related Conditions." Dr. Buchwald goes on to say that the most effective surgery for morbid obesity is bariatric surgery. Bariatric operations physically alter the digestive tract in order to either restrict calories or decrease absorption of calories. These procedures can improve most of the chronic conditions associated with obesity including diabetes, high blood pressure and osteoarthritis.
Types of Surgery
Surgery for obesity is divided into two categories: restrictive and malabsorption. Restrictive surgery entails limiting the amount of food intake the stomach can handle at one time. Malabsorption techniques work by creating a bypass around segments of the small intestine where normal nutrient absorption occurs. The most common operation is a gastric bypass, or Roux-en-Y procedure, which is both a restrictive and malabsorption procedure. A purely malabsorption technique no longer exists due to the high rate of complications these procedures produced.
Roux-en-Y
A Roux-en-y procedure, which can be done either through a small incision using a scope, or in an open fashion, which requires a large midline incision in the abdomen is the most common operation for morbid obesity. This procedure entails bypassing the duodenum, the first part of the intestine, and creating a bypass limb with the jejunum, a more distal limb of the small intestine. The jejunal limb is attached to an opening made in the stomach wall so that gastric contents will pass through this outlet and bypass the duodenum completely. The stomach is made into a small pouch, and the procedure is complete. Weight loss with this procedure usually exceeds 100 lbs. and levels off after one or two years. When done by a skilled surgeon, this technique is relatively safe and operative mortality is about 0.5 percent, according to Dr. Buchwald.
Laparoscopic Gastric Banding
Laparoscopic Gastric Banding (LAGB) procedure is done through the laparoscope and is the least invasive procedure for bypass surgery. By placing an adjustable band around the entrance to the stomach, the upper stomach is made into a very small pouch. This is purely a restrictive procedure, which limits the amount of calories that a patient can consume. LAGB does not require surgical division of the stomach or intestines and has a very low mortality rate. Weight loss after two years is approximately 45 to 75 percent of the excess body weight.
References
- "Surgery for Obesity and Related Diseases"; Consensus Conference Statement: Bariatric sugery for morbid obesity: Health implications for patients, health professionals and third-party payors; Henry Buchwald, M.D., Ph.D. F.A.C.S.; 2004
- UpToDate: Surgical management of severe obesity. Daniel Jone, MD, Robert Andrews, MD. 2010
Member Comments