eMedex Weight Loss Guide

In cases where excess body weight has reached a dangerously high level, sometimes the only alternative left to explore is surgery. Such conditions of severe obesity are very difficult to treat through non-surgical means. There are different kinds of surgeries that can help in various ways and it is imperative for the concerned individual to fully explore the pros and cons of the different weight loss procedures.

There are two basic approaches to weight loss surgeries: restrictive procedures and malabsorptive procedures. There are a number of different methods of surgery that come under the umbrella of these two broad categories.

1. Gastric Restrictive Procedure: Vertical Banded Gastroplasty (VBG)

This form of weight loss surgery falls under the first category of restrictive procedures. The process involves vertically stapling 6 cm of the upper stomach, creating a smaller stomach pouch. The emptying of the food from the pouch is slowed by the use of a band that makes the individual feel full.

Advantages

•    Reduces the amount of well-chewed food that passes through the digestive tract.
•    Nutrients, calories, and vitamins are fully absorbed by the body.
•    It is beneficial for long term weight maintenance.

Risks

•    Staple-line disruption can result in leakage and serious infection.
•    May require antibiotic treatment or an additional operation, in case of the aforementioned problem.
•    In the long run, this problem could cause weight gain.
•    The band can sometimes lead to complications of obstruction and perforation.

2. Malabsorptive Procedures: Biliopancreatic Diversion

The basic procedure of this surgery is quite similar to the aforementioned restrictive procedure. The only difference is that the size of the pouch is much larger. Through this pouch, food intake is restricted and the digestive process is altered to a great extent. The goal of this procedure is to put the bile and pancreatic juices in contact with the undigested food much closer to the end of the small intestine. This is achieved by changing the anatomy of the intestines. The absorption of nutrients and calories is also reduced through this procedure. There are basically three main approaches to this kind of surgery:

1)    Biliopancreatic Diversion (BPD)
2)    Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E)
3)    Biliopancreatic Diversion with “Duodenal Switch ”

Advantages

•    Patients are satisfied as these procedures enable them to eat their desired amount of food.
•    Due to the high levels of malabsorption, excess weight loss is easily achieved.
•    Long term weight loss and maintenance can be achieved by following simple guidelines.

Risks

•    Bowel movements tend to become very liquid, often permanently.
•    Malodorous stool or gas and abdominal bloating may occur.
•    Requires patients to take vitamin supplements for the rest of their lives, along with regular monitoring for proteins, anemia, and bone diseases.
•    The changes in the anatomy of the intestines can result in the formation of gallstones, which may lead to the removal of the gallbladder.
•    The body becomes vulnerable to intestinal irritation and ulcers.


2.    Combined Restrictive and Malabsorptive Procedure: Gastric Bypass Roux-en-Y

Medical advancements have made it possible to combine the benefits of both restrictive and malabsorbtive procedures. With the addition of malabsorption to restrictive surgery, the absorption of nutrients is aided because of the delay in the mixing of bile and pancreatic juices with the food. The individual seems to feel full much earlier on while feeling satisfied at the same time, thus diminishing the desire to consume more food. This complicated procedure has become the most popular form of weight loss surgery in the U.S.

Advantages

•    The rate of excess weight loss is much higher than purely restrictive procedures.
•    About 77% excess bodyweight can be reduced in one year.
•    It allows patients to maintain the reduced bodyweight in the long run.
•    Most problems associated with excess body weight disappear over a period of time.

Risks

•    Iron deficiency and anemia can develop because of poor absorption of iron and calcium.
•    Metabolic bone diseases resulting in pain, a humped back, fractures, and the loss of height are some of the possible side effects of bypassing the duodenum.
•    Dumping syndrome may result in unpleasant health conditions such as weakness, nausea, diarrhea, and faintness.

3. Laparoscopic Adjustable Gastric Banding

Through this procedure, a band is placed around the uppermost part of the stomach, dividing the stomach into two portions of different sizes. Although food digestion takes place in the normal way, the patient tends to feel full at an early stage.

Advantages

•    Food intake is restricted.
•    Digestive system remains unaltered.
•    Restriction can be increased or decreased by the adjustable band.
•    Surgery is reversible.

Risks

•    Tearing or gastric perforation may require additional operations.
•    Although food intake is restricted, patients may not feel satisfied.
•    Outlet obstruction may occur.
•    It may cause nausea and vomiting.
•    Stomach pouch dilatation may occur.