What is weight-loss surgery?
There are several different kinds of surgical procedures to help people who are significantly overweight. By reducing the size of the stomach, these procedures restrict the amount of food you can consume.
Long-term success depends in large part on permanently following a restricted diet and making major lifestyle changes.
This surgery is most often considered a last resort for people who are more than 100 pounds overweight, and who have not been successful in permanently reducing their weight through other methods. Gastric-bypass surgery should not be considered reversible. The decision to have this procedure must be made in consultation with a qualified surgeon, and after very careful consideration of the potential benefits and risks and the lifelong consequences. Back to top
Who qualifies for weight-loss surgery?
Surgery is sometimes the best option for severely obese people who cannot lose weight by traditional means or who suffer from serious obesity-related health problems. The surgery promotes weight loss by restricting food intake and, in some operations, interrupting the digestive process. As in other treatments for obesity, the best results are achieved with healthy eating behaviors and regular physical activity.
People who may consider gastrointestinal surgery include those with a body mass index (BMI) above 40 – about 100 pounds of overweight for men and 80 pounds for women. People with a BMI between 35 and 40 who suffer from type 2 diabetes or life-threatening cardiopulmonary problems, such as severe sleep apnea or obesity-related heart disease, may also be candidates for surgery.
The age range for obesity surgery is generally 16-60 years old. However, it may be appropriate for some adolescents in some extreme situations. People with substance abuse issues are not appropriate candidates, and current smokers are not eligible. Back to top
Which surgeries do you offer?
Roux-en-Y Gastric Bypass:
In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. No stomach or intestine is removed during surgery. The new connection between stomach pouch and intestine restricts intake and changes the way food is digested. The new, smaller stomach pouch allows the patient to feel full with much smaller meals. This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).
Lap Band:
The Lap Band is a device that is surgically placed around the stomach to cause weight loss. It consists of a small adjustable ring and an attached access port. The ring is placed around the top part of the stomach, partitioning the stomach into a small pouch. The access port is implanted under the skin of the abdomen. The tightness of the ring can be adjusted by adding or removing saline from the access port. As food is consumed, it quickly fills the small pouch, which causes a feeling of fullness.
Read about the Lap Band procedure as featured on the MedWatch TV show.
Abdominoplasty:
The abdominoplasty, or "tummy tuck" is a surgical procedure to remove excess skin and fat from the abdomen and to tighten the muscles of the abdominal wall. Good candidates for a tummy tuck are patients who have developed laxity in the skin and muscles of the abdomen and stomach areas. After several pregnancies, a Cesarean section, or large weight loss, a woman may be ready to make a call to her plastic surgeon. More and more men are also opting for this procedure. This procedure does produce a permanent, noticeable scar; however, it is one that is easily hidden by clothing. The scar is placed in a low crease in the abdomen or stomach skin. Back to top
How much weight am I going to lose?
Weight loss varies between the different procedures as well as between people. Bariatric surgeons use specific terminology to discuss expected weight loss. Excess body weight is defined as a person's current weight minus their ideal body weight. Success after bariatric surgery is defined as losing 50% of your excess body weight. On average, our patients lose 70-80% of excess weight after gastric bypass surgery. After a lap-band, patients lose on average 50% of their excess weight. Back to top
What are the benefits?
The emotional and physical benefits of achieving a healthy weight are significant. For example:
People who lose at least 50 percent of their excess weight report they have more energy, endurance, and ability to enjoy physical activities, as well as significant improvement in back and joint pain.
Research on the effects of major weight reduction have demonstrated a significant decrease in the risk of heart disease, and often improved blood pressure in patients with hypertension.
Many people with obstructive sleep apnea or respiratory problems enjoy marked improvement.
The majority of significantly overweight people who have diabetes enjoy tremendous improvement in blood sugar control following major weight reduction, and many no longer require medication.
Skin problems related to obesity usually resolve.
Acid reflux (indigestion) symptoms often improve or disappear. Back to top
What are the risks?
The gastric-bypass operation has a mortality rate of 1 percent or less; however, significant obesity itself increases the risk for many life-threatening diseases, including diabetes, heart disease, respiratory problems and liver dysfunction.
Complications which may occur during surgery, or soon after, include bleeding, a leak or narrowing of the anastomosis (where the loop of bowel is attached to the stomach pouch), abscesses inside the abdomen, wound infection, blood clots developing in the legs (deep venous thrombosis) or a blood clot going to the lungs (pulmonary embolism). Between 5 to 10 percent of patients experience a post-operative problem that requires medical attention.
Some patients may require up to 24 hours on the breathing machine (ventilator) following surgery, particularly those with existing respiratory problems such as sleep apnea.
Complications that may occur later include incisional hernia, narrowing or stricture of the anastomosis, small bowel obstruction, gallstone formation, anemia and diarrhea. Some complications may require additional surgeries.
Many patients experience an unpleasant side effect known as "dumping syndrome" when they consume food with high sugar content. This may include weakness, nausea and light-headedness. It usually passes within about 45 minutes. Back to top
Will this operation cure my diabetes?
Probably. Most patients lose enough weight that they no longer require any treatment for diabetes. Often patients who were taking more than 100 Units of insulin a day are discharged home without needing any. The effects of the operation on diabetes are very rapid - even before significant weight loss! People most likely to be completely free of insulin are those who have been diabetics for less than five years. There is a 95 percent chance of diabetes being cured after a gastric bypass if you have been diagnosed within the last 5 years. If your diagnosis of diabetes was more than 10 years ago, your chance of being cured after a gastric bypass is 54% with the remaining patients having marked improvement. On average, after a gastric bypass, diabetic patients will have normal fasting blood glucose and normal HbA1C with a very significant reduction, if not elimination of their medications. Back to top
Will my insurance pay?
Many health plans will cover this surgery if the person meets all requirements. For example, you must be able to document that you have seriously tried to lose weight multiple times through conventional methods without lasting results. Back to top