Considering Weight Loss Surgery?
Obesity is a chronic and progressive disease that can affect multiple organs in the body. People with clinically severe obesity are at great medical risk of disability or premature death. In fact, four hundred thousand Americans die prematurely each year of obesity related complications, or co-morbidities. At the top of the list of obesity related co-morbidities are adult onset diabetes, or Type 2 diabetes, and high blood pressure. High blood pressure caused by clinically severe obesity can contribute to heart attacks, congestive heart failure and stroke. Health concerns such as sleep apnea, asthma, low-back pain, urinary stress incontinence and severe acid reflux (GERD) are also a result of increased weight. Significant weight loss can often ease these conditions or reverse them completely.
What are the criteria for patients considering surgery for obesity or bariatric surgery?
Obesity is very difficult to treat. Many patients have tried multiple diets, medications and exercise regimes that had results that did not last. Surgery to promote weight loss by restricting food intake and interrupting digestive processes is an option for clinically severe obese patients that have been unsuccessful with other weight loss treatments.
Eligible patients for weight loss surgery often have a body mass index, or BMI, of 40 or greater. A BMI of 40 translates to about 100 pounds over ideal body weight for men or 80 pounds over ideal body weight for women.
Weight loss surgery may also be an option for people with a BMI of 35 of greater who suffer from progressive life-threatening obesity related health problems such as diabetes, obesity-related heart disease or severe sleep apnea. However as is true for other treatments for obesity, successful results depend significantly on knowledge, personal modification and behavior.
Introduction to Sleeve Gastrectomy
The sleeve gastrectomy is a surgery only on the stomach (it is only a restrictive procedure) and does not involve any surgery on the intestine (which would make it malabsorptive). Sleeve gastrectomy has also been called partial gastrectomy and vertical sleeve gastrectomy. It basically consists of making a stomach that looks like a pouch into a long tube; therefore the name “sleeve.” The sleeve gastrectomy (SG) removes two-thirds of the stomach, which provides for quicker satiety (sense of fullness) and decreased appetite. The smaller stomach pouch restricts food intake by allowing only a small amount of food to be eaten at one time. After the separation of the stomach into a smaller tube, the remainder of the stomach is removed. The valve at the outlet of the stomach emptying to continue which allows for the feeling of fullness.
SG is now an established first procedure (or first stage of a two part surgery) to prepare the obese patient biliopancreatic diversion or gastric bypass. It is also used as a single stage procedure. There is no anastomosis or new connections made between the stomach and small intestine in this procedure. There is no rerouting of the intestine. There is no malabsorption. There is no dumping syndrome. The sleeve gastrectomy is believed to have an advantage over the adjustable gastric band due to removal of the part of the stomach that produces the hormone (Ghrelin) that controls the desire to eat.
The potential complications of the operation on average typically less than 0.5% compared to 2% - 3% in a combined procedure.
Weight loss surgery (bariatric surgery) requires personal responsibility, lifestyle changes, long-term monitoring and follow up vitamins.
Studies show that patients that commit to eating healthy food, taking nutritional supplements and having routine blood work for monitoring purposes have the best long-term results.
Surgery gives patients the physical tool to assist with weight loss. Patients must be committed to making the emotional and physical changes necessary after weight loss surgery. This commitment will ensure successful weight loss and long-term weight maintenance.
Lack of exercise, poorly balanced meals, constant grazing, eating processed carbohydrates and drinking carbonated beverages are some of the most common reasons for weight regain. Good habits of food intake and exercise will need to be practiced for the rest of the patient’s life. This can be viewed as a small exchange when compared to the potential for restored health and improvements or elimination of many of the co-morbidities.
Why choose the Sleeve Gastrectomy?
The sleeve gastrectomy has the following advantages:
- It does not require the implantation of a foreign body such as a silastic ring used in gastric banding.
- The procedure mechanically decreases the size of the stomach but also decreases the secretion of the hormone ghrelin which is responsible for the feeling of satiety (fullness).
- The procedure offers the benefit of initially decreasing the body weight in the severely obese patient to prepare this patient for a staged procedure or other surgery at a later time.
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