Weight-loss surgery alters the body's digestive process by limiting the amount of food the stomach can hold and/or by limiting the absorption of nutrients. The most common procedures are restrictive, malabsorptive or a combination of both procedures. Restrictive procedures reduce the amount of food the stomach can hold, but don't interfere with the body's normal digestion of food and nutrients. Malabsorptive procedures bypass most of the small intestine so that fewer calories and nutrients are absorbed. Combined procedures restrict food intake as well as the amount of calories and nutrients the body absorbs.
Candidates are at least 100 pounds overweight. That translates to a body mass index of 40 or over. You should have previously attempted to lose weight through traditional methods, including dieting, nutritional counseling and commercial or hospital-based weight-loss programs. Candidates may have a body mass index of 35 and over if they have medical problems that are associated with obesity, such as hypertension and diabetes.
The adjustable gastric band (also known as the LAP-BAND® System in the U.S. ) is less invasive than gastric bypass. All the operations are done laparoscopically. By placing an adjustable band around the stomach, the surgeon creates an upper pouch. As the name suggests, the band can be adjusted in follow-up, outpatient procedures to ensure that the pouch is the right size to control weight loss.
During Roux-en-Y gastric bypass, a surgeon creates a small pouch at the top of the stomach using staples. The small intestine is then rearranged and connected directly to the pouch, creating a bypass of the small intestine.
The band is adjustable; the bypass is not adjustable. The band is reversible; the gastric bypass is irreversible.
That depends on the procedure and the individual. With the adjustable gastric banding procedure, weight loss progresses steadily over a 2- to 3-year period and then stabilizes. The final result is usually between 50 percent and 60 percent of the excess weight. After four years, studies show the level of weight loss is equal to that achieved by gastric bypass surgery.
After gastric bypass surgery, weight loss usually exceeds 100 pounds or up to 70 percent of the excess body weight, but it generally levels off in one to two years. A regain of up to 10 percent of your excess body weight is common. With adjustable gastric banding, weight gain is minimal.
Ultimately, one's goal weight should be determined by the individual with his surgeon and should be the recommended weight based on the patient's height.
The most common complication associated with adjustable gastric banding is the enlargement of the stomach pouch, which can occur if the stomach slips up through the band. However, modifications to the technique have been made to prevent this from occurring. There have also been cases where the band erodes into the stomach.
Research has found that patients who undergo a gastric bypass have longer operative times, more blood loss and longer hospital stays when compared to patients who have adjustable gastric banding. Up to 5 percent of patients undergoing gastric bypass may experience leaking, bleeding, wound infection or blockage. In addition, because a portion of the digestive tract is bypassed, the absorption of essential nutrients is reduced and medical complications can result. Intake of supplements is mandatory.
A patient's medical history and weight are used to determine which surgery is the best option. It is also important to talk with your surgeon to decide which option is right for you.
Weight-loss surgery can eliminate or improve most obesity-related medical complications, including diabetes, hypertension, high cholesterol, sleep apnea, reflux and osteoarthritis, as well as stress incontinence, dermatitis, muscle and joint pain. Improvements in body image and a reduction in the symptoms of depression have also been reported. Weight loss may also be associated with improved fertility and more favorable pregnancy outcomes.
The surgeon you choose should be experienced with the procedure you are considering. You should also determine if they are board-certified, and if they are members of the American Society for Bariatric Surgery.
Discuss their commitment to follow-up, because weight-loss surgery often involves lifetime follow-up. The doctor should be working with all of the aspects of management and assessment in a clinical, multidisciplinary setting. The affiliate hospital and their office facilities should be able to accommodate large patients and be able to support all of the components of their programs.
For more information about Dr. H. Joseph Naim, M.D., F.A.C.S., contact us at (310) 975-9546.
First, a rigorous medical and psychological screening process, performed by a team of doctors, will determine if you are a candidate. This process helps to identify the aspects of your health that will improve following surgery, as well as the aspects that may increase the risks associated with surgery.
You will also want to come to a complete understanding of the significant, lifelong, lifestyle changes you must commit to, including diet, exercise, limiting alcoholic intake and smoking cessation, if necessary.
That depends on the procedure. Patients who undergo laparoscopic adjustable gastric banding tend to stay in the hospital for a little less than one day, while the average hospital stays for patients who undergo a laparoscopic gastric bypass is two days.
Recovery times differ too. In one study, patients returned to normal activity in about one week after laparoscopic adjustable gastric banding and over 18 days after laparoscopic gastric bypass.
Immediately following adjustable gastric banding, only sips of water are allowed. Over the next two weeks, the consumption amount is increased gradually with fluids in the form of water and liquids, such as clear broth, skim milk, low-calorie juice and sugar-free ice pops. You will need to watch how many calories you eat and limit your liquid intake to avoid nausea and vomiting. Low-fat pureed foods, protein-rich chicken and fish, mashed potatoes and peas are started three to four weeks after the operation.
Patients who undergo gastric bypass follow a similar dietary progression.
Once healed, care must be taken to let your stomach adapt to its new environment. Vitamin supplementation are necessary, especially in patients who have undergone gastric bypass.
Lifetime follow-up is recommended, with at least three follow-up visits during the first year. Adjustable gastric banding requires more frequent visits for band adjustments.
You will need to adopt a healthy lifestyle, including a new nutrition plan and regular exercise, although exercise restrictions may be in place until you are healed.
Because of the decrease in food intake, constipation may occur. A laxative may be recommended.
You may want to consider or may require reconstructive operations after your weight stabilizes.
Medications can be prescribed as needed. However, your doctor may tell you to avoid aspirin and non-steroidal anti-inflammatory drugs, which can irritate the stomach.