 
|
 Weight loss surgery has been performed for over 30 years. Obesity has reached epidemic proportions with 2/3 of our population overweight or obese, and this number has been rising steadily. This is problematic because obese people are more prone to developing medical conditions such as Type 2 diabetes, high blood pressure, heart disease and even some cancers. All of these weight related medical conditions translate into decreased life expectancy for this population, ranging up to 20 years. In fact more than 300,000 obesity related deaths per year makes obesity the second leading cause of preventable deaths in the US, after smoking. Equally discouraging is that dietary efforts, including medically supervised weight loss programs, are successful in fewer than 5%. Fortunately, weight loss surgery, also known as bariatric surgery, yields far better results, and as a result obese patients are becoming healthier and living longer. Bariatric surgery has been performed for over 30 years. There are numerous studies that highlight its effectiveness and safety for the morbidly obese. Patients are losing weight and keeping it off for the long term; they are becoming healthier and living longer compared to obese counterparts that do not undergo surgery. Morbid obesity is defined by a body mass index (BMI) of 40 or greater. The NIH instituted criteria in 1991 that bariatric surgery candidates must have a BMI of at least 40 or a BMI of 35 or greater if they have weight related medical condition such as diabetes or high blood pressure. (A healthy BMI is 18.5 to 24.9, a BMI of 25 to 29.9 is considered overweight, and a BMI greater than 30 is obese.) Approximately 200,000 weight loss procedures were performed in 2008 nearly double the number in 2003. This dramatic increase in volume has been attributed to less invasive techniques including laparoscopic surgery. The majority of these procedures were gastric bypass and adjustable gastric banding. All forms of weight loss surgery reduce the volume of the stomach, in other words they are restrictive. Some also cause the intestine to absorb fewer calories and therefore are also malabsorptive. The gastric bypass (Roux-en-y Gastric Bypass) is the most common weight loss operation in the US, although banding is projected to overtake it within the next five years. The stomach is divided near the top, leaving a golf ball sized pouch to accommodate food, and then attached to the small intestine. The food bypasses the majority of the stomach and initial section of the intestine. The bypassed portion of the stomach is not removed; it still functions by making digestive juices, but just no longer receives food. This operation therefore is restrictive and to a lesser degree malabsorptive. The adjustable gastric band is a silicone band with an inflatable inner cuff. Like a wristwatch, the band is fastened around the upper stomach to create a new, tiny stomach pouch, similar in size to the gastric bypass pouch. As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food. Since there is no cutting, stapling, or stomach rerouting, it is considered the least traumatic of all weight loss surgeries. The band is connected to a port which is implanted under the skin. This port is accessible via a fine needle and allows for adjustments to be performed indefinitely. The tighter the cuff is adjusted, the more restriction the patient will feel. The Sleeve Gastrectomy has been popularized in the last 5 years as a primary weight loss operation. The stomach volume is reduced by removing a section of the stomach, leaving a narrow tubular portion. It is a purely restrictive operation, like the gastric banding, but leaves no foreign body. Because a portion of the stomach is removed the procedure can not be reversed, however it can be converted to a different weight loss operation. Biliopancreatic diversion with duodenal switch (BPDDS) is a malabsorptive procedure that has good weight loss results, but patients have a higher risk of nutritional deficiencies after surgery. It is often reserved for the extremely obese (BMI of 50 or greater). The benefits of surgery are well documented by numerous studies. Patients lose 50-80% of their excess weight and keep it off in the long term. Most weight related medical conditions are resolved or improved. For example 75% percent of patients resolved their diabetes after surgery and over 60% resolved their high blood pressure. The risk of dying from heart disease and cancer is reduced by over 50% and most importantly, life expectancy is increased. There are risks of surgery. The mortality rate of gastric bypass is 1 in 300 to 1 in 500 but these risks have been decreasing as surgeries are now being performed in specialized centers. Studies have actually shown a significantly greater risk for the morbidly obese who do not undergo surgery compared to those that do. The risk of nutritional deficiencies is avoidable if the patients adhere to simple dietary rules including vitamin supplementation. Those that are interested in exploring surgical options must understand the risks and benefits. They must adjust to new eating and exercising habits because without these behavioral changes results will be sub-optimal. Patients are repeatedly told that weight loss surgery is a “tool”, not a cure. Most realize it is not “the easy way out” but it is the most effective.
Dr Korman is a Weight Loss Surgeon and Medical Director of L.A. Bariatric Center which is recognized by the Surgical Review Committee as a Bariatric Surgery Center Of Excellence. He is board certified by the American Board of Surgery and a Medical Expert for the California Medical Board. His interests are in minimally invasive surgery including, laparoscopic surgery and the new frontier of endo-luminal surgery. Dr. Korman’s practice focuses on laparoscopic gastric bypass, adjustable gastric banding and revisional surgery. You can learn more at LABariatricCenter.com. |
