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Bariatric Surgery

Some individuals who suffer from severe obesity have tried dietary interventions and medications and found that those methods have not led to long-term success in weight loss. Yet, long-term weight loss is the only way to avoid the health consequences of obesity, which often include diabetes, high cholesterol and high blood pressure, and heart dysfunction. For people who have tried behavioral and dietary interventions but have not been able to lose a significant amount of weight, bariatric surgery can be the key to achieving long-term weight loss.

The American Heart Association states that bariatric surgery is a relatively safe procedure that can lead to long-term weight loss and significantly improved health. For individuals who are safe surgical candidates, bariatric surgery can aid weight reduction and thus greatly reduce an individual’s risk for cardiac disease and other major health problems.

Below, we discuss bariatric surgery procedures and the benefits and risks of bariatric surgery. If you would like to learn more about bariatric surgery at ProMedica Toledo Hospital, we encourage you to attend an informational seminar.

Bariatric Surgery Procedures

If you receive bariatric surgery at ProMedica Toledo Hospital, your physician will recommend either Roux-en-Y gastric bypass or gastric sleeve resection.

Roux-en-Y gastric bypass

Roux-en-Y gastric bypass is the operation most performed in the United States to induce weight loss. Most patients will lose about 75% of their excess weight in 12 – 18 months post-surgery. A weight loss of 60 – 70% is generally maintained.

During surgery, a small pouch is created at the top of the stomach using staples. The volume of the pouch is less than one ounce. This pouch is then attached to a limb of the small intestine so that food bypasses the stomach and the first part of the small intestine. The operation works because the patient feels full with smaller amounts of food.

Additionally, food absorption is inhibited and hormonal changes occur which temporarily suppress the appetite.

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Gastric sleeve resection

Gastric sleeve resection is preferred in patients who have serious small bowel problems, such as Crohn’s disease. This operation removes the left side of the stomach leaving a thin tube – or “sleeve” – down the right side. In short-term follow-up studies, weight loss with the sleeve resection is slightly less than with gastric bypass. However, if longer term studies demonstrate stable weight loss, this procedure will be a reasonable option for many patients.

Regardless of the procedure your physician suggests, 99% of all bariatric surgeries at ProMedica Toledo Hospital are performed laparoscopically. Laparoscopic surgery is a form of minimally invasive surgery, which means that smaller incisions are used so that healing time is faster. Laparoscopic surgery generally means less pain and scarring, decreased blood loss and reduced risk of infection compared to traditional surgery techniques.

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Benefits and Risks

Thanks to bariatric surgery, thousands of people have experienced a tremendous improvement in their overall health, well-being and outlook on life. However, if you are considering bariatric surgery, you need to consider both the benefits and potential risks. Listed below are benefits and risks all patients should be aware of before choosing bariatric surgery.

Benefits

  • Significant, sustained weight loss
  • Remission of Type 2 diabetes in 84% of patients. The remaining patients typically require less medication than they did before the surgery.
  • Lowered blood pressure: hypertension resolves about 80% of the time
  • Reduced risk of heart disease
  • Lowered cholesterol
  • Reduced sleep disorders: sleep apnea resolves about 80% of the time
  • Improved breathing
  • Resolution of symptoms of pseudotumor cerebri
  • Relief from acid reflux and/or gastroesophageal reflux disease (GERD)
  • Reduced osteoarthritis pain and improved mobility
  • Enhanced fertility in younger women
  • Reduced risk of cancer. The risk of breast and colon cancer is decreased by 80% in the first three years after gastric bypass.
  • Improved mood and self-esteem

Risks

  • Leaks may occur from the areas where the bowel is re-approximated, resulting in infection. If leakage occurs, an internal infection can occur from the digestive juices entering the body cavity.
  • Blood clots can occur. In order to avoid this problem, the patient receives blood-thinners, wears special compression cuffs during and after surgery and begins taking walks the evening of surgery.
  • Dumping syndrome can occur when the stomach’s contents move through the small intestine too rapidly.
  • Wound infection, although greatly reduced with laparoscopic surgery, is possible at incision sites.
  • Hernias can occur but are extremely rare with the laparoscopic approach.
  • Gallstones and/or gallbladder disease can develop due to the body’s rapid weight loss. A medicine taken for the first six months after bypass reduces the risk to 3%.
  • Vitamin deficiencies can occur, but can be prevented by taking daily vitamin supplements. Periodic lab testing ensures appropriate vitamin intake.
  • As with any surgical procedure, there is a risk of death. The first longitudinal studies have shown that risk of death within 30 days after gastric bypass is approximately 0.3%. The National Institutes of Health declare that the risks surrounding gastric bypass are no greater than they are with surgeries such as gallbladder removal or hip replacement.
  • Osteoporosis will occur unless the patient takes extra calcium and sometimes vitamin D. This is the most serious long-term problem.

Am I a candidate?

To be a candidate for bariatric surgery, a patient must be between the ages of 18-67. He or she should be a non-smoker for at least three months prior to the surgery (and must agree not to smoke after surgery). The patient should have a Body Mass Index (BMI) of 40 or more (about 100 pounds or more over ideal body weight); or patients with a BMI of 35 – 39.9 with serious medical conditions related to obesity that would improve with weight loss. (Click here to calculate your BMI.)

In addition to those physical characteristics, patients must also demonstrate certain lifestyle and emotional characteristics. Patients must have demonstrated the ability to make long-term dietary changes. Finally, a potential candidate for bariatric surgery needs to have the psychological ability to adjust to the physical, emotional and social changes brought about by the post-surgery weight loss and major lifestyle changes.

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