Surgical treatments for obesity
May 4, 1999
(WebMD) -- The history of surgical treatments for obesity includes numerous techniques quickly adopted and then rapidly abandoned after evidence proved them ineffective or harmful.
Today, three operations are considered fairly effective and safe treatments for obesity:
All three procedures are considered reasonably safe and have produced significant post-surgery weight loss. They can be performed with less than a 1 percent chance of surgery-related death in low-risk patients (those without concurrent health conditions, such as hypertension and diabetes) and less than 2 percent chance in high-risk patients. The goal of these surgeries is to reduce the stomach reservoir, which creates a sense of fullness from a smaller volume of food.
When do obese people qualify for surgical intervention?
Gastric bypass surgery is becoming the procedure of choice for weight-loss surgeons, partly because of its results. Of 608 patients, the average weight fell from 304.4 pounds to 204.7 pounds over 14 years after this surgery, according to one study. Most of this weight loss occurred the first year.
Gastric bypass surgery uses staples to create a small pouch out of the upper portion of the stomach and attaches a part of the large intestine to the pouch. Unlike the other two techniques, this procedure reduces the amount of calories absorbed by the body through "bypassing" the first portion of the intestine. After eating the equivalent of half a hamburger, the person with the small pouch stomach would feel full.
Bypassing the first part of the intestine can lead to poor absorption of nutrients and vitamins. "Dumping" -- diarrhea caused by the insufficient absorption of fluid from the intestine -- is common and occurs in 70.6 percent of these patients. Vitamin supplements are recommended for patients who have this surgery.
With vertical-banded gastroplasty, food passes through the intestines normally but the stomach's flow is restricted. The procedure uses staples to create a small pouch from the stomach's upper portion. A mesh ring encloses the stomach's middle part so that food must pass through a 5-centimeter opening to reach the stomach's lower portion.
Recent studies four years after surgery indicate that 36 percent of patients require repeat surgery either because of an excessive narrowing of the opening or a failure to lose weight.
Overall weight loss after vertical banded gastroplasty is 10 to 15 percent less than the loss after gastric bypass surgery.
The Kuzmak adjustable silastic band is another restrictive technique that uses an inflatable ring around the stomach to reduce the stomach's size and limit food intake. Unlike the other two surgeries, this procedure can be performed with the aid of laparoscopy, a visual/video aid that allows surgeons to see the patient's internal cavity. Laparoscopic surgery is less invasive than other kinds of abdominal surgery.
One study showed that 76 percent of patients experienced vomiting after having the procedure.
The average weight loss after Kuzmak adjustable silastic band surgery is 10 to 15 percent less than the loss after gastric bypass surgery.
Of the three, no single procedure stands out as significantly better than the others. Your doctor can discuss the pros and cons of each type of surgery. The choice, as with all surgeries, should be based on the patient's individual needs.
Copyright 1999 by WebMD, Inc. All rights reserved.
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