Weight Loss, Dieting & ObesityAnother WebTrev.Com Health Services specialist sub-site. |
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What About Weight Loss Surgery and Bariatric Surgery for Obesity? - Part Two.In Part One, we looked at the relevance, legitimacy and suitability of weight loss surgery as an alternative of last resort for the chronically morbidly obese. Now, in Part Two, we'll look at the available weight loss surgery options. Intestinal Bypass SurgeryAlmost in the dust bin of history now, the Intestinal Bypass procedure was original a treatment for certain cancers and severe ulcers back in the 1950's. When it was found that these patients lost weight after surgery, some surgeons began using it as an obesity treatment. The idea was that patients would eat food that would be poorly digested and through "malabsorption" pass through the system without the calories being absorbed. True though this was, it also meant that most of the usual dietary nutrients passed through and out of the body without being absorbed, too. Malnutrition was common, as were surgical complications and even death. It was major invasive surgery. Hopefully, other than possibly for cancer patients, this surgery will never be recommended to obese patients ever again. Gastric Bypass SurgeryGastric Bypass surgery is the most common form of weight loss surgery in the USA, though not in Europe where Lap Banding is more widely used. Gastric Bypass surgery is said to have a higher success rate than Lap Banding, with over 80 percent of patients losing at least two-thirds of their excess weight within two years. It does, however, come at considerable greater short term and long term risks, and greater expense. Gastric Bypass operations are major surgery and come with the risk of complications that major surgery entails. It is reported that 12 percent (some studies say up to 20 percent) of patients suffer surgical complications, and 1.9% of patients actually die within 30 days of the operation. Surgical complications can be many, from infections to perforations, leaking stomach acids, through to abdominal hernias. Subsequent to surgery, the rapid weight loss dramatically increases the risk of gallstones, though taking a preventative course of medications for six to twelve months after surgery can prevent that risk from eventuating. There are two main variations to Gastric Bypass surgery:
Both are "malabsorption" techniques with distinct similarities to Intestinal Bypass surgery discussed above, though not bypassing quite as much. The RGB causes food to bypass the lower stomach, the duodenum (upper small intestine) and the early part of the jejunum (lower small intestine). The result of this is that your body absorbs far fewer calories - and nutrients. The BPD is more extreme again, bypassing all that the RGB bypasses, plus the entire jejunum (lower small intestine) It must always be remembered that gastric bypass operations do not only prevent calories from being absorbed - the intestines are the major organs for the absorption of nutrients. Accordingly, Gastric Bypass surgery patients are strongly advised to take a broad spectrum multi vitamin and mineral supplement in order to minimize the risks of malnutrition. Even so, around 30 percent of patients develop nutritional deficiencies such as anemia, osteoporosis and bone diseases. Stomach StaplingThis surgery has been available for several decades, though is less common than in the past. A combination of high complication and infection rates and more modern methods such as Lap Banding has seen to that. Stomach stapling was an early and crude surgical method for reducing the size of a patients stomach, thus restricting their food intake capacity to about one cup size. Patients need to adjust their eating habits to cope. Vomiting is a common side-effect from not adapting eating portions and meal sizes to suit the reduced stomach capacity. It was not a simple procedure. It was serious major surgery that also left huge scars. In most cases, it was not reversible. Given that safer, adjustable and reversable methods through less invasive keyhole surgery are now available much cheaper, it is difficult to think of a single reason why anyone would even consider stomach stapling anymore. Lap BandingLap banding is a more modern and much safer alternative to stomach stapling. Lap banding is more common than Gastric Bypass surgery in Europe, though it is the other way around in the USA. The Lap Band (Laparoscopic adjustable gastric band) is inserted via keyhole surgery. It is placed around the upper stomach to create a smaller "stomach pouch" which restricts and reduces the amount a patient can eat, leading to feeling full faster. The silicon band has an inner balloon which can either be filled with fluid, or deflated, allowing it to be adjusted as required by relatively simple keyhole surgery. In this regard, Lap Banding does serve to create a permanent change in behavior rather than just a short term quick fix. It should be noted, though, that the truly and determinedly gluttonous can still find ways to stuff themselves with calories and "bypass" the lap band. (eg melting down a tub of ice cream and drinking it.) Accordingly, it doesn't work for everyone. There is the same risk of vomiting as is found with stomach stapling if a patient doesn't adapt their meal sizes to their reduced stomach capacity. Still, reports indicate that around 75% of patients experience significant weight loss over a period of eighteen months of the surgery. Some reports claim that Gastric Bypass surgery produces better results than Lap Banding, though the risk differentials are important to note. Lap banding has a risk of complications of around 5 percent, and an almost zero death rate, compared to the much higher 12 percent complications rate and 1.9% death rate within 30 days for Gastric Bypass surgery. Furthermore, in the event of complications or even to "fine tune" the performance, Lap Banding is both adjustable and reversable. Lap Banding is considerably cheaper than Gastric Bypass surgery. The procedure is done via keyhole surgery and takes only about one hour, and the patient is home within two days. LiposuctionLiposuction is increasing in popularity as a cosmetic surgery procedure. It literally involves inserting a tube under the skin and vacuuming out fat cells. Responsible Cosmetic Surgeons caution patients against thinking in terms of liposuction for weight loss purposes. It is generally recommended for body shaping purposes, not for weight loss. Liposuction does nothing to generate or encourage permanent lifestyle, exercise or dietary changes that caused a patient to be overweight in the first place. Predictably, eventually the body will regenerate the removed fat cells and the weight will be regained. In the mean time, it is not possible to evenly extract fat cells from throughout the body. Liposuction is only effective in certain "pockets" of body fat close to the skin surface, and will not remove fat build-up inside the arteries, liver and other organs, and so forth. Research published in the June 2004 issue of the New England Journal of Medicine shows that there are no health benefits to be gained from even large weight losses via liposuction. It produces no benefits in terms of blood pressure, cholesterol or triglyveride levels, insulin sensitivity and so forth. Accordingly, while liposuction may have some legitimate other uses, weight loss is not one of them. Jaw WiringAnother method from times past, though not totally out of favour. It works by restricting food intake. Although weight loss is almost assured, the history of patients shows that they regain the lost weight after the wiring is removed. It does next to nothing to ensure permanent behavioral changes in the patient. Accordingly, it is only a short-term and temporary form of surgical intervention, and that is rarely what a patient either wants or needs. |
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