Obesity is a chronic condition in which there is an excessive accumulation of fat in the body. Obesity is defined as a Body Mass Index (BMI) of 30 to 34.9 and extreme or morbid obesity is a BMI of 40 or more. Obesity is a global problem affecting people of almost all age groups, and is associated with increased risk of cardiac problems, diabetes, high blood pressure, breathing difficulties, and other diseases.
Bariatric surgeons first began to recognise the potential for surgical weight loss while performing operations that required the removal of large segments of a patient’s stomach and intestine. After the surgery, doctors noticed that in many cases patients were unable to maintain their pre-surgical weight. With further study, bariatric surgeons were able to recommend similar modifications that could be safely used to produce weight loss in morbidly obese patients. Over the last decade these procedures have been continually refined in order to improve results and minimize risks. Today’s bariatric surgeons have access to a substantial body of clinical data to help them determine which weight loss surgery should be used and why. Today, there are two basic approaches that weight loss surgery takes to achieve change:
- Restrictive procedures that decrease food intake. This includes gastric banding and sleeve gastrectomy.
- Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool. This can also incorporate an element of restriction. Gastric bypass – roux en Y; and mini bypass are examples of these type of procedures. There are moe complex procedures including duodenal switch procedures etc.
Gastric Banding and Sleeve Gastrectomy: Not only limits how much can be eaten at one time, but also decreases hunger between meals by sending signals to the brain that tell it you are satisfied. Gastric banding now is considered not entirely appropriate for weight loss given its high rate of failure : band erosions/slippages and required subsequent removal.
There are a number of different procedures – that may need to be considered.
- lap band
- sleeve gastrectomy
- Gastric bypass surgery – roux loop/minibypass – omega loop – single anastomosis
- endoscopic surgery – gastroplasty; gastric balloon.
Risks with surgery are both categorised into general and specific risks. there are risks associated with the short term and also the long term. These include:
- leak – from staple line/joins.
- vitamin/mineral deficiency
- bowel obstruction/internal hernias
- weight regain
These risks can be associated with readmission/prolonged stay in hospital and mortality (death) – 0.5-1%.