Benefits of Weight Loss

Weight loss surgery is a serious surgery. Its growing use to treat morbid obesity is the result of three factors:

• Our current knowledge of the significant health risks of morbid obesity
• The relatively low risk and complications of the procedures versus not having the surgery
• The ineffectiveness of current non-surgical approaches to produce sustained weight loss (Diet, exercise and behavior modifications result in less than 10 percent long-term weight loss versus 60-80 percent excess weight loss with surgery)

Surgery should be viewed first and foremost as a method for alleviating this debilitating, chronic disease. In most cases, the minimum qualification for consideration as a candidate for the procedure is 100 lbs. above ideal body weight or those with a Body Mass Index of 40 or greater. Plus, patients must demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of their lives after having weight loss surgery.

However, the benefits of the surgery are striking and undeniable.

• An improvement of obesity-related conditions

Obesity-Related Health Conditions	Resolved/Cured (%) after surgery	Improved (%) after surgery
High Blood Pressure	92%	100%
Diabetes	95%	100%
Sleep Apnea Syndrome	98%	100%
Gastroesophageal Reflux	98%	100%
Urinary Stress Incontinence	97%	100%
Degenerative Arthritis	90%	100%
High Cholesterol	70%	85%
*Wittgrove AC and Clark GW. "Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3-60 month follow-up". Obesity Surgery. 2000;10:233. Pories WJ et al. Ann. Surg. 1995;222: 339."

• Improvements in quality of life
• Effectively maintaining long term weight loss

Laparoscopic Surgery (Minimally Invasive)

For the last decade, laparoscopic procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still "experimental." In fact, laparoscopy has become the predominant technique in some areas of surgery and has been used for weight loss surgery for several years.

When a laparoscopic operation is performed, a small video camera is inserted into the abdomen. The surgeon views the procedure on a separate video monitor. The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. A recent study shows that patients who had laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and lung function and higher overall oxygen levels. Additional benefits of laparoscopy are shorter hospital stay and fewer wound complications such as infection, scarring, or hernia; patients return more quickly to pre-surgical levels of activity. (Ref. 1)

Laparoscopic procedures for weight loss surgery employ the same principles as their "open" counterparts and produce similar excess weight loss. The American Society for Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.

1) Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM. Laparoscopic vs. Open Roux-en-Y Gastric Bypass: A Randomized Study of Outcomes, Quality of Life, and Costs. Ann Surg 2001; 234:279-291.

Open vs. Laparoscopic


Choosing a Surgical Procedure

While most patients enjoy an improvement in obesity-related health conditions (such as mobility, self- image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer.

That is why you should make the decision to have weight loss surgery only after careful consideration and consultation with a qualified weight loss surgeon who can answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. As part of routine evaluation for weight loss surgery, a nutritional and psychological consult are required. This is to help establish a clear understanding of the post- operative changes in behavior that are essential for long-term success.

It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. There can be unexpected outcomes in even the simplest procedures. What can be said, however, is that weight loss surgery will only succeed when the patient makes a lifelong commitment. Some of the challenges facing a person after weight loss surgery can be unexpected. Lifestyle changes can strain relationships within families and between married couples. To help patients achieve their goals and deal with the changes surgery and weight loss can bring, our multi-disciplinary team offers follow-up care that includes support groups, nutritionists, psychologists and other forms of continuing education.

Ultimately, the decision to have the procedure is entirely up to you. After reviewing all the information, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.

Laparoscopic Gastric Band (LAP-BAND™)

Laparoscopic gastric band (LAP-BAND™) is a restrictive procedure, it works by reducing the amount of food consumed at one time, yet doesn't interfere with the normal absorption of food. The surgeon places an adjustable, hollow band around the upper part of your stomach. The band divides the stomach into two sections, a small upper pouch and a larger lower section. The band is then connected by a tube to a reservoir placed beneath your skin during surgery. After surgery, the size of the opening between the upper stomach pouch and the rest of the stomach is narrowed by injecting saline into the reservoir via a fine needle through the skin causing the inner part of the band to expand. As the opening that divides the two stomach sections becomes narrower with subsequent adjustments, food stays longer in the upper stomach pouch and one feels full for a longer period of time.

Advantages of LAP BAND™

• The primary advantage of this restrictive procedure is that it reduces the amount of food consumed at one time, yet doesn't interfere with the normal absorption of nutrients and vitamins. Studies show that patients can maintain 55%-65% of targeted excess weight loss even five years after surgery.
• It is the least invasive surgery since there is no stomach stapling or cutting, or intestinal rerouting; there is no risk of intestinal leak or dumping.
• Serious health risks are significantly improved or cured.
• The surgery is reversible and the band can be removed.
• The band can be adjusted in the office without requiring further surgery.
• Surgery takes approximately one hour to perform and hospital stay is one to two days.

Disadvantages of LAP BAND™

• Regular follow up is critical for optimal weight loss. The band needs to be adjusted approximately 3-5 times in the first year to obtain the desired long term weight loss, therefore patients need to be committed to regular follow up with the same surgeon for the first few years.
• Patients who are sweet eaters (high calorie shakes, chocolate or soda) will have a more difficult time losing weight with this procedure.
• Other risks of surgery include slippage, erosion into the stomach or port/tube problems that may require another operation to correct.

Laparoscopic Gastric Bypass

This procedure combines the restrictive aspect of Lap-BandTM with a malabsorptive component. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The connection or outlet from this newly formed pouch empties directly into the lower portion of the intestine (jejunum), thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the first part of the intestine (duodenum) and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Advantages of Gastric Bypass

• According to the American Society for Bariatric Surgery and the National Institutes of Health, the Roux- en-Y gastric bypass is one of the most frequently performed weight loss procedures in the United States.
• Studies show that patients can maintain 65%-80% of targeted excess weight loss even at ten years after surgery.
• Serious health risks are significantly improved or cured.
• Surgery takes approximately two-three hour to perform and the hospital stay is two to three days.

Disadvantages of Gastric Bypass

• Bypassing a segment of small intestine results in poor absorption of iron, calcium and certain vitamins.
• To prevent nutritional deficiencies, patients will need to take daily vitamins including calcium, iron, multivitamins and protein supplements for the rest of their lives.
• A condition known as "dumping syndrome" can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. For most patients, this syndrome is short lived.
• The surgery is irreversible.