Bariatric Surgery for Weight Loss
BARIATRIC (WEIGHT LOSS) SURGERY
WHAT IS IT?
There are several different types of surgeries to help people lose weight. Together, these procedures are known as Bariatric surgery. The goal in each one is the same: to physically reduce the size of the stomach to help limit the volume of food you can eat at one time. To compare: the stomach normally can hold about 3 pints (6 cups) of food. Each of the weight loss surgeries reduces the volume of food to about 1/2 cup or less. With gastric bypass, the new smaller stomach volume is only as large as a walnut!
WHY IT IS DONE:
Surgery to lose weight is an option if you are extremely overweight (morbid obesity), have serious medical risks from being obese, and when diet, exercise and medication approaches have not worked. The surgery is done to help you lose a significant amount of weight – typically 100 pounds or more – which in turn reduces your risk of medically serious or life-threatening medical problems, such as:
- High blood pressure and/or stroke
- Heart disease and heart attacks
- Severe sleep apnea that can cause medical complications and even sudden death
- Type 2 Diabetes Mellitus
- GERD, or gastroesopheageal reflux disease, that in turn can cause lung damage
WHAT ARE THE TYPES OF WEIGHT LOSS SURGERY?
During your consultation with the bariatric surgeon, your physician will evaluate you individually, and recommend the procedure that is best for your situation, taking into account your BMI, your eating habits, any other medical conditions you have, previous surgeries and your responses, as well as the risks for each procedure, your personal preferences, and your budget.
These are the four most common surgeries for weight loss:
Roux-en-Y Gastric Bypass:
This is the earliest method devised, and it is still the most commonly used procedure to reduce the size of the stomach and limit the amount of food you can eat at one time. It may be done as an open abdominal surgery (more invasive, longer recovery) or as a laparoscopic minimally invasive procedure with “keyhole” incisions and more rapid recovery.
In simple terms, the surgeon makes a small pouch at the top of stomach, closes it off from the rest, and connects the pouch to the small intestine. You cannot eat a large quantity of food so this helps weight loss by reducing the amount of calories you are able to eat. When you eat, the food bypasses most of the stomach and first part of the small intestine to enter GI tract at the middle part of small intestine.
Laparoscopic Adjustable Gastric Banding (LAGB). Also called “Lap-band” surgery): This minimally invasive method uses “keyhole” incisions for the surgeon to insert an inflatable band around the upper part of the stomach, making only a small pouch at the top of the stomach to hold food. The surgeon can adjust the band from outside the body, similar to the way you tighten your belt, as a way to control food intake based on the size of the pouch. The smaller the pouch, the less you eat before feeling “full” – which helps you lose weight.
Sleeve Gastrectomy (“Gastric sleeve”), also called vertical sleeve gastrectomy: This is a newer approach in which the stomach is surgically reshaped to form a tube smaller than the normal stomach volume. The smaller size tube makes you eat less, which means fewer calories, allowing you to lose weight. Studies have shown that this simpler procedure if usually enough for sufficient weight loss, without the risks and complications of the older, more complex procedure from which it is derived.
Vertical banded Gastroplasty: (“Stomach stapling”): In this method, the surgeon uses surgical staples to divide the stomach into two parts to reduce the amount you can eat at once. Stapling is not used as much now, because it is not as effective for long term results on weight loss.
WHAT TO EXPECT:
All of the weight loss surgeries are major surgeries that may take several hours. The surgeries are done in the hospital under general anesthesia so that you are unconscious during the procedure. You are then taken to a recovery room for several hours so that the medical staff can observe you for any complications or reactions to the medications. Your length of stay in hospital after surgery will depend primarily on the type of procedure you have and your overall health. Patients having an open abdominal gastric bypass may need 5-6 days in hospital, while those having the same procedure laparoscopically may only need to stay in hospital 24-36 hours.
Following surgery, typically you are not allowed to eat for a day or two so that the incisions in the stomach and intestinal tract can heal. Then the diet is liquids only, followed by ground or soft foods before being able to eat regular food in small portions. You will be given very specific instructions on what and how much you can eat, and will need frequent monitoring of various blood tests to check your metabolic and nutritional status to reduce the risk of vitamin and other deficiencies.
ARE YOU A CANDIDATE?
There are many medical and health risks that can be helped with weight loss surgery for those who are morbidly obese. Each hospital and surgeon will have criteria for the patients they accept. In the United States, in general, gastric bypass and other weight loss surgeries are reasonable to consider if you meet one of these criteria:
- Body Mass Index (BMI): greater than 40 (extreme obesity)
- BMI less than 40 if you also have serious medical risk(s): You may qualify for certain types of bariatric surgery for weight loss at lower BMI levels IF you also have one of the following: Type 2 Diabetes, hypertension, extreme sleep apnea, or other clear weight-related medical problems.
There are other criteria that are often required, such smoking cessation, meeting medical guidelines to reduce risks for major surgery, willingness to make major lifestyle changes in diet and exercise, commitment to participate in long term monitoring and medical followup.
WHAT BENEFITS CAN I EXPECT?
Many patients experience significant weight loss, improved blood sugar regulation, improved exercise tolerance, improved sleep, and overall better quality of life. For maximum and long term benefit, however, patients need to commit to healthy changes in behavior and a regular exercise program to maintain long term success. For that reason, our Med Expert Chile team recommends including both psychological and physical therapy sessions combined with surgery to develop you make the lifestyle changes that will improve your success with weight loss and help you keep the weight off for many healthy years ahead.
WHAT ARE THE POSSIBLE RISKS?
All forms of bariatric surgery for weight loss are major surgeries that can have serious risks and side effects, including nutritional deficiencies if not managed properly. Your risks of developing complications during surgery depends on several key factors: your general health before surgery, your BMI, your medical conditions, the skill of the surgeon and surgical team, the quality of the hospital facility.
Any major surgery has potential general risks that we do our best to minimize by carefully evaluating all our patients with medical and surgical review and consultation before you ever leave home to do our best to be sure that:
- you meet the appropriate criteria for the procedure,
- you are medically stable to travel and undergo surgery,
- you are mentally prepared and feel comfortable with your surgeon,
- your surgeon has the right training and experience to meet your needs,
- the hospital has all the facilities and equipment to properly carry out the surgery recommended.
Med Expert Chile will help has selected the leading JCI-accredited hospitals and top specialists as the resources for our patients for such high complexity surgeries and recommends hospitals known for meticulous attention to reducing risks of infection and complications during surgeries.
General risks of any major surgery can include, but not limited to, infection, excessive bleeding or blood clots, adverse reactions to anesthesia, inadvertent damage to other tissues surrounding the surgical site, or in very rare cases, disability or death. Specific risks known to be possible for your particular procedure will be discussed ahead of time by your surgeon.
We do everything possible to reduce these risks and help you feel comfortable and prepared to go forward with surgery.
WHAT DOES IT COST?
We do not sell “Off-the-shelf” surgeries at a fixed cost. We determine the right procedure for each person after our medical-surgical consultation to discuss your best options. A precise cost estimate can only be given after our Medical Director and Surgeons have completely evaluated your specific case and your medical needs and discussed all this with you.