Weight Loss Surgery What Are The Options

To understand how surgical procedures aid the​ grossly overweight person to​ reduce their body fat,​ it​ helps to​ first understand the​ digestive process that is​ responsible for handling the​ food we​ take in.

Once food is​ chewed and swallowed,​ it’s on​ its way through the​ digestive tract,​ where enzymes and digestive juices will break it​ down and allow our systems to​ absorb the​ nutrients and calories. in​ the​ stomach,​ which can hold up to​ three pints of​ material,​ the​ breakdown continues with the​ help of​ strong acids. From there it​ moves into the​ duodenum,​ and the​ digestive process speeds up through the​ addition of​ bile and pancreatic juices. It’s here,​ that our body absorbs the​ majority of​ iron and calcium in​ the​ foods we​ eat. the​ final part of​ the​ digestive process takes place in​ the​ 20 feet of​ small intestine,​ the​ jejunum and the​ ileum,​ where calorie and nutrient absorption is​ completed,​ and any unused particles of​ food are then shunted into the​ large intestine for elimination.

Weight loss procedures involve bypassing,​ or​ in​ some way circumventing the​ full digestive process. They range from simple reduction of​ the​ amount you can eat,​ to​ major bypasses in​ the​ digestive tract. to​ qualify for many of​ these surgeries,​ a​ person must be termed “morbidly obese”,​ that is,​ weighing at​ least 100 lbs. over the​ appropriate weight for their height and general body structure.

Gastric Bypass

In the​ mid 1960s,​ Dr. Edward E. Mason discovered that women who had undergone partial stomach removal as​ the​ result of​ peptic ulcers,​ failed to​ gain weight afterwards. From this observation,​ grew the​ trial use of​ stapling across the​ top of​ the​ stomach,​ to​ reduce its actual capacity to​ about three tablespoons. the​ stomach filled quickly,​ and eventually emptied into the​ lower portion,​ completing the​ digestive process in​ the​ normal way. Over the​ years,​ the​ surgery evolved into what is​ now known as​ the​ Roux-en-y Gastric Bypass. Instead of​ partitioning the​ stomach,​ it​ is​ divided and separated from the​ rest,​ with staples. the​ small intestine is​ then cut at​ approximately 18” below the​ stomach,​ and attached to​ the​ “new”,​ small stomach. Smaller meals are then eaten,​ and the​ digested food moves directly into the​ lower part of​ the​ bowel. as​ weight loss surgeries are viewed overall,​ this is​ considered one of​ the​ safest,​ offering long-term management of​ obesity.

Gastric Banding

A procedure that produces basically the​ same results as​ the​ stomach stapling/bypass,​ and is​ also classed as​ a​ “restrictive” surgery. the​ first operations,​ involved a​ non-flexing band placed around the​ upper part of​ the​ stomach,​ below the​ esophagus,​ creating an​ hourglass shaped stomach,​ the​ upper portion being reduced to​ the​ same 3-6 ounce capacity. as​ technologies advanced,​ the​ band became more flexible,​ incorporating an​ inflatable balloon,​ which when triggered by a​ reservoir placed in​ the​ abdomen,​ was capable of​ inflating to​ cut down the​ size of​ the​ stoma,​ or​ deflating to​ enlarge it. Laparoscopic surgery means smaller scars,​ and less invasion of​ the​ digestive tract.

Biliopancreatic Diversion

A combination of​ the​ gastric bypass,​ and Roux-en-y re-structuring,​ that bypasses a​ significant section of​ the​ small intestine,​ thereby creating the​ probability of​ malabsorption. the​ stomach is​ reduced in​ size,​ and an​ extended Roux-en-y anastomosis is​ attached to​ the​ smaller stomach,​ and lower down on​ the​ small intestine than is​ normal. This permits the​ patient to​ eat larger amounts,​ but still achieve weight loss through malabsorption. Professor Nicola Scopinaro,​ University of​ Genoa,​ Italy,​ developed the​ technique,​ and last year published the​ first long-term results. They showed an​ average 72% loss of​ excess body weight,​ maintained over 18 years,​ the​ best long-term results of​ any bariatric surgical procedure,​ to​ date. BPD patients require lifelong follow-ups to​ monitor calcium and vitamin intake. the​ advantages of​ being able to​ eat more and still lose weight,​ are countered by loose or​ foul smelling stools,​ flatus,​ stomal ulcers,​ and possible protein malnutrition.

Jejuno-Ileal Bypass

One of​ the​ first weight loss procedures for the​ grossly obese,​ was developed in​ the​ 1960s,​ a​ strictly malabsorptive method of​ reducing weight,​ and preventing gain. the​ jejuno-ileal bypass reduced the​ lower digestive tract to​ a​ mere 18” of​ small intestine,​ from the​ natural 20 feet,​ a​ critical difference when it​ came to​ absorption of​ calories and nutrients. in​ the​ end-to-end method,​ the​ upper intestine was severed below the​ stomach,​ and re-attached to​ the​ small intestine much lower down,​ which had also been severed,​ thereby “cutting out”,​ the​ majority of​ the​ intestine. Malabsorption of​ carbohydrate,​ protein,​ lipids,​ minerals and vitamins,​ led to​ a​ variation,​ the​ end-to-side bypass,​ which took the​ end of​ the​ upper portion,​ and attached it​ to​ the​ side of​ the​ lower portion,​ without severing at​ that point. Reflux of​ bowel contents into the​ non-functioning upper portion of​ small bowel,​ resulted in​ more absorption of​ essential nutrients,​ but also less weight loss,​ and increased weight gain,​ post-surgery. as​ a​ result of​ the​ bypass,​ fatty acids are dumped in​ the​ colon,​ producing an​ irritation that causes water and electrolytes to​ flood the​ bowel,​ ending in​ chronic diarrhea. the​ bile salt pool necessary to​ keeping cholesterol in​ solution is​ reduced by malabsorption and loss through stool. as​ a​ consequence,​ cholesterol concentration in​ the​ gall bladder rises,​ increasing the​ risk of​ stones. Multiple vitamin losses are a​ major concern,​ and may result in​ bone thinning,​ pain and fractures. Approximately one third of​ patients experience an​ adjustment in​ the​ size and thickness of​ the​ remaining active small intestine,​ which increases the​ absorption of​ nutrients,​ and balances out the​ weight loss. However,​ over the​ long term,​ all patients undergoing this bypass are susceptible to​ hepatic cirrhosis. in​ the​ early 1980s,​ one study showed that approximately 20% of​ those who had undergone JIB,​ required conversion to​ another bypass alternative. the​ procedure has since been largely abandoned,​ as​ having too many risk factors.

While surgical methods of​ reducing weight are valuable to​ the​ morbidly obese,​ they are not without risks. Patients may require more bed rest post-surgery,​ resulting in​ an​ increased chance of​ blood clots. Pain may also cause reduced depth of​ breathing,​ and complications such as​ pneumonia.

Before undergoing any fat/weight reduction surgery,​ a​ severely overweight person needs to​ thoroughly understand the​ benefits and risks,​ and must make a​ commitment to​ their future health. Having a​ smaller stomach is​ not going to​ stop the​ chronic sugar-snacker,​ from “grazing” on​ high calorie sweets. Nor does a​ steady supply of​ pop,​ concentrated sweet juices and milk shakes,​ reduce the​ calorie intake. With some bypass surgeries,​ certain foods can aggravate side-effects that need not be that severe,​ if​ common sense diets are adhered to. Surgery can be a​ “shortcut” to​ weight loss,​ but it​ can also reduce your enjoyment of​ life,​ if​ you are unable to​ adhere to​ the​ regimens that go with it.

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