Bariatric Surgery Guide

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Bariatric Surgery Guide

Introduction to Bariatric Weight Loss Surgery

Bariatric surgery is a term derived from the Greek words:

weight

and

treatment

. In simple terms,bariatrics concerns the causes, prevention and treatment of severe overweight, a condition known asobesity. Bariatric operations are major gastrointestinal procedures which alter the capacity and/or theanatomy of thedigestive system. Some bariatric procedures are performed using general anesthesia via amidline abdominal incision. Some bariatric surgeons also use laparoscopic surgical techniques, involvingsmaller instruments connected to cameras through which they view the operational site. The two types of bariatric surgeries are (1) restrictive - likeLap Band®, and (2) combined restrictive and malabsorptive -such asRoux-en-Y gastric bypass. The first type of surgical procedure simply reduces the size of thestomach, using staples and/or a band, resulting in a drastic reduction in the quantity of food it can ingest.The second reduces stomach capacity

and

bypasses the upper part of the small intestine, causing areduction in the number of calories

and

nutrients which the body absorbs.Stomach bypass operations differ in both how the stomach is sectioned (stapling, banding or gastrectomy), and how much of theduodenum and jejunum are bypassed. Currently, most obesity clinics and bariatric centers favor the LapBand adjustable gastric banding procedure and the Proximal Roux-en-Y Gastric Bypass. Obesity expertsestimate that patients undergoing gastric bypass and gastric bands will exceed 175,000 in 2007.

How Does Bariatric Surgery Affect The Digestive Process?

Before Surgery

Food is chewed in the mouth, then swallowed, passing through the esophagus to the stomach, (roughlythe size of a melon) where stomach acids dissolve it into smaller particles. The liquid (chyme) then passesinto the small intestine where enzymes and bile continue the digestive process. The first section is the

duodenum

, the shortest section. Here, calcium, iron and a few vitamins are absorbed. The second andthird sections are the

jejunum

and

ileum

, both about ten feet in length. Here, the bulk of food nutrients(vitamins and minerals) and calories are absorbed.

After Surgery

During both main types of obesity surgery, the size of the stomach is reduced by up to 90 percent, to thesize of an egg or even the size of a thumb. Typically, its capacity is 3-4 tablespoons of food.

Thisstomach reduction drastically reduces the quantity of food which can be consumed in onesitting and speeds up satiety

. During bypass surgery, the digestive tract below the stomach is alsoaltered. After leaving the small stomach pouch, food is re-routed to bypass most of the

duodenum

and isdirected into the final part of the

jejunum

. Because

the food passes along a much reduced length of small intestine, and comes into contact with smaller amounts of digestive enzymes

, fewercalories and nutrients are absorbed.

Is Bariatric Surgery An Easy Solution for Weight Loss?

No. According to the American Society For Bariatric Surgery, gastric reduction surgery is not an easy

option for obesity sufferers. It is a drastic step, and carries the usual pain and risks of any majorgastrointestinal surgical operation.

Does Bariatric Surgery Involve New Eating Habits?

Yes. Alltypes of gastrointestinal obesity surgerycompel patients to change their eating habits radically,and make them very ill if they overeat. And after bariatric surgery is performed, patients remain at alifelong risk of nutritional deficiencies.

Does Bariatric Surgery Typically Lead to Major Weight Loss?

Yes and No. Some patients who undergo bariatric gastrointestinal surgery lose more than 100 pounds inweight - some lose as much as 200 pounds weight. Typically, patients who undergo adjustable gastricbanding procedures, such as Lap-Band lose less weight than those who have gastric bypass likeBiliopancreatic Diversion (BPD)orDuodenal Switch (BPD-DS). Some patients reach a normal weight, while others remain overweight, although less overweight than before. However, in order to

maintain

this typeof weight reduction, patients must follow carefully the post-operative guidelines relating to diet andexercise.

Who Is A Candidate for Bariatric Weight Loss Surgery?

Some bariatric surgeons accept patients in their 60's, and some even operate on teenagers. But becausebariatric surgery is a last-gasp treatment solution for obesity, to be used when conventional weight lossprograms have been tried and failed, candidates must have severe obesity-related health problems.

•

Typically, to qualify for bariatric surgery you must be 'morbidly obese', which usually means beingoverweight by 100 pounds (man) or 80 pounds (woman) with a Body Mass Index (BMI) of 40+.

•

Alternatively, bariatric surgery may be appropriate if you are 80 pounds overweight (BMI 35+)

and

have a serious obesity-related condition like type 2 diabetes or life-threatening cardio-pulmonaryproblems such as severe sleep apnea or obesity-related heart disease.

Is Hospitalization Necessary Before Undergoing Bariatric Surgery?

Not usually, although patients with extremely severe obesity (End Stage obesity syndrome) may need tobe hospitalized before undergoing weight loss surgery in order to lower the health risks of surgery.

Is Obesity Surgery Dangerous?

Yes. Both types of bariatric surgery (gastric banding and gastric bypass) involve major operations lastingone to two hours (longer if performed laparoscopically) and patients typically need three to five nights inhospital. The first night following the operation is usually spent in a high dependency unit or intensive careenvironment. (Note: After laparoscopic bariatric surgery, patients typically remain in hospital for 2-3 days,rather than the 4-5 days after open surgery. Patients typically return to work after 2-3 weeks, comparedto 4-6 weeks after open surgery.) The level of health risk varies according to patient condition, type of procedure and the experience of the surgeon. (Patients are five times more likely to die if the surgeon hasless experience, per University of Washington Study.) But in general, bariatric surgeries carry all thepossible health risks of any major medical operation.

Do Bariatric Patients Regularly Suffer From Health Complications?

Typically, it depends upon patient-condition, the complexity of the specific operation and the skill andexperience of the surgeon. Recent research suggests that 4 out of 10 patients suffer complications withinsix months of surgery. Of these patients, up to 20 percent required re-hospitalization to treat specificproblems relating to their stomach bypass or gastric banding procedure. As well as perioperative and post-operative health problems, patients should expect to face a number of longer term physical and emotionalproblems. To begin with, the recommended post-operative diet regime requires an immediate and drasticchange of eating habits. Gastric bypass also necessitates nutritional supplementation for life. Secondly,after losing a significant amount of weight, patients typically experience a distressing amount of looseskin. Removal will require cosmetic/plastic surgery. Your surgeon and/or the staff at your obesity clinic willadvise you about the specific weight-related health issues you are likely to face.

Are The Health Risks Of Bariatric Surgery Greater Than The Risks Of Obesity?

For most patients suffering from morbid obesity (BMI 40+), super-obesity (50+) or end stage obesitysyndrome (BMI 60+), the big question is, do the benefits of bariatric surgery outweigh its risks? Theanswer is Yes. Severe obesity is a chronic, frequently progressive, life threatening disease, and the knownhealth risks associated with morbid obesity far outweigh the risks associated with surgery. Publishedstudies indicate that someone who is 100 percent above his/her ideal weight has a risk of mortality tentimes higher that of a person of normal weight. By comparison, the mortality rate for bothvertical bandedgastroplasty,adjustable gastric bandingand roux-en-y gastric bypass is less than one percent. Morbidity (ie. rate of disease) in the immediate post-operative period is roughly ten percent or more, although thecombined risk of the most serious complications is less than three percent. In the later postoperativeperiod, other health complications can and do arise, and may require corrective surgical treatment. Also,some patients are unable to comply with post-operative eating and exercise guidelines over the long term.But in general the overriding health benefit of bariatric treatment is now well established.

How Important Is Patient Attitude For The Success Of Bariatric Surgery?

Very important! The higher the motivation of patients to lose weight and manage the post-operativerequirements of dietary modification and behavioral therapy, the more successful surgery is likely to be, insolving their obesity and weight problems. The pre-op screening process adopted by obesity clinics toidentify good candidates for bariatric surgery, is strongly influenced by patient attitude.

What Is The Cost of Bariatric Weight Loss Surgery?

Bariatric gastrointestinal surgical operations cost about $25,000 or more, depending on the experience of the surgeon, the medical team, the surgical procedure and the level of post-op services chosen.

Is Bariatric Surgery Covered By Health Insurance?

Health insurers are slowly beginning to accept that obesity surgery can deliver powerful medical benefitsthat will save them money in the long run, especially where convention weight loss remedies haveconsistently failed to reduce obesity. Therefore in several states, obesity surgeries like gastric bypass andlap band are covered by most medical insurance plans. However, patients may need to work closely withtheir surgeon or clinic to submit the necessary forms to the health insurance company in order to receiveauthorization for weight loss surgery. This includes a Letter of Medical Necessity which typically (a)Patient's weight (BMI 40+ or 35+ with health complications), (b) List of obesity-related medical symptoms(eg. type 2 diabetes, sleep apnea, raised blood pressure, high blood fats, insulin problems), (c) How longpatient has been overweight (at least five years), (d) History of failed weight-loss programs, with details of type of program, whether or not medically supervised, amount of weight lost.

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