Bariatric Surgery – Should we go under the knife?

Many people when told by their doctor that its time to lose some weight respond by going on a diet.    But in the majority of cases they find that dieting is too difficult and give up. They start the diet with the best of intentions, but quickly find out that dieting involves eating less food.   That is usually a deal-breaker for most fat people.

So after trying and failing at one diet after another, they look for the easy way out.  A light bulb goes on in their head and the idea of weight loss surgery comes into view.   Its almost too obvious a solution.   Book into the local hospital, get a lap band or gastric bypass operation  performed and Bob’s your uncle … your very fat uncle!

But wait a minute! Is surgery really the answer? What is the downside? What are the risks?

The surgery that deals with weight issues is called Bariatric surgery. It includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach or diversion with a switch or by resecting and re-routing the small intestines to a small stomach pouch.

Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 23% from 40%.

But my personal take on it is that given the risks associated with any surgery, you would have to be bordering on insanity to use a surgical approach to weight loss when there are diets that do work if the dieter is prepared to comply with the dietary restrictions.

For someone who thinks that surgery is the magic bullet to solve their weight problems, check out the following videos of women who had the operation and now have to live with masses of loose skin flopping around.     I recognise that there can be urgent cases where someone is going to drop dead if they don’t shed the weight yesterday, but for all other cases, a bit of short term pain dieting would surely be preferable to resorting to the risks of surgery.


 

Some of the types of Bariatric Surgery are listed below:

Adjustable gastric band

The restriction of the stomach also can be created using a silicone band, which can be adjusted by addition or removal of saline through a port placed just under the skin.

Sleeve gastrectomy

Sleeve gastrectomy, or gastric sleeve, is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach.

Intragastric balloon

Intragastric balloon involves placing a deflated balloon into the stomach, and then filling it to decrease the amount of gastric space. The balloon can be left in the stomach for a maximum of 6 months and results in an average weight loss of 5–9 BMI over half a year

Gastric bypass surgery

A common form of gastric bypass surgery is the Roux-en-Y gastric bypass. Here, a small stomach pouch is created with a stapler device, and connected to the distal small intestine. The upper part of the small intestine is then reattached in a Y-shaped configuration.

How effective is the surgery?

The maximum weight loss occurs in the first 10 months after surgery. More recent studies have demonstrated that the medium (3–8 years) and long term (> 10 years) weight loss results for RYGB and LAGB become very similar.[23] However, the range of excess weight loss for LAGB patients (25% to 80%) is much broader than that of RYGB patients (50% to 70%). Data (beyond 5 years) for sleeve gastrectomy indicates weight loss statistics similar to RYGB.

Several recent studies report decrease in mortality and severity of medical conditions after bariatric surgery but long term effects are not clear. The judges are still out on the effectiveness of this surgery. It seems clear that this surgery is very popular within the medical profession because of the lucrative opportunities it provides for the surgeons.

Adverse effects from weight loss surgery:

  • One study showed 21.9% complications during the initial hospital stay and a total of 40% risk of complications in the subsequent six months.  Problems are more common in those over 40
  • Common problems were gastric dumping syndrome in about 20%. This means that they experience bloating and diarrhea after eating, necessitating small meals or medication
  • Leaks at the surgical site (12%)
  • Incisional hernia (7%)
  • Infections (6%)
  • Pneumonia (4%)
  • Metabolic bone disease manifesting as osteopenia and secondary hyperparathyroidism have been reported after Roux-en-Y gastric bypass surgery due to reduced calcium absorption.
  • Increased risk of fracture has also been linked to bariatric surgery.
  • Rapid weight loss after obesity surgery can contribute to the development of gallstones as well by increasing the lithogenicity of bile.
  • Adverse effects on the kidneys have been studied with hyperoxaluria that can potentially lead to oxalate nephropathy and irreversible renal failure,
  • Rhabdomyolysis leading to acute kidney injury, and impaired renal handling of acid and base has been reported after bypass surgery.
  • Nutritional derangements due to deficiencies of micronutrients like iron, vitamin B12, fat soluble vitamins, thiamine, and folate are especially common after malabsorptive bariatric procedures.
  • Seizures due to hyperinsulinemic hypoglycemia have been reported.

So think very carefully before putting yourself under the surgeons knife. Have you really exhausted ALL other options?

doctor

REFERENCES:

http://en.wikipedia.org/wiki/Bariatric_surgery

http://en.wikipedia.org/wiki/Revision_weight_loss_surgery

http://en.wikipedia.org/wiki/Vertical_banded_gastroplasty_surgery

http://www.sages.org/wiki/laparoscopic-weight-loss-surgery/

http://thebariatricsurgery.wordpress.com/

http://www.dietsinreview.com/diets/Bariatric_Surgery/

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