Surgical Options For The Treatment Of Obesity And How They Work

Although there have been many procedures described for the treatment of obesity including wiring the jaws shut, implanting a pacemaker onto the stomach wall, and partitioning the stomach into compartments, only a handful of procedures have become accepted by the medical community at large and placed into widespread practice by bariatric surgeons (those who specialize in the surgical treatment of obesity). This article offers a brief description of the two most commonly performed procedures, the Roux-en-Y gastric bypass and the adjustable gastric band, as well as an explanation as to how they work. Both of the procedures are generally performed laparoscopically meaning through several tiny incisions using long instruments and a camera. The laparoscopic approach has shown to be as effective as “open” operations (through a single large incision) but with much less pain and a faster recovery.

The Roux-en-Y Gastric Bypass (RYGB) is the most commonly performed operation for obesity and due to its consistent and excellent outcomes as well as its long track record, is the procedure of choice of most bariatric surgeons in the United States. First performed in 1966, the procedure has undergone several modifications but has been largely unchanged over the last 15 years. This operation entails dividing the gut in two places: a small stomach pouch is created from the remainder of the stomach and the small intestine is divided near its beginning. Two connections are made to reconstitute the food stream such that most of the stomach and the first portion of the small intestine is bypassed. The RYGB works by allowing people to get full on a much smaller portion size and remain full for long periods of time. Because the gastric pouch empties directly into the small intestine, there is a potential for the “dumping syndrome” which provides a strong negative feedback for eating sweet, calorie-dense food or drinks and forces patients to eat healthier. There is a profound metabolic benefit from this surgery that leads to rapid improvement and often resolution of many diseases including diabetes, high cholesterol, hypertension, infertility among many others. Patients tend to achieve a weight loss of 65 to 75% of their excess weight by 12 to 18 months and 80% of patients achieve long-term success.

The Adjustable Gastric Band (AGB) also known as the “Lap Band?” and “Realize Band?”, is an adjustable device composed of an inflatable silastic band placed around the top of the stomach connected by tubing to a “port” or drum implanted under the skin. The operation is generally performed as an outpatient procedure with minimal risk but the weight loss comes from the mandatory periodic adjustments conducted in the office. The adjustments entail placing a needle through the skin into the port and injection of fluid causes the band to tighten while removing fluid loosens the band. The band works by causing satiety, or a sense of fullness, when the band is inflated to the optimal amount. Patients with an optimally-inflated band have a pleasant, comfortable full feeling with appetite suppression for long periods of time. When the band is too loose, they are hungry and searching for food and not losing weight. The band requires periodic adjustments to reach that optimal zone and keep it there since fluid can diffuse slowly through the band. Weight loss comes from appetite suppression and portion control only when the band is optimally filled. Since there is no dumping syndrome to serve as a negative feedback following consumption of sweet calorie-dense foods and liquids, the LAGB requires more discipline for a successful result and, when groups of patients are compared, patients with the LAGB do not lose as much weight or fare as well in outcomes of obesity-related medical conditions.

By: Vera Jones

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Daniel E. Swartz is author of this article on Bariatric Surgery. Find more information about Fresno here.