Bariatric Surgery

Bariatric surgery or weight loss surgery is one solution to obesity. This approach recognizes the limitations of diets and traditional weight loss programs. While the early use of bariatric surgery in the United States dates back to the 1950s, at that time, the surgery often resulted in complications. The procedure became more common in the 1970s with the development of gastroplastry (stomach stapling). Complications of this procedure also became known as it was used more frequently, and it was replaced by gastric bypass procedures and banding procedures as the two most common types of weight loss surgery today. Laparoscopic adjustable gastric banding (LAGB) is the most commonly used surgical procedure to treat morbid obesity in Europe, Australia, and South America

To undergo this surgery, the patient must be substantially overweight, often defined by a prospective patient's body mass index (BMI), a measure that takes into account both height and weight. The BMI must [Page 129]be above 40 for the surgery to be recommended if the patient does not have serious medical conditions that would be helped by the surgery. If the BMI of the patient is between 35 and 39 with associated severe medical problems such as diabetes, hypertension, or high cholesterol, surgery is also appropriate. Many health insurance plans also require proof of failed prior attempts at other weight loss approaches before they will pay for the surgery.

Bypass procedures are designed to reduce food intake and are complex procedures generally performed under general anesthesia. There are two main types practiced today: Roux-en-Y-gastric bypass (traditional and laparoscopic) and biliopancreatic diversion bypass. Roux-en-Y is the more commonly performed procedure, with around 140,000 procedures completed in the United States in 2005. In both techniques, a small stomach pouch is created to curb food intake, by closing off a portion of the stomach. A part of the small intestine is attached to the stomach pouch so that food can bypass the duodenum. Most patients spend two to three days in the hospital for the main surgical procedure, and one to two for the laparoscopic procedure. Both bypass procedures restrict food intake and reduce hunger to promote healthy weight loss. Generally, two to five weeks of recovery are required. Most weight loss occurs within the first year.

Gastric banding is a newer procedure and promotes weight loss through restriction in food uptake. A small silicone band filled with saline solution is placed around the upper portion of the stomach pouch, and stapled into place, reducing the capacity of the stomach. Surgery generally takes only an hour, and often requires either no hospital stay or a single night. Recovery is short, and often as little as a week of restriction from normal activies is required, with minimal discomfort from the surgery itself. As the band and stomach adjust, refills of saline solution become necessary for the band to maintain its effectiveness, resulting in frequent doctor office visits. While this procedure generally has a faster recovery time and is less expensive, it does not lead to the most rapid weight loss of the procedures, and is generally more successful in patients who have less weight to lose to obtain an ideal weight (such as 50 pounds), whereas gastric bypass surgery is more successful in patients who need to lose 100 pounds or more.

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