Tuesday, May 3, 2016

Bariatric Surgery for Severe Obesity

Bariatric Surgery for Severe Obesity

Clinical Trials
Severe obesity is a chronic condition that is hard to treat with diet and exercise alone. Bariatric surgery is an operation on the stomach and/or intestines that helps patients with extreme obesity to lose weight. This surgery is an option for people who cannot lose weight by other means or who suffer from serious health problems related to obesity. The surgery restricts food intake, which promotes weight loss and reduces the risk of type 2 diabetes. Some surgeries also interrupt how food is digested, preventing some calories and nutrients, such as vitamins, from being absorbed. Recent studies suggest that bariatric surgery may even lower death rates for patients with severe obesity. The best results occur when patients follow surgery with healthy eating patterns and regular exercise.

Bariatric Surgery for Adults
Currently, bariatric surgery may be an option for adults with severe obesity. Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity. Clinically severe obesity is a BMI > 40 or a BMI > 35 with a serious health problem linked to obesity. Such health problems could be type 2 diabetes, heart disease, or severe sleep apnea (when breathing stops for short periods during sleep).

Recent Development
The Food and Drug Administration (FDA) has approved use of an adjustable gastric band (or AGB) for patients with BMI > 30 who also have at least one condition linked to obesity, such as heart disease or diabetes.

Who is a good adult candidate for surgery?
Having surgery to produce weight loss is a serious decision. Anyone thinking about having this surgery should know what it involves. Answers to the following questions may help patients decide whether weight-loss surgery is right for them.

Is the patient:

  • Unlikely to lose weight or keep it off over the long term using other methods?
  • Well informed about the surgery and treatment effects?
  • Aware of the risks and benefits of surgery?
  • Ready to lose weight and improve his or her health?
  • Aware of how life may change after the surgery? (For example, patients need to adjust to side effects, such as the need to chew food well and the loss of ability to eat large meals.)
  • Aware of the limits on food choices, and occasional failures?
  • Committed to lifelong healthy eating and physical activity, medical follow-up, and the need to take extra vitamins and minerals?

There is no sure method, including surgery, to produce and maintain weight loss. Some patients who have bariatric surgery may have weight loss that does not meet their goals. Research also suggests that many patients regain some of the lost weight over time. The amount of weight regain may vary by extent of obesity and type of surgery. Habits such as snacking often on foods high in calories or not exercising can affect the amount of weight loss and weight regain. Problems that may occur with the surgery, like a stretched pouch or separated stitches, may also affect the amount of weight loss.

Success is possible. Patients must commit to changing habits and having medical follow-up for the rest of their lives.

Bariatric Surgery for Youth
Rates of obesity among youth are high. Bariatric surgery is sometimes used to treat youth with extreme obesity. Although it is becoming clear that teens can lose weight after bariatric surgery, many questions still exist about the long-term effects on teens' developing bodies and minds.

Who is a good youth candidate for surgery?
Experts in childhood obesity and bariatric surgery suggest that families consider surgery only after youth have tried for at least 6 months to lose weight and have not had success.1 Candidates should meet the following criteria:

Have extreme obesity (BMI > 40)
Be their adult height (usually at age 13 or older for girls and 15 or older for boys)
Have serious health problems linked to weight, such as type 2 diabetes or sleep apnea, that may improve with bariatric surgery
In addition, health care providers should assess potential patients and their parents to see how emotionally prepared they are for the surgery and the lifestyle changes they will need to make. Health care providers should also refer young patients to special youth bariatric surgery centers that focus on meeting the unique needs of youth.

Mounting evidence suggests that bariatric surgery can favorably change both the weight and health of youth with extreme obesity. Over the years' gastric bypass surgery has been the main operation used to treat extreme obesity in youth. An estimated 2,700 youth bariatric surgeries were performed between 1996 and 2003.2 A review of short-term data from the largest inpatient database in the United States suggests that these surgeries are at least as safe for youth as adults. As yet, AGB has not been approved for use in the United States for people younger than age 18. However, favorable weight-loss outcomes after AGB for youth have been reported abroad.

The Normal Digestive Process
Normally, as food moves along the digestive tract, digestive juices and enzymes digest and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold about 3 pints of food at one time. When the stomach contents move to the duodenum (the first part of the small intestine), bile and pancreatic juice speed up digestion. Most of the iron and calcium in the food we eat is absorbed there. The other two parts of the nearly 20 feet of small intestine absorb nearly all of the remaining calories and nutrients. The food particles that cannot be digested in the small intestine reside in the large intestine until eliminated.

How does surgery promote weight loss?
Bariatric surgery restricts food intake, which leads to weight loss. Patients who have bariatric surgery must commit to a lifetime of healthy eating and regular exercise. These healthy habits may help patients maintain weight loss after surgery.

Types of Bariatric Surgery
The type of surgery that may help an adult or youth depends on a number of factors. Patients should discuss with their health care providers what kind of surgery is suitable for them.

What is the difference between open and laparoscopic surgery?
Bariatric surgery may be performed through "open" approaches, which involve cutting the stomach in the standard manner, or by laparoscopy. With the latter approach, surgeons insert complex instruments through 1/2-inch cuts and guide a small camera that sends images to a monitor. Most bariatric surgery today is laparoscopic because it requires a smaller cut, creates less tissue damage, leads to earlier hospital discharges, and has fewer problems, especially hernias occurring after surgery.

However, not all patients are suitable for laparoscopy. Patients who are considered extremely obese, who have had previous stomach surgery, or who have complex medical problems may require the open approach. Complex medical problems may include having severe heart and lung disease or weighing more than 350 pounds.

What are the surgical options?
There are four types of operations that are commonly offered in the United States: AGB, Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with a duodenal switch (BPD-DS), and vertical sleeve gastrectomy (VSG). (See Figure 1.) Each surgery has its own benefits and risks. The patient and provider should work together to select the best option by considering the benefits and risks of each type of surgery. Other factors to consider include the patient's BMI, eating habits, health conditions related to obesity, and previous stomach surgeries.

Adjustable Gastric Band

AGB works mainly by decreasing food intake. Food intake is reduced by placing a small bracelet-like band around the top of the stomach to restrict the size of the opening from the throat to the stomach. The surgeon can then control the size of the opening with a circular balloon inside the band. This balloon can be inflated or deflated with saline solution to meet the needs of the patient.

Roux-en-Y Gastric Bypass

RYGB restricts food intake. RYGB also decreases how food is absorbed. Food intake is limited by a small pouch that is similar in size to the pouch created with AGB. Also, sending food directly from the pouch into the small intestine affects how the digestive tract absorbs food. The food is absorbed differently because the stomach, duodenum, and upper intestine no longer have contact with food.

Biliopancreatic Diversion with a Duodenal Switch

BPD-DS, usually referred to as a "duodenal switch," is a complex bariatric surgery that includes three features. One feature is to remove a large part of the stomach. This step makes patients feel full sooner when eating than they did before surgery. Feeling full sooner encourages patients to eat less. Another feature is re-routing food away from much of the small intestine to limit how the body absorbs food. The third feature changes how bile and other digestive juices affect the body's ability to digest food and absorb calories. This step also helps lead to weight loss.

In removing a large part of the stomach, the surgeon creates a more tubular “gastric sleeve” (also known as a VSG, discussed later). The smaller stomach sleeve remains linked to a very short part of the duodenum, which is then directly linked to a lower part of the small intestine. This surgery leaves a small part of the duodenum available to absorb food and some vitamins and minerals.

However, when the patient eats food, it bypasses most of the duodenum. The distance between the stomach and colon becomes much shorter after this operation, thus limiting how food is absorbed. BPD-DS produces significant weight loss. However, a decrease in the amount of food, vitamins, and minerals absorbed creates chances for long-term problems.

Some of these problems are anemia (lower than normal count for red blood cells) or osteoporosis (loss of bone mass that can make bones brittle).

Vertical Sleeve Gastrectomy

VSG surgery restricts food intake and decreases the amount of food used. Most of the stomach is removed during this surgery, which may decrease ghrelin, a hormone that prompts appetite. Lower amounts of ghrelin may reduce hunger more than other purely restrictive surgeries, such as AGB.

VSG has been performed in the past mainly as the first stage of BPD-DS (discussed earlier) in patients who may be at high risk for problems from more extensive types of surgery. These patients' high risk levels are due to body weight or medical issues. However, more recent research indicates that some patients who have VSG can lose a lot of weight with VSG alone and avoid a second procedure. Researchers do not yet know how many patients who have VSG alone will need a second stage procedure.

What are the side effects of these surgeries?
Some side effects may include bleeding, infection, leaks from the site where the intestines are sewn together, diarrhea, and blood clots in the legs that can move to the lungs and heart.

Examples of side effects that may occur later include nutrients being poorly absorbed, especially in patients who do not take their prescribed vitamins and minerals. In some cases, if patients do not address this problem promptly, diseases may occur along with permanent damage to the nervous system. These diseases include pellagra (caused by lack of vitamin B3—niacin), beri beri (caused by lack of vitamin B1—thiamine) and kwashiorkor (caused by lack of protein).

Other late problems include strictures (narrowing of the sites where the intestine is joined) and hernias (part of an organ bulging through a weak area of muscle).

Two kinds of hernias may occur after a patient has bariatric surgery. An incisional hernia is a weakness that sticks out from the abdominal wall's connective tissue and may cause a blockage in the bowel. An internal hernia occurs when the small bowel is displaced into pockets in the lining of the abdomen. These pockets occur when the intestines are sewn together. Internal hernias are thought to be more dangerous than incisional ones and need prompt attention to avoid serious problems.

Some patients may also require emotional support to help them through the changes in body image and personal relationships that occur after the surgery.

Friday, October 14, 2011

How Does Bariatric Surgery Affect The Digestive Process?

How Does Bariatric Surgery Affect The Digestive Process?(2)

Bariatric Treatment

After Surgery

During both main types of obesity surgery, the size of the stomach is reduced by up to 90 percent, to the size of an egg or even the size of a thumb. Typically, its capacity is 3-4 tablespoons of food. This stomach reduction drastically reduces the quantity of food which can be consumed in one sitting and speeds up satiety. During bypass surgery, the digestive tract below the stomach is also altered. After leaving the small stomach pouch, food is re-routed to bypass most of the duodenum and is directed 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, fewer calories and nutrients are absorbed.

Bariatric Treatment

Saturday, September 24, 2011

Bariatric surgery

Bariatric Surgery

Bariatric Treatment

Bariatric surgery, or weight loss surgery, is a type of procedure performed on people who are dangerously fat (obesity), for the purpose of losing weight. This weight loss is usually achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery).

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%.

The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI 35 and serious coexisting medical conditions such as diabetes. However, research is emerging that suggests bariatric surgery could be appropriate for those with a BMI of 35 to 40 with no comorbidities or a BMI of 30 to 35 with significant comorbidities.

Bariatric Treatment

Does-bariatric-surgery-typically-lead to.....

Wednesday, September 14, 2011

Does Bariatric Surgery Typically Lead to Major Weight Loss?

Does Bariatric Surgery Typically Lead to Major Weight Loss?
Bariatric Treatment
Some patients who undergo bariatric gastrointestinal surgery lose more than 100 pounds in weight - some lose as much as 200 pounds weight. Typically, patients who undergo adjustable gastric banding procedures, such as Lap-Band lose less weight than those who have gastric bypass like Biliopancreatic Diversion (BPD) or Duodenal Switch (BPD-DS). Some patients reach a normal weight, while others remain overweight, although less overweight than before. However, in order to maintain this type of weight reduction, patients must follow carefully the post-operative guidelines relating to diet and exercise.
Bariatric Treatment
is-bariatric-surgery-dangerous ?

Sunday, August 14, 2011

Who Is A Candidate for Bariatric Weight Loss Surgery?

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 because bariatric surgery is a last-gasp treatment solution for obesity, to be used when conventional weight loss programs 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 being overweight 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-pulmonary problems such as severe sleep apnea or obesity-related heart disease.
Bariatric Treatment.

Thursday, July 14, 2011

Is Bariatric Surgery Dangerous?

Is Bariatric Surgery Dangerous?

Yes. Both types of bariatric surgery (gastric banding and gastric bypass) involve major operations lasting one to two hours (longer if performed laparoscopically) and patients typically need three to five nights in hospital. The first night following the operation is usually spent in a high dependency unit or intensive care environment.
(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, compared to 4-6 weeks after open bariatric 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 has less experience, per University of Washington Study.) But in general, bariatric surgeries carry all the possible health risks of any major medical operation.
Bariatric Treatment

Tuesday, June 14, 2011

Do Bariatric Patients Regularly Suffer From Health Complications?

Do Bariatric Patients Regularly Suffer From Health Complications?

Bariatric Treatment
It depends upon patient-condition, the complexity of the specific operation and the skill and experience of the surgeon. Recent research suggests that 4 out of 10 patients suffer complications within six months of surgery.
Of these patients, up to 20 percent required re-hospitalization to treat specific problems 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 emotional problems.
To begin with, the recommended post-operative diet regime requires an immediate and drastic change 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 loose skin. Removal will require cosmetic/plastic surgery. Your surgeon and/or the staff at your obesity clinic will advise you about the specific weight-related health issues you are likely to face.
Bariatric Treatment