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Understanding Gastric Surgery

Posted Aug 24 2008 1:49pm

ANNOUNCER: Obesity is reaching epidemic proportions in the United States, with an estimated nine million Americans falling into the category of morbidly obese. Traditional methods of losing weight are unsuccessful for many people, so some people who are extremely overweight increasingly are turning to weight loss surgery.

JAIME PONCE, MD: The purpose of weight loss surgery is to improve the health of morbidly obese patients. To improve the health, meaning that the medical problems that they have they can resolve or improve, or to prevent those medical problems from happening.

ANNOUNCER: Body mass index, or BMI, is the index commonly used to determine if someone is overweight or obese. It is based on a person's weight relative to his or her height. A normal BMI is 18.5 to 24.9. A score equal to or above 25 is considered overweight. A score equal to or above 30 is considered obese. And a score equal to or above 40 is considered extremely obese.

JAIME PONCE, MD: An ideal candidate for surgery is somebody that has a BMI, a body mass index, of 40 or more, which is about 100 pounds or more above their ideal weight; or somebody that has a BMI in between 35 and 40 with associated medical problems. In addition to that, the person needs to be an adult. The person has to be overweight for at least five years, and has to have tried to lose weight before, several times, and failed.

ANNOUNCER: There are three main types of surgical procedures designed to promote weight loss in obese people.

GEORGE WOODMAN, MD: The first is malabsorptive procedures, and those procedures are designed to help a person not absorb much of what they eat.

ANNOUNCER: Malabsorptive surgeries shorten the length of a patient's small intestine and changes where it connects to the stomach, thus causing food to be poorly digested and incompletely absorbed. These procedures are the least commonly performed weight loss surgeries.

GEORGE WOODMAN, MD: The two most commonly performed types of weight loss surgery are restrictive procedures and combined procedures. Restrictive procedures reduce how much the stomach can hold.

ANNOUNCER: Adjustable gastric banding is a restrictive procedure. A silicon band is implanted around the very top of a patient's stomach. The band narrows the stomach so that a small pouch forms above the band. Following surgery, the patient's doctor can inject saline into the band to tighten the band to increase the restriction.

GEORGE WOODMAN, MD: Combined procedures restrict how much the stomach can hold, but they also reduce how much you absorb, but to a smaller extent than the malabsorptive procedures by themselves.

ANNOUNCER: Gastric bypass surgery is a combination of restrictive and malabsorptive techniques. A patient's stomach is stapled and a small pouch about the size of an egg is created. Then, a portion of the small intestine is bypassed. That portion of the small intestine is not involved in digestion and not involved in absorption.

JAIME PONCE, MD: The advantage of the gastric bypass is that it has a proven track record; it's been used in the United States for about 30 years. What it does, with the bypass, you lose the weight in about a year. You lose about 60 to 70 percent of your excess weight.

ANNOUNCER: As with any major surgery, complications can occur. Problems associated with bariatric surgery can range from minor to life threatening. Complications can occur during, immediately after, or within weeks or several months of surgery. Additional surgery, readmission to the hospital, medication, or nutritional supplements may be required in some situations. Surgeons can explain the risks unique to individual patients and unique to the type of weight loss operation they choose. One advantage of the adjustable gastric band is that it can be fine-tuned for each patient.

GEORGE WOODMAN, MD: One of the reasons that the band works is that it's tailored to meet an individual's weight loss needs.

FELIX SPIEGEL, MD: By adjusting it, we can prevent the patient from gaining their weight back, and we have clinical data and trials ten or more years after LAP-BAND® surgery showing that weight regain is minimal.

ANNOUNCER: Unlike gastric bypass patients, adjustable gastric band patients do not need to add supplements to their diet.

FELIX SPIEGEL, MD: Because there is no malabsorptive component, these patients don't need lifetime supplementation with specialized vitamins.

ANNOUNCER: Both the adjustable gastric band and the gastric bypass are effective surgeries. And although the average gastric bypass patient will lose weight more quickly, over the course of three to five years weight loss is very similar between the two procedures. So how do patients decide which procedure is right for them?

GEORGE WOODMAN, MD: Which procedure is right for which patient is really up to that particular patient. It's important for them to do their homework, whether that means getting a book, going to some seminars, talking to their medical doctor, talking to a surgeon, talking to their friends. They need to make an educated decision on their own. If they have questions, we're here for them. We can help answer specific questions. We can guide them in a certain direction, but we will not make that decision for them.

Surgery, regardless of which one you choose, is just a tool. It's just a procedure that's going to help a patient, significantly help them, to lose weight. It's not going to make them lose weight. It's not going to change their lifestyle for them, but it gives them a tool to help them to achieve their goals.

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