Laparoscopic Gastric Bypass and Lap-Band Surgery

Patients who undergo bariatric surgery, either laparoscopic gastric bypass or laparoscopic gastric banding, experience significant weight loss after surgery. Both operations decrease the size of the functional stomach, causing an individual to feel full faster. This lowers the amount of food that one consumes and can significantly lower the number of calories consumed.

Why Laparoscopic Bariatric Surgery?

Obesity is a worldwide problem of increasing prevalence. Ideally, and in its less severe stages, obesity can be controlled with diet management and a regular exercise program. At times, obesity may be so severe that it is termed morbid obesity. Medically, this term is defined as a body mass index (BMI) greater than 40 kg/m^2. Although this calculation depends upon both an individuals height and weight, persons who are approximately 100 pounds over their ideal body weight are likely to be morbidly obese. Between 3-7% of the adult US population currently suffers from morbid obesity. Several life-threatening complications such as diabetes, high blood pressure and coronary artery disease are associated with this condition. Medical weight reduction practices often do not yield good results in these situations. Surgical intervention may be indicated to stop weight gain, achieve weight loss and reverse some of the obesity-related medical conditions described above. Laparoscopic gastric bypass surgery is an ideal surgical procedure whose utility in combating morbid obesity is recognized by both medical and surgical specialists. The United States government also supports bariatric surgery in appropriate candidates, as Medicare will cover the costs of this treatment. Although the criteria that insurance carriers look for in determining whether or not an individual warrants this surgery vary, doctors generally agree on a set of qualifying criteria. The decision to proceed with surgery always represents a comparison between risks and benefits, as any surgical procedure involves some risk. Generally accepted criteria for proceeding with this type of surgery include that an individual have been obese for at least five years, be between the ages of 18 and 65 years and have no medical or psychiatric contraindications to undergoing surgery. Candidates must also have failed a regimented and organized diet program for at least six months.Other criteria include an organized set of measurements. Those who have a BMI greater than 40 or those with a BMI of 35 or more who are also suffering from life-threatening illnesses curable with weight loss are considered as possible candidates for bariatric surgery. Something to remember, however, is that is not acceptable to undergo bariatric surgery if you suffer from untreated depression or any other major psychiatric disorder.

Defining Morbid Obesity

Obesity is a serious disease with symptoms that build slowly over an extended period of time. The National Institutes of Health (NIH) define morbid obesity as: 

The disease of morbid obesity interferes with basic physical functions such as breathing or walking. Long-term implications of the disease include shorter life expectancy, serious health consequences in the form of weight-related conditions such as type 2 diabetes and heart disease, and a lower quality of life with fewer economic and social opportunities.

Obesity is a serious public health issue in the U.S. 24 million U.S. adults are living with morbid obesity and may qualify for bariatric surgery based on NIH guidelines.By 2010, it’s projected that there may be 31 million U.S. adults living with morbid obesity and may qualify for bariatric surgery based on NIH guidelines.

Co-morbid Conditions

Bariatric surgery may improve some pre-existing health conditions. The presence of obesity increases the risk of a number of medical conditions, including cancer. A co-morbid condition is a health condition related to a primary disease such as obesity. There are many health conditions related to morbid obesity, but some of the most common are:

An emerging body of literature demonstrating relationships between maternal obesity and structural birth defects, including an increased risk of spina bifida and heart defects. These conditions occur more frequently in people with morbid obesity. Mortality rates from many of these conditions are also higher among people with morbid obesity.

Bariatric Surgery: A Tool

Bariatric surgery is intended for people who are 100 pounds or more overweight (with a Body Mass Index (BMI) of 40 or greater) and who have not had success with other, less risky weight loss therapies such as diet, exercise, and medications. In some cases, a person with a BMI of 35 or greater and one or more co-morbid condition may be considered for bariatric surgery. Bariatric surgery has a history of helping patients effectively transform their health. Bariatric surgery restricts the amount of food patients can eat and, depending on the procedure, the number of calories and nutrients the body can absorb. As a tool, bariatric surgery has impressive long-term weight loss results and, in many cases, has resolved or improved co-morbid conditions.

Bariatric surgery should not be considered until you and your doctors have explored all other options. The best approach to bariatric surgery calls for a discussion of the following:

There are several different bariatric surgery procedures, but the two general ways in which they work are restriction and malabsorption:

Restriction limits the amount of food you can eat. Whether it is a gastric banding device around the stomach or a surgically-created, smaller stomach pouch, restriction ensures that the patient feels satisfied with less food.

Malabsorption limits the number of calories and nutrients your body can absorb. During malabsorptive procedures, the surgeon reroutes the small intestine so that fewer calories and nutrients are absorbed.

Commonly performed bariatric procedures include:

• Gastric bypass
• Gastric banding
• Sleeve gastrectomy
• Biliopancreatic diversion with duodenal switch

Weight Loss Strategy and Treatment

Diet
To lose weight, your body must burn more calories than you eat and/or drink. A diet plan should be based on your health and lifestyle needs, and would include reducing the number of calories you take in.

Exercise
Frequent and regular physical activity is beneficial to most anyone—whether they are pre- or postsurgery. Generally, an exercise program includes cardiovascular exercise such as walking, swimming, or cycling, strength training using resistance bands, weights, or machines, and stretching. Speak with your primary care physician before beginning any physical activity.

Prescription Weight Loss Medications
Prescription weight loss medications may be considered a supplement to diet and exercise. Only a healthcare professional can prescribe these weight loss medications.

The above chart compares the long-term effectiveness of three different obesity treatments: diet and exercise, weight loss medications, and bariatric surgery.

Bariatric surgery clearly has the best weight loss outcome compared to the other two treatments— 50 to 70 percent of people were able to lose at least 50 percent of the excess weight and keep it off for five years. After five years, only 2 to 5 percent of the people who dieted and exercised had maintained a weight loss of at least 10 percent.People who had taken weight loss medications were not able to maintain any weight loss.