Weight Loss Surgery
What is Morbid Obesity?
Morbid obesity is a chronic disease, meaning that its symptoms build slowly over an extended period of time. An estimated 5-10 million Americans are considered morbidly obese. Obesity becomes “morbid” when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that can result either in significant physical disability or even death.
Body Mass Index (BMI)
The definition of morbid obesity is based on a person’s body mass index. You can calculate your BMI online by using our online calculator in the right column.
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What does your BMI mean? A person is considered overweight if his/her BMI is more than 25, obese if BMI is more than 30, and morbidly obese if BMI is more than 40.
Risk of health problems
Obesity is known to increase a person’s risk of many health problems (known as “co-morbidities”). Below is a list of some of the more common co-morbidities associated with obesity.
› Diabetes (high sugar)
› Hypertension (high blood pressure)
› Degenerative joint disease (arthritis)
› Sleep apnea syndrome (health problems related to snoring)
› Gallstones
› Female menstrual irregularities
› Heart disease
› Lung disease
› Certain cancers
Morbid obesity can also be related to problems with a person’s psychological well-being. For example, people who are morbidly obese may become depressed or have a sense of helplessness about their weight problem.
Risk of death
Obesity is associated with an increased risk of death from all causes, and this risk increases as a person’s weight (BMI) increases. This is especially true for people in the morbidly obese category (BMI more than 40).
Social and economic impact
Severe obesity can also limit a person’s access to everyday comforts and activities that many people take for granted. The small seats in airplanes and movie theaters are good examples of this. People who are morbidly obese are often the subject of inappropriate looks and comments from other people. This type of behavior can have a major impact on a person’s social and work life, and can even lead to job discrimination.
If you or someone you love is morbidly obese, please call us at (828) 327-9178 to get a full assessment of your condition. Weight loss surgery may be an option for you.
Laparoscopic surgery
Weight loss surgery can be performed laparoscopically in almost all cases. This means that instead of a large incision, several small puncture holes are made in the abdomen, as shown below.
Through these holes, long and slender instruments are used to perform the operation. The surgeon can see inside with a small television camera, which shows the operation on a television screen next to the patient in the operating room.
Laparoscopic technique has several advantages over the older “open” technique. Patients typically have less pain with the laparoscopic operation, and also have fewer wound complications such as infection or hernia. Patients are also typically able to return to their pre-surgical level of activity more quickly than patients who have the open technique.
Laparoscopic Roux-en-Y Gastric Bypass (RNY)
Gastric bypass dramatically decreases the amount of food a person can consume, while at the same time allowing a sense of fullness and satisfaction with smaller meals. According to the American Society for Bariatric Surgery (ASBS) and the National Institutes of Health (NIH), Roux-en-Y gastric bypass is one of the current gold standard techniques for weight loss surgery. At Hickory Surgical Clinic, laparoscopic gastric bypass surgery has been the cornerstone of our surgical weight loss program for over 6 years.
There are four major steps to the RNY gastric bypass operation:
- The stomach is divided to create a small stomach pouch.
- The small intestine is divided to create a “Roux” limb.
- The intestine is attached to the new stomach pouch.
- The intestine is re-connected to form a “Y”-shaped connection.
This procedure reduces the size of the stomach into a small pouch that can only hold a small amount of food (about 1-2 tablespoons). The food travels from this small pouch directly into the intestine, bypassing the great majority of the stomach.
The stomach pouch fills with food rapidly and empties slowly. When the pouch gets full, the brain responds with a feeling of fullness even though the person has only consumed a very small amount of food.
This operation has other effects on a person’s appetite as well. For example, ghrelin is a “hunger hormone” which stimulates the appetite. When a person loses weight by dieting, the amount of ghrelin in the bloodstream usually increases, resulting in more hunger. RNY gastric bypass operation actually decreases ghrelin levels, resulting in less hunger.
Risks of Surgery
As with any operation, there are risks associated with weight loss surgical procedures. Possible risks include, but are not limited to:
› Complications due to anesthesia and medications
› Blood clots (deep vein thrombosis)
› Pulmonary embolus
› Intestinal leak
› Bleeding
› Possible need for an open operation
› Death
Long-term complications may also arise, particularly in patients who are not able or willing to follow the postoperative diet instructions and maintain lifelong followup with their doctor. Some possible long-term problems include:
› Inadequate weight loss
› Ulcers
› Vitamin and mineral deficiencies
› Adhesions and/or hernias
› Possible need for other procedures in the future
For more information about morbid obesity and the laparoscopic Roux-en-Y gastric bypass operation, please visit the weight loss surgery info site from Ethicon Endo-Surgery.
Gastric bypass surgery should be considered a “tool” to allow a person more control over the consumption of food.
Other Surgical Options
There are a variety of other weight loss operations, and also variations of the standard RNY operation performed at some other centers. Every operation has certain advantages and disadvantages. The Roux-en-Y gastric bypass operation offered at the Hickory Surgical Clinic is a nationally standardized procedure that has a well-established track record of excellent weight loss results, weight loss that is maintained over long-term followup, and low risk for most patients. For these reasons we agree that this operation is the “gold standard” for the surgical treatment of morbid obesity.
It is important to understand the different surgical options and how they differ from the standard RNY gastric bypass. This will help develop a better understanding of how the RNY gastric bypass works, and why it is performed the way it is. To learn more about gastric bypass and other weight loss surgical options, visit the ASMBS web site: The Story of Surgery for Obesity.
If you or someone you love is morbidly obese, please call us at (828) 327-9178 to get a full assessment of your condition. Weight loss surgery may be an option for you.
Laparoscopic Adjustable Gastric Banding (Lap Band, or Realize Band)
Like the gastric bypass operation, the adjustable gastric band procedure reduces the effective size of the stomach. With gastric bypass, this is accomplished by stapling and dividing the stomach. With the adjustable gastric band, this is accomplished using a plastic band that fits around the top part of the stomach like a belt. The band is hollow and is filled with fluid. By adding or removing fluid from the band, the band can be tightened or loosened.
As with gastric bypass, the stomach pouch fills with food rapidly and empties slowly. When the pouch gets full, the brain responds with a feeling of fullness even though the person has only consumed a very small amount of food. Unlike gastric bypass, there is no re-routing of the intestines.
One of the advantages of the adjustable gastric band procedure is that it is a less complex operation than most other weight loss operations. There is no stapling, cutting, or rerouting of the stomach or intestines. This generally leads to a shorter length of time in the operating room under anesthesia, and a shorter length of stay in the hospital. Since there are no staple lines, there is a lower risk of leaking. The band is also adjustable – it can be tightened or loosened depending on the needs of the patient. This procedure is also more easily reversible than other weight loss operations.
This disadvantages of the adjustable gastric band procedure includes a generally slower initial weight loss than with gastric bypass surgery. Some patients may take up to three years to acheive their final weight loss results. Also, overall long-term weight loss results may not be as good with the adjustable gastric band as with gastric bypass.
Laparoscopic surgery
As with gastric bypass, the adjustable gastric band operation can be performed laparoscopically in almost all cases. This means that instead of a large incision, several small puncture holes are made in the abdomen. Through these holes, long and slender instruments are used to perform the operation. The surgeon can see inside with a small television camera, which shows the operation on a television screen next to the patient in the operating room.
Risks of Surgery
As with any operation, there are risks associated with weight loss surgical procedures. Possible risks include, but are not limited to:
› Complications due to anesthesia and medications
› Blood clots (deep vein thrombosis)
› Pulmonary embolus
› Intestinal leak
› Bleeding
› Possible need for an open operation
› Death
Long-term complications may also arise, particularly in patients who are not able or willing to follow the postoperative diet instructions and maintain lifelong followup with their doctor. Some possible long-term problems include:
› Inadequate weight loss
› Band slippage
› Band erosion into the stomach
› Infection of the band or port
› The port or plastic tubing may break
› Vitamin and mineral deficiencies
› Possible need for other procedures in the future
For more information about morbid obesity and the adjustable gastric band procedure, please visit the Lap-Band info site from Allergan, or the Realize Band web site from Ethicon Endosurgery.
The adjustable gastric band surgery should be considered a “tool” to allow a person more control over the consumption of food.
Other Surgical Options…
It is important to understand the different surgical options and how they differ from the gastric bypass and adjustable gastric band operations. To learn more about the Lap Band, gastric bypass and other weight loss surgical options, visit the ASMBS web site: The Story of Surgery for Obesity.
If you or someone you love is morbidly obese, please call us at (828) 327-9178 to get a full assessment of your condition. Weight loss surgery may be an option for you.
Information about Sleeve Gastrectomy – Coming Soon!
We’ll put a comparison chart here soon…
