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Posted on Jul 27, 2015 in Health & Wellness

Bariatric Surgery

Written by: Maritza Manresa

Bariatric surgery has been around for many years, but is one of the general surgery specialties that has improved the most over the past twenty years. Gastric Bypass was originally developed in 1967, but other forms of weight loss surgeries had been practiced since 1954 with many complications. Bariatric surgery is not intended to be a solution to the common weight loss problem experienced by many.

This type of surgery is intended for patients who cannot lose weight by other means or who suffer from serious health problems related to obesity such as high cholesterol, diabetes, high blood pressure, and sleep apnea. Basically, bariatric surgery restricts food intake thus promoting weight loss. Although, a safe and pretty common procedure, as with any other type of surgery, there are always risks and side effects associated with it as well as multiple factors that should be taken into consideration before undergoing such procedure.

According to Ocala Health Surgical Group’s Dr. Angel Caban, Board Certified American Board of Surgery Advanced Laparoscopy and Bariatric Surgery, there are three types of bariatric surgery: Adjustable Gastric Band, Vertical Sleeve Gastrectomy (commonly known as sleeve surgery), and Gastric Bypass. Not every type of surgery is appropriate for everyone. The type of surgery performed on a patient depends not only on the patient’s preference or risk tolerance, but also on the patient’s eating habits, weight and/or weight distribution.

Adjustable Gastric Band surgery is mostly done laparoscopically and it is done on an outpatient basis. Normally surgery lasts approximately thirty minutes and consists of inserting a band (looks like a bracelet) around the top of the stomach thus restricting the size of the opening. The band has a circular balloon inside of it that can be inflated through a port with saline solution thus creating a feeling of fullness. With this type of surgery the patient can lose approximately 40% of the excess body weight in a period of two to two and a half years. Of all three types of surgeries, the band surgery requires the least amount of recovery time. On the other side of the coin it has the lowest long term success rate as people tend to get discouraged losing weight at such a slow pace.

Sleeve surgery works similar to the band in that it results in restricting food intake as well as decreasing the amount of food used by the body. With this type of surgery most of the stomach is removed, which may also decrease ghrelin, a hormone that stimulates appetite. As it is the case with the band surgery, sleeve surgery is done laparoscopically 99% of the times and the hospital stay is limited to one to two days. On the down side, it can take up to three months before the patient can completely go back to normal. Nevertheless, patients lose between 60 to 70% of the excess body weight in a year to a year and a half.

Lastly, the Gastric Bypass surgery restricts food intake and also decreases how food is absorbed. This procedure involves dividing the stomach into a small portion and a large portion. The small portion of the stomach is sewn or stapled together to create a small pouch where the food will go – holding maybe a cup of food. Thus, with such a small stomach, the patient will feel full quickly and eat less. During surgery, after the new small pouch has been created, it is disconnected from the first part of the small intestine (duodenum) and then connected to a part further down in the small intestine called the jejunum. By creating this shortcut, the food then passes directly from the new small stomach pouch into the jejunum, bypassing the duodenum. This process curbs the patient’s absorption of calories and nutrients. This surgery has a great long term success rate as the average excess body weight loss with this surgery is between 70 to 80% in a period of a year to year and a half. On the down side, however, average recuperating time for this surgery can also take up to three months.

Although it may seem like the best and easiest solution to a weight problem, having bariatric surgery is not as easy as just going to the doctor and requesting to have it done. There are multiple factors the patient must take into consideration first. For instance, one of the biggest concerns is the extra loose skin that results from rapid excessive weight loss. The removal of this skin is considered to be cosmetic surgery and not covered by insurance. Thus, the patient must be mentally and financially prepared to either deal with this new aesthetics problem or have cosmetic surgery to have it removed. Another factor to take into consideration is that in addition to having to meet your health insurance requirements (if your health insurance is going to pay for it), you must also go through a psychological evaluation, a nutritional evaluation, and be smoke free for at least three months prior to surgery, if you are a smoker.

To cover the surgery, most health insurance companies will require the patient to have a body mass index (BMI) of 35 or higher along with two or more comorbidities such as high blood pressure, diabetes, high cholesterol, back pain and sleep apnea. The psychological evaluation is required to determine if there is an underlying problem causing the obesity, which means surgery may not be the answer, and to make sure the patient understands there must be realistic expectations with the surgery. Additionally, in some cases the doctor may require a sleep study/pulmonary evaluation, a cardiology evaluation and a GI evaluation prior to determining if a patient is a candidate for surgery.

Bariatric surgery is not a cosmetic procedure to enhance your appearance or a quick fix to your being overweight.In fact, depending on the type of surgery, it can be an intensive procedure with multiple risks and side effects as with any other surgery. “About 25% of people who undergo bariatric surgery will regain the weight if they don’t change their lifestyles and eating habits,” said Dr. Caban. Thus, patients must be willing to make those critical lifestyle changes in order for the surgery to be successful in the long term.