Any type of surgery that permanently changes the size of the stomach, bypasses part of the small intestine, or both, is called bariatric surgery. This is not the same as liposuction, a procedure that involves the suctioning of fat from certain parts of the body for cosmetic surgery.
Liposuction may alter a person’s shape, but it does not improve overall health. Weight loss operations, on the other hand, can provide a major benefit to both life and death, such as a diabetes type 2 treatment, for the right person.
A brief anatomy lesson
For weight loss there are a number of different surgeries but before we talk about them, it is important we have a basic undertanding of the parts of our body involved in the surgeries.
When we eat food and we swallow it, the food travels from your mouth to the esophagus, a long muscular tube that connects the mouth to the stomach. at the base of the esophagus, where it connects to the stomach, there is a sphincter or band that closes to prevent food from coming back up.
The stomach is a stretchable pouch that can hold about 2000 cc., aproximately the contents of a two-liter soda bottle. There the food mixes with hydrochloric acid and several other digestive juices to break the food down.
From the stomach, food passes through another sphinter called the pyloric valve into the small intestine, which is between fifteen and twenty feet long. the first section of the small intestine is called the duodenum; this is where the partially digested food is mixed with bile from the liver and juices from the pancreas. Iron and calcium are absorbed here.
Next, food passes into the middle section, which is known as the jejunum, and finally, into the last section of the small intestine,called the illeum. These two sections are where the majority of calories and vitamins are taken out of the food and converted into forms the body can use.
From the samll intestine, food travels through yet another sphincter into the large intestine, or colon. after it passes through the colon, it is eliminated from the body as waste. Food, and therefore calories, is absorbed in the small intestine but not in the colon.
Types of weight loss surgery
A few decades ago, a common type of weight-loss surgery involved bypassing (or even removing) all but a few inches of small intestine. This type of surgery created serious medical complications because only a very little intestinal surface was left to absorb food. Contemporary procedures are not only much safer but far more effective.
Nowadays, ther are three different categories of weight-loss surgery:
Restrictive. Surgeries in this category simply reduce the amount of food the stomach can hold by reducing the size of the stomach.
Malabsorptive. surgeries in this category change the shape of the digestive tract, limiting the number of calories and nutrients that the body can absorb from food.
Combination. This third category is a combination of the two previous ones.
The two operations most widely used are gastroplasty and bypass surgery. We’ll talk in more greater detail about these surgeries in my next articles.
Gastroplasty This is a restrictive procedure which limits the capacity of the stomach to store food. Sutures, staples, or a band across the upper end of the stomach creates a pouch roughly the size of a small egg. As a result, a person will feel full after eating only a very small amount of food.
Bypass surgery This is a malabsorptive procedure in which food passes from the stomach directly to the jejunum (the second segment of the small intestine), bypassing the duodenum (the short first segment of the small intestine). This procedure bypasses far less of the intestine than the older procedures, but it still reduces the amount of calories absorbed by the body.
When done by itself, the stomach banding or stapling procedure is relatively simple and can be performed in as little as half an hour. However, bariatric surgery commonly includes a more complex combination procedure called a Roux-en-Y gastric bypass, or simply gastric bypass for short, considered by many to be the current gold standard for weight-loss surgery.
Roux-en-Y gastric bypass or gastric bypass
In this weight-loss operation, the surgeon creates a small pouch in the upper part of the stomach and then he connects it directly to the small intestine. This way, the food bypasses the lower part of the stomach, the duodenum and part of the jejunum. The rest of the stomach does not receive any food but continues to make its usual juices. These drain out of the stomach through the bypassed duodenum, to end up in the part of the small intestine connected to the stomach pouch. As a result, stomach juices can still participate in digestion.
Most of these operations are performed using laparoscopy, a procedure in which the surgeon makes a few small incisions in the abdomen. The surgeon inserts special instruments through the tiny incisions and manipulates them while watching a video monitor. The advantage of this approach is that recovery is shorter and less painful for the patient.
Who qualifies for bariatric surgery?
Bariatric surgery is reserved for people with significant weight problems (the medical term is morbid obesity): those with a body mass index (BMI) greater than 40 or with a BMI of 35 with medical complications such as diabetes, high blood pressure, high cholesterol, or sleep apnea.
These individuals are typically 80 to 100 pounds or more overweight and have suffered ongoing problems related to weight –emotional, social, and even economic- that affect overall quality of life. In addition, candidates for this type of surgery should meet some additional criteria:
The weight problem has been chronic and has persisted despite the individual’s diligent efforts to lose weight by altering diet, habits, and exercise.
The individual must be able to understand the nature of the surgery, its potential benefits and risks, and the changes in lifestyle that are necessary for a successful long-term outcome.
What can you expect after a gastric bypass operation?
The stomach pouch fills rapidly, so that a small amount of food will create a sense of fullness. Eating too rapidly, or taking in more than the pouch can hold, will cause some discomfort or even sudden vomiting. Furthermore, certain types of concentrated carbohydrates (especially sweets) can provoke a “dumping syndrome”, characterized by 15 to 60 minutes of sweating, rapid heartbeat, cramps, diarrhea, or all of the above. Needless to say, these experiences quickly train a person to eat much less, to eat very slowly, and to avoid sweets.
As a result of these drastic changes in eating patterns, significant weight loss, typically 70 to 80 percent of excess weight, occurs during the first two years after surgery, with the most rapid loss during the first six months. Some individuals regain 5 to 10 percent of their weight back between the two and five years after surgery, but overall 80 percent of those who have this surgery will maintain their weight loss for five years or longer, a much better result than that typically seen with other weight-loss approaches.
If you are considering surgery for weight loss, keep in mind that is not a passive, easy, lazy approach to weight loss. You will have to make serious changes in your eating habits. You will have to make a lifelong commitment to appropriate food choices and exercise.