Bariatric surgery is a surgical weight-loss procedure
that reduces or bypasses the stomach or small
intestine so that severely overweight people can
achieve significant and permanent weight loss.
Obesity surgery should not be performed on people
who are less than twice their ideal weight. It also is
not appropriate for people who have substance addictions
or who have psychological disorders.
Other considerations
in choosing candidates for obesity surgery
include the general health of the person and his or her
willingness to comply with follow-up treatment.
Obesity surgery is usually performed in a hospital
by a surgeon who has experience with obesity surgery
or at a center that specializes in the procedure.
General
anesthesia is used, and the operation takes 2–3 hours.
The hospital stay lasts about a week.
Three procedures are currently used for obesity
surgery:
Gastric bypass surgery.
Probably the most common
type of obesity surgery, gastric bypass surgery has
been performed in the United States for about 25
years.
In this procedure, the volume of the stomach
is reduced by four rows of stainless steel staples that
separate the main body of the stomach from a small,
newly created pouch. The pouch is attached at one
end to the esophagus.
At the other end is a very small
opening into the small intestine. Food flows through
this pouch, bypassing the main portion of the stomach
and emptying slowly into the small intestine
where it is absorbed.
Vertical banding gastroplasty.
In this procedure, an
artificial pouch is created using staples in a different
section of the stomach. Plastic mesh is sutured into part of the pouch to prevent it from dilating.
In both
surgeries the food enters the small intestine farther
along that it would enter if exiting the stomach normally.
This reduces the time available for absorption
of nutrients.
The procedure is normally done laparoscopically,
meaning that the surgeon makes one or
more small incisions in the abdomen and inserts the
necessary tools and instruments through the tiny
holes.
He or she can view the patient’s organs via
an inserted camera that displays pictures on a monitor.
This method makes for a faster and easier recovery
than a large incision.
Jejunoileal bypass.
Now a rarely performed procedure,
jejunoileal bypass involves shortening the small
intestine. Because of the high occurance of serious
complications involving chronic diarrhea and liver
disease, it has largely been abandoned for the other,
safer procedures
After patients are carefully selected as appropriate
for obesity surgery, they receive standard preoperative
blood and urine tests and meet with an
anesthesiologist to discuss how their healthmay affect
the administration of anesthesia.
Pre-surgery counseling
is done to help patients anticipate what to
expect after the operation.
