Surgical Procedures - BARIATRIC / WEIGHT LOSS SURGERY

PROBLEMS WITH WEIGHT CONTROL?

Difficulty in controlling weight can lead to a variety of health problems including high blood pressure, heart disease, diabetes, high cholesterol, an increased risk of developing certain cancers, heartburn and arthritis. The bottom line is that as far as your health is concerned being overweight is not good for you.

We all know the answer to the problem, eat less and exercise more. However, in spite of the apparent simplicity of the solution this is not an effective way of controlling weight long term. Time and again we hear from people who are able to lose significant amounts of weight only to be frustrated by finding that in spite of their very best effort and intentions it all goes back on again in a few short months. Why should this be the case? The answer is simple: to a very large extent, our weight is determined, by our genes. As far as our genes are concerned we are supposed to be the weight we are and if we loose weight they take steps to get us back to the weight we were before. So that is why people often feel ravenously hungry after completing their diet. Their bodies are telling them "You are too thin. You need to put on weight".

MEDICAL THERAPY

In the UK there are two drugs licensed to help in weight reduction, Orlistat (which stops fat taken in the diet being absorbed) and Sibutramine (which works as an appetite suppressant). Both produce modest weight loss but are currently only license for up to 2 years. Patients regain their former weight quickly when the medication is stopped.

OBESITY SURGERY

Bariatric surgery is the only proven means of providing effective long term weight loss. We offer a full range of procedures: Gastric banding, gastric bypass and sleeve gastrectomy. All of these operations are performed laparoscopically under general anaesthetic in hospital.

GASTRIC BAND

The gastric band is an adjustable device which is placed around the upper stomach. When inflated it stops feelings of hunger and reduces the amount you eat leading to weight loss. With the band the follow up you receive is very important as this determines how effective the band will be in helping you to lose weight. It is safe and effective and can, if necessary, be reversed easily. The operation is performed laparoscopically (keyhole surgery) and takes only about 40 minutes. You will be allowed home at between 24 and 72 hours after surgery with a diet sheet that starts with fluids and builds up to solid food over the next 6 weeks Eight weeks postoperatively we inflate the balloon in the band using a special needle placed through the skin into the reservoir. The amount of fluid in the balloon will need to be adjusted over subsequent weeks to produce the required weight loss.

GASTRIC BYPASS

Also known as Roux-en-y gastric bypass, this operation has been around for a long time and was, until the introduction of the band, the commonest weight loss procedure. Studies have shown it to be a very effective way of producing rapid and long term control of your weight. You can expect to loose 70% of your excess weight with this operation. The operation is performed laparoscopically and takes approximately 4 hours. The upper part of the stomach is divided and joined onto the small bowel so that the main reservoir of the stomach is bypassed. A small amount of small bowel is also bypassed. The hospital stay is 3 to 5 days. Fluid is started on the first postoperative day and built up to full diet by six weeks.

SLEEVE GASTRECTOMY

In this operation the stomach is reduced to a long this tube which restricts what you can eat. The speed of weight loss is somewhere between that of the band and the bypass. You can expect to loose 70% of your excess weight with this operation.

RISKS

All surgical procedures are associated with some risk. In deciding whether to undergo weight loss surgery it is necessary to balance the risks of the procedure against the risks of obesity.

Complications that can occur following bariatric surgery include wound and chest infections, bleeding, injuries to the stomach and bowel and leaks from joins in the bowel. It has generally been supposed that surgery on overweight patients was associated with increased risk of complications. However, a recent publication has shown that the risks are no greater than in non-overweight patients.

RIGHT FOR YOU

If you meet the following criteria then you may be suitable for weight loss surgery. In deciding on surgery you will need to discuss the risks of undergoing an operation against the risks of remaining obese.

A body mass index greater than 40 or a body mass index greater than 35 in the presence of associated conditions such as diabetes, sleep apnoea, high blood pressure etc.
Aged 18-65
To have tried other means of weight reduction such as dieting or drug therapy before considering surgery.
Should be fit for an operation.
Pregnancy not anticipated in the first two years following surgery.
No psychiatric or drug dependency problems.
Obesity related health problems.
Must understand the need for long term follow up and long term commitment to maintaining a reduced weight.

PLANNING

During your consultation, Mr Heath will listen to your story and perform a brief relevant examination. He will then explain the different types of obesity surgery to you and their risks and benefits. Your will have ample opportunity to ask questions and you will receive a letter detailing everything that has been discussed.

BEFORE WEIGHT LOSS SURGERY

You will receive a letter detailing what you need to do before surgery. It is important to take a special diet for two weeks prior to surgery in order to reduce the size of your liver and make surgery easier and safer.

AFTER WEIGHT LOSS SURGERY

If you have had a band inserted you will be able to go home the day after surgery and if you have had a bypass 48 hours after the operation. Patients undergoing sleeve gastrectomie's stay four or five days. Most people will be able to return to work within 2 weeks.

Patients with bands will have their first inflation four weeks after surgery and further inflations as required. As time passes visits will be less frequent. Even so all patients should be seen once yearly.

YOUR HEALTH

Weight loss surgery has been reported to improve several co-morbid conditions including diabetes mellitus, sleep apnoea and obesity associated hypoventilation, high blood pressure and serum lipid abnormalities. In a recent study, diabetic patients who underwent gastric bypass surgery had a risk of death three times less than those who had not. The results of a recent study comparing the health problems experienced by two groups of patients, one which underwent weight reduction surgery and the other who did not, are shown in the table below. Those who had undergone weight loss surgery had fewer healthcare problems than those who had not.

	Weight Reduction Surgery	No Surgery
Arthritis	5%	12%
Cancer	2%	8%
Deaths	1%	6%
Diabetes and endocrine disease	9%	27%
Heart disease	5%	27%
Infectious diseases	9%	37%
Lung disease	3%	11%
Number of days in Hospital during a 5 year period	21 days	36 days