weight loss for patients with severe obesity are not effective in the long term, except in rare instances. Data reviewed at that time showed that nearly all participants in any non-surgical weight loss program for severe obesity regained their lost weight within five years. Although prescription and non-prescription medications are available to induce weight loss, there is no role for long-term medical therapy in the management of morbid obesity. Drugs that reduce appetite can result in an 11 to 22 pound weight reduction; however, weight regain is rapid once medication is withdrawn. Various professional weight loss programs use behavior modification techniques, in conjunction with low calorie diets and increased physical activity. Weight losses of one to two pounds per week have been reported. However, nearly all weight loss is regained after five years.
A number of weight loss operations have been devised over the past 40 years. The two operations recognized by most surgeons today include the vertical banded gastroplasty and the Roux-en-y gastric bypass. The vertical banded gastroplasty involves the construction of a small pouch with a restricted outlet to the lower stomach. The outlet may be externally reinforced to prevent disruption and dilation. The gastric bypass procedure involves constructing a small gastric pouch, which is constructed of a Y-shaped limb of small bowel of varying lengths (Roux-en-y gastric bypass). Choosing between these procedures involves the surgeons' preference and consideration of the patient's eating habits. The gastric bypass procedure generally results in greater weight loss but has a higher risk of nutritional deficiencies.
Who should be considered for obesity surgery?
The following guidelines for selecting patients for obesity surgery were established by the National Institute of Health (NIH):
- Patients should exceed ideal body weight by at least 100 Ibs. or 100%.
- They should have no known causative metabolic or endocrine causes for the morbid obesity.
- They should have an objectively measurable complication (physical, psychological, social or economic) that might benefit from weight reduction.
- They should be intelligent enough to understand the full importance of the proposed surgical procedure, including all known and unknown risks.
- They should be willing to be observed for a prolonged period.
- They should have attempted weight reduction using conservative treatment modalities without success. In rare circumstances, patient who are not quite 100 Ibs. or 100% above ideal body weight are candidates for surgical intervention if they have significant medical problems that might benefit from weight reduction.
How is laparoscopic obesity surgery performed?
The laparoscopic approach to obesity surgery is different from the traditional "open" approach that uses a 10 to 12 inch incision only in the method of accessing the stomach and intestines. In other words, the operations are exactly the same as the open approach, except five to six small incisions (1/4 to 1/2 inch) are used instead of the ten to twelve inch abdominal incisions. In a laparoscopic procedure, the laparoscope, which is connected to a video camera, is inserted through small abdominal incisions, giving the surgeon a magnified view of the patient's internal organs on a television monitor. The entire operation is performed "inside" the abdomen after gas has been utilized to expand the abdomen.
Effect of surgery on associated medical conditions:
Weight-reduction surgery has been reported to improve conditions such as sleep apnea, diabetes, high blood pressure, and high cholesterol. Many patients report an improvement in mood and other aspects of psychosocial functioning after surgery .
Because the laparoscopic approach is performed in a similar manner to the open approach, the long-term results are comparable. Advantages of the laparoscopic approach include, reduced postoperative pain, shorter hospital stay (1-3 days), a faster return to work (5-10 days) and improved cosmesis.
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