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Questions
and Answers about Bariatric Surgery
How Does Bariatric Surgery Affect The Digestive
Process?
Before Surgery
Food is chewed in the mouth, then swallowed, passing
through the esophagus to the stomach, (roughly the
size of a melon) where stomach acids dissolve it
into smaller particles. The liquid (chyme) then
passes into the small intestine where enzymes and
bile continue the digestive process. The first
section is the duodenum, the shortest
section. Here, calcium, iron and a few vitamins are
absorbed. The second and third sections are the
jejunum and ileum, both about ten feet in
length. Here, the bulk of food nutrients (vitamins
and minerals) and calories are absorbed.
After Surgery
During both main types of obesity surgery, the size
of the stomach is reduced by up to 90 percent, to
the size of an egg or even the size of a thumb.
Typically, its capacity is 3-4 tablespoons of food.
This stomach reduction drastically reduces the
quantity of food which can be consumed in one
sitting and speeds up satiety. During bypass
surgery, the digestive tract below the stomach is
also altered. After leaving the small stomach pouch,
food is re-routed to bypass most of the duodenum
and is directed into the final part of the
jejunum. Because the food passes along a much
reduced length of small intestine, and comes into
contact with smaller amounts of digestive enzymes,
fewer calories and nutrients are absorbed.
Is Bariatric Surgery An Easy Solution for Weight
Loss?
No. According to the American Society For Bariatric
Surgery, gastric reduction surgery is not an easy
option for obesity sufferers. It is a drastic step,
and carries the usual pain and risks of any major
gastrointestinal surgical operation.
Does Bariatric Surgery Involve New Eating Habits?
Yes. All
types of gastrointestinal obesity surgery compel
patients to change their eating habits radically,
and make them very ill if they overeat. And after
bariatric surgery is performed, patients remain at a
lifelong risk of nutritional deficiencies.
Does Bariatric Surgery Typically Lead to Major
Weight Loss?
Yes and No. Some patients who undergo bariatric
gastrointestinal surgery lose more than 100 pounds
in weight - some lose as much as 200 pounds weight.
Typically, patients who undergo adjustable gastric
banding procedures, such as Lap-Band lose less
weight than those who have gastric bypass like
Biliopancreatic Diversion (BPD) or
Duodenal Switch (BPD-DS). Some patients reach a
normal weight, while others remain overweight,
although less overweight than before. However, in
order to maintain this type of weight
reduction, patients must follow carefully the
post-operative guidelines relating to diet and
exercise.
Who Is A Candidate for Bariatric Weight Loss
Surgery?
Some bariatric surgeons accept patients in their
60's, and some even operate on teenagers. But
because bariatric surgery is a last-gasp treatment
solution for obesity, to be used when conventional
weight loss programs have been tried and failed,
candidates must have severe obesity-related health
problems.
-
Typically, to qualify for bariatric surgery you
must be 'morbidly obese', which usually means
being overweight by 100 pounds (man) or 80
pounds (woman) with a Body Mass Index (BMI) of
40+.
-
Alternatively, bariatric surgery may be
appropriate if you are 80 pounds overweight (BMI
35+) and have a serious obesity-related
condition like type 2 diabetes or
life-threatening cardio-pulmonary problems such
as severe sleep apnea or obesity-related heart
diseas
Is Hospitalization Necessary Before Undergoing
Bariatric Surgery?
Not usually, although patients with extremely severe
obesity (End Stage obesity syndrome) may n
eed to be hospitalized before undergoing weight loss
surgery in order to lower the health risks of
surgery.
Is Obesity Surgery Dangerous?
Yes. Both types of bariatric surgery (gastric
banding and gastric bypass) involve major operations
lasting one to two hours (longer if performed
laparoscopically) and patients typically need three
to five nights in hospital. The first night
following the operation is usually spent in a high
dependency unit or intensive care environment.
(Note: After laparoscopic bariatric surgery,
patients typically remain in hospital for 2-3 days,
rather than the 4-5 days after open surgery.
Patients typically return to work after 2-3 weeks,
compared to 4-6 weeks after open surgery.) The level
of health risk varies according to patient
condition, type of procedure and the experience of
the surgeon. (Patients are five times more likely to
die if the surgeon has less experience, per
University of Washington Study.) But in general,
bariatric surgeries carry all the possible health
risks of any major medical operation.
Do Bariatric Patients Regularly Suffer From Health
Complications?
Typically, it depends upon patient-condition, the
complexity of the specific operation and the skill
and experience of the surgeon. Recent research
suggests that 4 out of 10 patients suffer
complications within six months of surgery. Of these
patients, up to 20 percent required
re-hospitalization to treat specific problems
relating to their stomach bypass or gastric banding
procedure. As well as perioperative and post-
operative health problems, patients should expect to
face a number of longer term physical and emotional
problems. To begin with, the recommended
post-operative diet regime requires an immediate and
drastic change of eating habits. Gastric bypass also
necessitates nutritional supplementation for life.
Secondly, after losing a significant amount of
weight, patients typically experience a distressing
amount of loose skin. Removal will require
cosmetic/plastic surgery. Your surgeon and/or the
staff at your obesity clinic will advise you about
the specific weight-related health issues you are
likely to face.
Are The Health Risks Of Bariatric Surgery Greater
Than The Risks Of Obesity?
For most patients suffering from morbid obesity (BMI
40+), super-obesity (50+) or end stage obesity
syndrome (BMI 60+), the big question is, do the
benefits of bariatric surgery outweigh its risks?
The answer is Yes. Severe obesity is a chronic,
frequently progressive, life threatening disease,
and the known health risks associated with morbid
obesity far outweigh the risks associated with
surgery. Published studies indicate that someone who
is 100 percent above his/her ideal weight has a risk
of mortality ten times higher that of a person of
normal weight. By comparison, the mortality rate for
both
vertical banded gastroplasty,
adjustable gastric banding and roux-en-y gastric
bypass is less than one percent. Morbidity (ie. rate
of disease) in the immediate post-operative period
is roughly ten percent or more, although the
combined risk of the most serious complications is
less than three percent. In the later postoperative
period, other health complications can and do arise,
and may require corrective surgical treatment. Also,
some patients are unable to comply with
post-operative eating and exercise guidelines over
the long term. But in general the overriding health
benefit of bariatric treatment is now well
established.
How Important Is Patient Attitude For The Success Of
Bariatric Surgery?
Very important! The higher the motivation of
patients to lose weight and manage the
post-operative requirements of dietary modification
and behavioral therapy, the more successful surgery
is likely to be, in solving their obesity and weight
problems. The pre-op screening process adopted by
obesity clinics to identify good candidates for
bariatric surgery, is strongly influenced by patient
attitude.
What Is The Cost of Bariatric Weight Loss Surgery?
Bariatric gastrointestinal surgical operations cost
about $25,000 or more, depending on the experience
of the surgeon, the medical team, the surgical
procedure and the level of post-op services chosen.
Is Bariatric Surgery Covered By Health Insurance?
Health insurers are slowly beginning to accept that
obesity surgery can deliver powerful medical
benefits that will save them money in the long run,
especially where convention weight loss remedies
have consistently failed to reduce obesity.
Therefore in several states, obesity surgeries like
gastric bypass and lap band are covered by most
medical insurance plans. However, patients may need
to work closely with their surgeon or clinic to
submit the necessary forms to the health insurance
company in order to receive authorization for weight
loss surgery. This includes a Letter of Medical
Necessity which typically (a) Patient's weight (BMI
40+ or 35+ with health complications), (b) List of
obesity-related medical symptoms (eg. type 2
diabetes, sleep apnea, raised blood pressure, high
blood fats, insulin problems), (c) How long patient
has been overweight (at least five years), (d)
History of failed weight-loss programs, with details
of type of program, whether or not medically
supervised, amount of weight lost
Are Cosmetic or Plastic Surgery Operations Covered
By Health Insurance?
No. Post-op plastic surgery procedures (like
abdominoplasty, tummy tuck etc.) to remove loose
skin caused by massive weight loss, are deemed to be
'cosmetic' rather than health related operations. As
a result they are not usually covered by medical
insurance plans.
What Do Doctors Think About Surgical Treatment For
Obesity?
Many of the current standards and guidelines for
performing bariatric surgery were set in 1991, by a
Consensus Panel of physicians, sponsored by the
National Institutes of Health (NIH). In particular,
they established the body mass index (BMI) as the
basis for selecting candidates for surgical
treatment, to which was added the presence of severe
comorbid conditions. The panel also stated the
necessity for patients to receive multidisciplinary
care by a team of doctors and therapists, to handle
their weight-related co-morbidities, and emotional
needs. Bariatric operations were viewed as a means
of enabling patients to change their lifestyle and
eating habits, in order to reduce and manage their
obesity. Since 1991, there have been significant
developments in the field of gastric reduction
surgery, especially laparoscopy. As a result, a new
Consensus Conference, sponsored by the American
Society for Bariatric Surgery (ASBS), was held in
2004, which updated the evidence and the conclusions
of the NIH consensus panel. They concluded that: (1)
Bariatric surgery is the most effective treatment
for severe clinical obesity. (2) Stomach bypass is
one of four types of surgical treatment for morbid
obesity. (3) Laparoscopic surgery is as effective
and as safe as traditional open surgery. (4)
Bariatric patients should receive comprehensive
pre-op assessment, and multi-disciplinary post-op
support, in order to achieve the best weight loss
results.
Should You Have Bariatric Surgery?
The health dangers of severe obesity are well
documented. Words like globesity and
diabesity are evidence of the growing impact of
this body-fat disease. Also, statistics show that
severely obese patients have little chance of losing
weight using conventional diets. However, this does
not mean that bariatric surgery is a guaranteed
solution for obesity. Long term studies of bariatric
patients suggest that 1 in 2 fail to maintain any
significant weight loss, and many patients regain
all the weight they lose. Patients who have
realistic expectations, a positive attitude and,
above all, a genuine commitment to making lifelong
changes in their attitude to food and exercise,
typically achieve much better results.
Inform Yourself About Bariatric Surgery
Do not believe everything you read about bariatric
surgery. Before taking any decisions, talk with
patients who have undergone this form of weight loss
surgery. Find out about the problems, issues and
health risks involved. Listen carefully to the
advice offered by your obesity clinic. When choosing
a clinic, always inquire about what post-op
support services they offer, such as counseling,
email or forum support
Surgical Travels
has developed relationships with two of the finest
medical facilities in the world to perform Gastric
Surgeries. We evaluated the JCI Rated Hospitals,
their history and experience in performing
procedures, and the training and qualification of
the surgeons. |
