Are You a Candidate for Obesity Surgery? Part 2

If you qualify for weight loss surgery, and have passed the medical and psychological tests, chances are you will undergo one of two common procedures- Rous-En-Y (pronounced roo en why) gastric bypass or adjustable gastric banding.

Rous-En-Y gastric bypass is the more invasive and complicated of the two procedures, but is highly effective. The average loss of excess weight (difference between actual weight and ideal weight) is somewhere between 65-75%. Moreover, the rate of improvement of co-morbid conditions such as diabetes, high blood pressure and high cholesterol are estimated at around 90%, 90% and 95% respectively. One study has also pointed to a 40% reduction in all-cause mortality although the incidence of accidents and suicides was higher in the bypass group when compared to a morbidly obese control population.

How Does it Work?
The procedure involves creating a pouch of stomach whose volume is no bigger than those small cups that come with over the counter liquid cold medicines (about 30 milliliters) and attaching it to the second part of the small intestine. This bypasses the end part of the stomach, the first portion of the small intestine known as the duodenum, and the very first part of the second portion of the small intestine known as the jejunum. The smaller stomach causes earlier satiety when eating and the bypass of the duodenum and jejunum causes decreased absorption of calories, leading to significant weight loss.

Possible Complications
However, because other vital nutrients are also absorbed in the duodenum and jejunum, dietary supplementation is often necessary to avoid deficiencies of vitamin B12, iron, calcium and vitamin D. Another potential complication is dumping syndrome (flushing, nausea, diarrhea and cramping) which comes from rapid emptying of the newly created stomach pouch into the jejunum. Some patients have also developed hypoglycemia (low blood sugar) and others have had pulmonary embolism (a blood clot in the lungs) as complications of the procedure. The overall perioperative mortality of the procedure is around 0.5%.

Adjustable gastric banding is a simpler though less effective procedure with fewer side effects. Essentially, a fluid filled band is laparoscopically placed around the first part of the stomach, restricting the size of the stomach and causing earlier satiety, decreased hunger and weight loss. Because the band is adjustable, it can be filled with more fluid by the surgeon to increase the degree of restriction on the stomach if the patient is not losing weight fast enough or not experiencing a significant decrease in hunger after the band is placed. The data on adjustable gastric banding are scant but excess weight loss is estimated between 50-65%. One trial which included patients who underwent adjustable gastric banding and had type 2 diabetes showed a 73% remission rate in the banding group compared with 13% with a medically treated group. The procedure has none of the malabsorptive side effects that the bypass method has. The perioperative mortality is 0.1% and complications usually stem from physical issues related to the band, such as slippage, erosion, vomiting and port site problems, all of which may require more surgery (albeit minor) to correct.