Dieting, exercise and medication have long been regarded as the conventional methods to achieve weight loss. Sometimes these efforts are successful in the short term. However, for 97% of people who are morbidly obese, the results do not last. For many, this can translate into what’s called the yo-yo diet syndrome, where patients continually gain and lose weight with the possibility of serious psychological and health consequences.

 

Sufferers from morbid obesity frequently re-gain more than what they lost on the diet plan. This is thought to be partially due to ghrelin, a hunger hormone, which increases during dieting and increases the body’s drive for more food. Recent research from the National Institutes of Health confirms that for patients with morbid obesity, conventional methods of weight loss generally fail to produce permanent weight loss. Several studies have shown that patients who go on diets, exercise programs or medication are able to lose approximately 10% of their body weight, but tend to regain two-thirds of it within one year and all of it within five years. Another study found that less than 5% of patients in weight-loss programs were able to maintain their reduced weight after 5 years.

 

The fact remains that morbid obesity is a complex, multifactorial chronic disease. According to NIH research, weight-loss surgery, when compared to other non-surgical interventions, is the only method that has been proven to be effective in the long term for most patients with clinically severe obesity.

 

 

Over the years, studies show that weight-loss surgery, with its inherent risks factored in, is the most successful and only clinically proven method for long-term management of morbid obesity. At 90 to 100 pounds overweight, the risk of dying from obesity is almost 10 times higher than the risk of dying from gastric bypass surgery

 

Surgical options have continued to evolve and the Alvarado Surgical Weight-Loss Program is pleased to offer patients the laparoscopic gastric bypass and gastric banding (Lap-Band) laparoscopic surgery options. The laparoscopic gastric bypass is recognized as the Gold Standard among surgical weight-loss procedures. Both the laparoscopic gastric bypass and the gastric banding provide a tool that can help achieve and maintain significant weight loss, improve health and enhance quality of life. Both procedures are potentially reversible, if the patient desires.

 

 

Gastric Banding: Approved by the FDA in 2001, gastric banding (or Lap-Band) is one of the least invasive treatments for morbid obesity. It induces weight loss by reducing the capacity of the stomach, which restricts the amount of food that can be consumed. Since its clinical introduction in 1993, almost 150,000 banding procedures have been performed around the world and more than 30,000 in the U.S. alone.

During the procedure, surgeons usually use laparoscopic techniques (using small incisions and long-shafted instruments) to implant an inflatable silicone band into the patient’s abdomen. Like a wristwatch, the band is fastened around the upper stomach to create a new, tiny stomach pouch that limits and controls the amount of food you eat. It also creates a small outlet that slows the emptying process into the residual stomach and intestines. As a result, patients experience an earlier sensation of fullness, making it easier for patients to lose weight by consuming less food.

 

Since there is no division of the stomach, the gastric banding procedure is described as being less traumatic compared to other weight-loss surgeries. As with the gastric bypass, the laparoscopic approach to the surgery offers the advantages of reduced post-operative pain, shortened hospital stay and quicker recovery.

 

To modify the size of the band, its inner surface can be inflated or deflated with a saline solution. The band is connected by tubing to an access port, which is placed below the skin on the upper abdomen during surgery. After the operation, the surgeon adjusts the amount of saline in the band by entering the port with a fine needle through the skin.

 

Generally, patients require at least 6-12 adjustments in the initial months after surgery to obtain the appropriate degree of “tightness” to feel full on an appropriate amount of food. The band may require further adjustments as months and years pass, so patients need to be committed to frequent doctor visits.

 

Gastric Bypass Roux-en-Y: The gastric bypass procedure is considered to be the most advanced and most successful procedure for weight-loss surgery. It is the most frequently performed U.S. weight-loss procedure. In this procedure, a small (15-20cc) stomach pouch is created (usual stomach is approximately 1,500cc or greater). The remainder of the stomach is not removed, but is completely divided from the smaller stomach pouch. The outlet from this newly formed stomach pouch is then connected directly to the jejunum, the first part of the small intestine where digestion takes place.

 

This connection bypasses calorie absorption in the duodenum, the first 12-inch section of the small intestine directly below the stomach. This is done by dividing the small intestine just beyond the duodenum and constructing a connection with the new, smaller stomach pouch. The remaining (large) stomach is connected into the digestive tract approximately 75cm downstream of the new stomach. This allows for the body to continue with normal absorption of nutrients in the small intestine, as the “large” stomach continues to make chemicals that are vital to the normal digestive process.

 

Gastric bypass is not a principally malabsorptive procedure. Gastric bypass is primarily a restrictive procedure, which gives the patient a feeling of fullness and satiety on a very small amount of food, with a very small degree of malabsorption. Gastric bypass is the only weight-loss operation that has been shown to reduce levels of ghrelin (the hunger hormone), which significantly reduces cravings for food, and results in “satiety” and not just “fullness.”

 

Malabsorptive procedures, such as the biliopancreatic diversion (BD) and duodenal switch (DS), have fallen out of favor due to high risk of complications and are, therefore, not offered at Alvarado.

 

Roux-en-Y gastric bypass can be done either as a laparoscopic (minimally invasive) or open procedure. The laparoscopic procedure is performed through five or six small incisions, rather than with one large incision, as with the open procedure. The laparoscopic approach leads to less discomfort, thereby allowing a faster recovery. If the laparoscopic gastric bypass is performed by a highly skilled surgeon, it has been shown to result in less complications than the open procedure.

 

U.S. studies show that the average maintained excess weight loss after gastric bypass is 50% to 75%. Success rates at Alvarado Hospital have been consistently higher than national averages. It is important to recognize that the long-term success with weight loss is widely variable, depending on choice of surgeon, surgical technique, patient compliance and commitment to aftercare.

 

Physician Referral and More Information

 

To be referrered to a bariatric surgeon or for more information on Alvarado Hospital's surgical weight-loss program, call 619-229-3334 or toll-free 800-ALVARADO (800-258-2723) or e-mail peggy.wilkinson@alvaradohospital.com.