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Weight Loss Surgery

September 14th, 2010 · No Comments

Weight Loss Surgery: Extreme Medical Intervention for When Lives Are.
For most of us, those extra pounds we need to lose are a hassle – inconvenient and unwanted, a little pesky reminder of our overindulgences. For some, though, excess weight is not only inconvenient, it is actually life threatening. Weight Loss Surgery (WLS) is offering some of these people a new chance at life.

Who Is a Candidate for Weight Loss Surgery?

Persons who are “morbidly obese” (typically defined as having a BMI of 35 or greater, generally meaning at least 100 pounds over their recommended weight range) may be at risk for significant health effects. These include increased risk of hypertension, high blood pressure, heart disease, heart attack, sleep apnea, diabetes, arthritis, back pain and certain forms of cancer. In addition, the excess weight limits the lifestyle of many people, making simple everyday tasks challenging – and in some cases, impossible.

Weight Loss Surgery is a desperate and permanent attempt to correct what dieting and exercise cannot. Physicians screen their patients rigorously before referring them for WLS – this is not a diet drug, to be dispensed readily. However, some patients have metabolic issues and cannot lose the weight, either due to their genetics or to the effects of years of restricted dieting, or both. When normal dieting fails, and the patient reaches a point where their everyday lifestyle is dramatically affected and their life is actually at risk because of their weight, WLS may be considered.

What Is Weight Loss Surgery?

Normally, a human will have approximately 20 feet of small intestine (comprised of the ileum and the jejunum). The duodenum connects the stomach to the jejunum, and the ileum feeds into the colon. In the WLS procedure, the surgeon bypasses part or all of the small intestine using surgical staples to form a small pouch out of the stomach.

There are two major types of Weight Loss Surgery, which is also called Bariatric Surgery. Both of these are dramatically different from the old “stomach stapling” of 20 years ago. Nonetheless, they are still not without risks.

The first is called a Roux-En-Y Gastric Bypass (RNY) and is the most common technique. In this procedure, the surgeon actually staples off the majority of the stomach area. A small pouch is left intact, and this is connected with the digestive tract, bypassing the duodenum and part of the jejunum. Approximately three to five feet of small intestine are bypassed. In the Fobi Pouch technique, the stomach is left attached. Other variations dissect and remove the unused stomach.

In a far less common procedure, the Extensive Gastric Bypass procedure, almost the entire small intestine is bypassed. Approximately 15 feet of small intestine is bypassed after the surgically segmented into a much smaller pouch, the extra stomach is removed. In a variation of this called the Duodenal Switch, a small portion of the duodenum is left attached to help reduce “dumping syndrome.” In general, weight loss is more rapid with the Extensive Gastric Bypass; however, some physicians worry about nutritional deficiencies with this form of the surgery.

Vertical Gastric Banding (VBG), where physical bands are placed to create the pouch but no small intestine is bypassed, is an older technique that is rarely performed anymore. The complications with this procedure are similar to the RNY technique, plus some patients complained about discomfort from the bands themselves.

Some surgeons will perform these procedures laparoscopically (that is, through tiny incisions using large telescopes and long-handled instruments) instead of through the large abdominal incision that is typical. This is a far more advanced procedure and requires additional skill and technique to perform correctly; in addition, patients with adhesions (internal scar tissues) from previous surgeries or infections may not be candidates for laparoscopic surgery. In the end, the best procedure is the one your surgeon is the most skilled at performing!

Recovering From Weight Loss Surgery

Life after WLS can be a huge adjustment. Initially, patients are kept for several days in the hospital. Upon returning home, they must adapt to eating very small meals. Because the stomach is literally only a fraction of its previous size, WLS patients can only eat very small amounts at one time. A steak and potatoes dinner is not only unhealthy for them, but is literally impossible to eat. The stomach pouch initially can only hold two tablespoons of food at one time; it eventually stretches until it can hold ? to 1 cup of food – still not a lot!

Furthermore, because some of the food passes through the small intestine undigested, and one of the areas that was removed helped finish the digestion and absorption process, the patient literally cannot handle a large volume of food. Overeating will generally result in vomiting, as the patient’s system is unable to process this volume of food at one time. Because of the body’s basic metabolic needs, though, these small meals cannot sustain them, so patients must learn to eat more frequent small meals and regular small, healthy snacks.

The foods that are well tolerated by the WLS patient are generally those that are relatively bland, and not excessively sweet or high in fat. Learning what your body will and won’t tolerate is somewhat of a matter of trial and error; however, a list of healthy alternatives and suggested volumes is provided. Food must be well chewed, especially anything fibrous, as the digestive system is severely shortened. Vitamin supplements are needed to replace the body’s ability to absorb nutritional vitamins during the digestion process.

There are online support groups as well for WLS patients. Unlike traditional “diets,” Weight Loss Surgery is permanent and dramatically lifestyle changing. Those who have gone through the surgery can provide insight into strategies on making the adjustment more smoothly. They can give new WLS advice, tips and hints on proper nutrition, physical recovery, what to expect, etc.

Does it Work?

While WLS is clearly not for everyone, I have four friends who have been through this procedure. All were (prior to their surgery) “morbidly obese” and all had been diagnosed as high-risk due to their weight. In every case, the WLS required a significant lifestyle adjustment, both in activity level and in meal planning and preparation.

All four of my friends have lost significant amounts of weight. Two have lost over 100 pounds each, and one is nearing that number. The fourth has lost about 60 pounds but says she has more energy and self-esteem now than she ever remembers having before. Two of the four had fairly long (physical) recoveries, and one was hospitalized with post-surgical complications (which cleared fairly quickly but were of a serious nature at the time).

The weight loss is rapid – generally patients will lose their weight over 12 – 24 months. Patients must work with their physicians to monitor their diets, and make sure that their weight loss patterns are normal and healthy for them as individuals. What one person experiences may be totally different than what another experiences, weight loss wise.

All four of my friends who had WLS are able to do physical activities and be involved in their children’s lives in ways that were never physically possible before, and two of the four have started formal exercise programs. They have commented on their increased energy levels, and all have increased self-esteem levels. They are unanimously enjoying watching their bodies “shrink!” One thing to consider is that the changes are relatively dramatic, and that your friends and co-workers will definitely notice the changes (over time, at least). You also will not be able to partake in large social lunches or dinners; you will need to stay on your special diet (quantity wise) for the rest of your life. This may be embarrassing if you are a very private person; however, the potential health benefits of lowered body mass will hopefully help you overcome your embarrassment at leaving most of your lunch untouched. One friend says that she and her husband order a full meal and split it between the two of them (they both had WLS) and still usually have leftovers to take home.

Is Weight Loss Surgery Right for You?

Bariatric surgery should never be considered as a first attempt to lose weight. This is a serious and permanent change, and like any major surgery, has serious and potentially deadly risks associated with it. This is a procedure that should be considered a “last resort” – for persons who are unable to control their weight through normal means (diet, exercise and even prescription medication) and who face serious health risks if their weight issues are not resolved fairly quickly.

Some complications of WLS include development of gallstones, abdominal hernias, development of “aprons” (excess skin tissue that hangs loosely on the abdomen), nutritional deficiencies.

If you are considering WLS, I would strongly advise you to research the matter thoroughly. If you have tried exercise, dieting and even medication to no avail, you may want to discuss WLS with your doctor to see if you are a candidate. Talk to your doctor about the pros and cons, and weigh the risks of the surgery and the pain of recovery (and the permanent lifestyle change required) with the risk of keeping the weight on.

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