Is weight-loss surgery right for you?
By Kevin Helling, M.D. Jan 18, 2017
Obesity is a disease. It affects more than 72 million Americans, including 28 percent of Wyoming adults. While it can be caused by a wide variety of lifestyle, genetic and metabolic factors, the associated health risks can be severe.
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Wyoming Medical Center's Weight Management Program offers a team approach to losing weight and keeping it off. But when non-surgical weight loss efforts have failed, consultation with a bariatric surgeon may be beneficial.
These may include Type 2 diabetes, high blood pressure, sleep apnea, high cholesterol, non-alcoholic fatty liver disease, arthritis, acid reflux or other gastrointestinal disorders and heart disease, not to mention depression and low self-esteem.
Who qualifies for bariatric surgery?
The National Institutes of Health have established qualification criteria for weight-loss surgery. The criteria are based on the Body Mass Index (BMI), which is a calculated ratio of weight to height. To qualify for weight-loss surgery, you must have:
- BMI of 40 or greater, or more than 100 pounds overweight, OR
- BMI of 35 or greater and at least one obesity related health problem, AND
- Inability to achieve sustained healthy weight loss despite prior weight-loss efforts.
Wyoming Medical Center offers two main surgical procedures for weight-loss: Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy.
What is Laparoscopic Roux-en-Y gastric bypass?
In the Roux-en-Y gastric bypass the surgeon creates a small, egg-sized stomach pouch. Then the small intestine is divided and connected to the newly created pouch in a configuration that bypasses the majority of the stomach, as shown in the diagram.
- How it works: Gastric bypass works to achieve weight loss and improve health conditions by a variety of mechanisms. First, the small size of the stomach pouch accommodates only small amounts of food. Second, the majority of the stomach and the initial segments of the small bowel are bypassed, preventing absorption of calories and nutrients in that portion of the intestine. Following gastric bypass, hunger hormone levels are drastically diminished leading to decreased desire to eat. Also, the hormones responsible for high blood sugar in diabetics are immediately altered, resulting in blood sugar normalization almost immediately following surgery.
- Advantages: Roux-en-Y gastric bypass is considered the gold standard of weight-loss operations because it causes the greatest weight loss and the most rapid and significant resolution of weight-related illness. Most patients typically lose about 70 to 80 percent of their excess body weight following the procedure.
- Disadvantages: Patients are committed to taking vitamins on a daily basis for the rest of their lives. Periodic blood tests are performed to check vitamin levels. Because the intestine is re-routed, complications can occur including leak at the connection sites, bowel obstruction and ulcer development.
What is Laparoscopic Sleeve Gastrectomy?
Laparoscopic sleeve gastrectomy is a highly effective surgical option for treatment of morbid obesity and has surpassed gastric bypass as the most commonly performed weight loss operation in the world. It involves the surgical removal of 80 to 90 percent of the stomach, leaving behind a small sleeve that resembles the sleeve of a shirt, as shown in the diagram.
- How it works: Sleeve gastrectomy has two primary mechanisms that cause weight loss. First, the small, thin stomach functions to limit the amount of food intake. Second, and most importantly, the portion of the stomach that is removed contains the majority of the cells that produce hunger hormones responsible for appetite stimulation. Similar to the gastric bypass, without hunger hormones patients have a drastically decreased urge to eat. Remission of diabetes also occurs rapidly following the sleeve gastrectomy by similar mechanisms.
- Advantages: One primary advantage of the sleeve over the bypass is that no re-routing of the GI tract is performed, which decreases the risk of post-operative complications. Patients who have the sleeve gastrectomy typically lose about 60 to 70 percent of their excess body weight.
- Disadvantages: Complications can rarely occur following sleeve gastrectomy and include narrowing or stricture of the sleeve, leak or acid reflux.
Dr. Helling is a general surgeon with a fellowship in advanced laparoscopy and weight-loss surgery.