Weight Loss Surgery Procedures - Which is Right for You?
Courtesy of Ehticon Endo Surgery

The most important step in weight loss surgery is getting all of the information you need about the various surgical options. Ultimately your bariatric surgeon and other physicians are your best resource for information about the procedure they will recommend to you for weight loss. When you ask a question, make sure you understand the answer. Do not hesitate to ask for a clearer explanation given in simpler language. The decision to have a weight loss surgical procedure may take several visits to their offices and consultation with more than one doctor. Ask your doctor for names of other patients who have had similar weight loss surgeries and who are willing to discuss their experiences, good and bad, with you.

You may choose to research weight loss surgery on your own via the Internet or through your local library. As with any search for medical information, be sure that your sources are responsible, recognized experts in the field you are investigating. An excellent resource for weight loss surgery is the American Society for Bariatric Surgery. You'll find the information on how to contact the ASBS in   section of this site.

Although the results of weight loss surgery can be drastic, there are potential risks and complications. Before making your decision, you should be well informed. These steps are necessary if you are to give what is called "informed consent" for the surgical procedure. Informed consent is a legal term meaning that a patient agrees that they have received and understood enough information about a procedure's benefits and risks to allow them to make a decision that is right for them. Your bariatric surgeon will require you to sign a consent form before performing your procedure. Before you sign a consent form, you should have a solid understanding of what is about to take place. You should know what you would need to do to live well after the operation. And you should be aware of the signs or symptoms of complications to look for which may occur after your weight loss surgery.

How Weight Loss Surgery Reduces Weight

Bariatric surgeons first began to recognize the potential for surgical weight loss while performing operations that required the removal of large segments of a patient's stomach and intestine. After the surgery, doctors noticed that in many cases patients were unable to maintain their pre-surgical weight. With further study, bariatric surgeons were able to recommend similar modifications that could be safely used to produce weight loss in morbidly obese patients. Over the last decade these procedures have been continually refined in order to improve results and minimize risks. Today's bariatric surgeons have access to a substantial body of clinical data to help them determine which weight loss surgeries should be used and why.

 

Today, the American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:

  • Restrictive procedures that decrease food intake
  • Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool

 

Restrictive Procedures

The theory is simple. When you feel full, you are more likely to have reduced feelings of hunger and will no longer feel deprived. The result is that you are likely to eat less. Restrictive weight loss surgery works by reducing the amount of food consumed at one time. It does not, however, interfere with the normal absorption (digestion) of food. In a restrictive weight loss procedure, the surgeon creates a smaller upper stomach pouch. The pouch, with a capacity of approximately 1/2 to 1 oz. (15 to 30 ml), connects to the rest of the stomach through an outlet known as a "stoma." In a cooperative and compliant patient, the reduced stomach capacity, along with behavioral changes, can result in consistently lower caloric intake and consistent weight loss.

During recovery, patients must adhere to the strict specific dietary guidelines and restrictions their bariatric surgeon prescribes. While these guidelines may vary from one surgeon to the next, it is important for each patient to follow the surgeon's guidelines. When the time comes to resume eating "regular" food, the patient must learn to adapt to a new way of eating. At each meal, they are restricted to consuming approximately 1/2 to a full cup of food before feeling uncomfortably full. Patients who see the best results from a restrictive weight loss procedure are those who learn to eat slowly, eat less, and avoid drinking too many fluids, particularly carbonated beverages. If the patient fails to follow these guidelines, they can stretch the stomach pouch and/or the stoma outlet and defeat the purpose of the surgery. The effectiveness of a restrictive procedure is reduced by constant snacking or by drinking high-calorie, high-fat liquids. Failure to achieve the expected level of weight loss is usually the result of a patient failing to comply with the recommended dietary and behavior modifications, such as increased exercise and regular support group attendance.

 

The Gastrointestinal Tract

To better understand how weight loss surgery works, it is important to understand how your gastrointestinal tract functions. As the food you consume moves through the gastrointestinal tract, various digestive juices and enzymes are introduced at specific stages that allow absorption of nutrients. Food material that is not absorbed is then prepared for elimination. A simplified description of the gastrointestinal tract appears below. Your doctor can provide a more detailed description to help you better understand how weight loss surgery works.

  1. The esophagus is a long muscular tube, which moves food from the mouth to the stomach.
  2. The abdomen contains all of the digestive organs.
  3. The stomach, situated at the top of the abdomen, normally holds just over 3 pints (about 1500 ml) of food from a single meal. Here the food is mixed with an acid that is produced to assist in digestion. In the stomach, acid and other digestive juices are added to the ingested food to facilitate breakdown of complex proteins, fats and carbohydrates into small, more absorbable units.
  4. A valve at the entrance to the stomach from the esophagus allows the food to enter while keeping the acid-laden food from "refluxing" back into the esophagus, causing damage and pain.
  5. The pylorus is a small round muscle located at the outlet of the stomach and the entrance to the duodenum (the first section of the small intestine). It closes the stomach outlet while food is being digested into a smaller, more easily absorbed form. When food is properly digested, the pylorus opens and allows the contents of the stomach into the duodenum.
  6. The small intestine is about 15 to 20 feet long (4.5 to 6 meters) and is where the majority of the absorption of the nutrients from food takes place. The small intestine is made up of three sections: the duodenum, the jejunum and the ileum.
  7. The duodenum is the first section of the small intestine and is where the food is mixed with bile produced by the liver and with other juices from the pancreas. This is where much of the iron and calcium is absorbed.
  8. The jejunum is the middle part of the small intestine extending from the duodenum to the ileum; it is responsible for digestion.
  9. The last segment of the intestine, the ileum, is where the absorption of fat-soluble vitamins A, D, E and K and other nutrients are absorbed.
  10. Another valve separates the small and large intestines to keep bacteria-laden colon contents from coming back into the small intestine.
  11. In the large intestines, excess fluids are absorbed and a firm stool is formed. The colon may absorb protein, when necessary.