Surgery – Weight Loss

The first step to achieving your weight-loss goals is to learn about obesity, weight-loss and bariatric surgeries. In this section, you will learn why weight-loss is important, why individuals choose weight-loss surgery, and how a weight-loss surgeon decides upon on the type of surgical procedure.

The extensive information published by the American Society of Metabolic and Bariatric Surgery is a great place to start.

Aged over 18 years.

BMI>40 without or >35 with obesity related health conditions.

Metabolic syndrome conditions (BMI>30) including high blood pressure, high triglycerides (lipids) and diabetes/insulin resistance.

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This is a restrictive procedure. The stomach is reduced in size from a sac shape to a tube that holds around 150ml. It involves removal of over ¾ of the stomach, which is divided with a special stapling device. It used to be the first stage of the BPD bypass procedure but has been performed as a stand alone procedure for over 5 years. The operation significantly reduces hunger by reducing levels of the hormone “Ghrelin” which is predominantly produced in the upper stomach and is removed during this procedure.

• Keyhole surgery usually takes just over 1 hour and requires 3-4 days in hospital
• No adjustments required
• No foreign material to get infected or leak
• No fixed obstruction for food to get stuck
• Normal dietary intake by the majority of patients
• No malabsorption
• Significantly safer than Bypass surgery
• More effective and better tolerated than Gastric Banding
• Reliable – provided you follow a sensible diet and exercise regularly then good results are expected
• Low risk of requiring further surgery

• Not reversible (however most people considering weight loss surgery are after a permanent solution)
• Risk of leakage from the staple line (<1%) in the first 2 weeks is a major potential complication, which may require further surgery and intensive care

• Those who want to not only feel full earlier, as with the procedures, but quiet their food cravings as well thanks to hormonal changes triggered by the surgery
• Calorie counters: The procedure modifies the digestive system so it won’t process as many calories as before

• 60-70% average excess weight loss (EWL) at 1 year

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This is a restrictive procedure. The stomach is reduced in size from a sac shape to a tube that holds around 150ml. It involves removal of over ¾ of the stomach, which is divided with a special stapling device. It used to be the first stage of the BPD bypass procedure but has been performed as a stand alone procedure for over 5 years. The operation significantly reduces hunger by reducing levels of the hormone “Ghrelin” which is predominantly produced in the upper stomach and is removed during this procedure.

• Highly effective for weight loss and diabetes
• Effectively stops bile and gastric reflux
• Gastric bypass patients may experience dumping syndrome, a very uncomfortable result of consuming high fat and high sugar foods.

• More complex surgery with higher risks
• Mild malabsorption which requires lifelong nutritional supplementation and annual screening blood tests to prevent vitamin and mineral deficiency
• Potential for anastomotic stricture, ulcers, pouch dilatation
• Small future risk of internal hernias causing bowel obstruction which can require emergency surgery and may be life-threatening
• Further revision surgery is difficult with limited options

• Those who want to not only feel full earlier, as with the procedures, but quiet their food cravings as well thanks to hormonal changes triggered by the surgery
• Calorie counters: The procedure modifies the digestive system so it won’t process as many calories as before

• 70% average excess weight loss at 1-2 years

• Gastric bypass patients typically only need to stay 1-2 nights in hospital.
• Most patients recover fully in 2 to 4 weeks.

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Whilst some patients have had excellent results with adjustable gastric banding, unfortunately, side effects and complications are becoming increasingly common.

These Include:

• Reflux, Regurgitation, Vomiting
• Inability to eat healthy foods
• Maladaptive diet

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