Morbidly Obese vs. Upwardly Mobile: Minimally Invasive Surgeries Offer New Hope

Laparoscopic Surgery:

First Choice for “Last Resort” Treatment Two Choices. One Goal. What are the Results?

There are many young to middle-aged adults whose health is being jeopardized by morbid obesity, people who are at least 100 pounds overweight or twice their ideal weight. This excess weight often limits their ability to succeed and move ahead in both business and social situations. They also risk such life-threatening conditions as diabetes, cardiovascular disease, hypertension, orthopedic problems, gall bladder disease and sleep apnea. While numerous medical therapeutic approaches to morbid obesity have been advocated, including low-calorie diets, drugs, behavioral modification and exercise therapy, the majority of patients fail to maintain the reduced body weight. The only treatment proven effective in the long-term management of morbid obesity is bariatric surgery, such as a laparoscopic gastric bypass or laparoscopic adjustable gastric banding procedure

Laparoscopic Surgery: First Choice for "Last Resort" Treatment Many morbidly obese patients are reluctant to undergo gastric bypass surgery-traditionally an open, invasive procedure. But thanks to the new, minimally invasive surgical techniques, this "last-resort" treatment has become more appealing.

By laparoscopy, the surgeon performs the same operation as in open surgery, but through small incisions.
Tiny slits in the abdomen allow a surgeon to insert a camera-equipped scope and surgical instruments to perform surgical procedures less invasively. Laparoscopic techniques are equally successful and offer many added patient benefits. These benefits include less post-operative pain, reduced risk of wound infection, a shorter hospital stay, faster recovery and a more rapid improvement in quality of life.

Two Choices. One Goal.

There are two types of laparoscopic surgeries that are popular to treat extreme weight loss.

The most commonly known, Roux-en-Y gastric bypass, involves refashioning the stomach into a small pouch and bypassing part of the small intestine. This not only limits the absorption of food but also produces a feeling of fullness with a small meal.

Roux-en-Y gastric bypass has been used for years with clinical results attesting to its effectiveness. The procedure is irreversible and patients are advised to thoroughly evaluate its risk factors before surgery.

A less extreme alternative is the Lap-Band Surgery, or adjustable gastric banding. Approved by the FDA, the procedure involves less risk than the Roux-en-Y. Instead of bypassing the stomach, a balloon-like device is banded around the stomach to produce a small upper gastric pouch, which causes an early feeling of fullness and satiety after a small meal. The balloon - like device is inserted through a small incision and inflated to cinch the stomach and limit its capacity. The operation takes about 60 minutes and usually requires a one-day hospital stay. The band can later be tightened or loosened as needed—without further surgery—by adjusting the amount of solution through a portal under the patient’s skin. The device can even be removed entirely if necessary.

Reduced risk, simplicity and reversibility make the Lap-Band very attractive

What are the Results?

Results depend on a variety of factors and vary with each patient.
Most gastric bypass patients experience fairly rapid weight loss in the first three to six months after surgery. Weight loss slows, but generally continues up to 12 to 18 months after surgery, averaging 70 to 75 percent of excess body weight.

With the Lap-Band, weight loss is generally slower and more gradual compared to the gastric bypass. Typically, patients lose up to 55 percent of their excess body weight within 18 months following laparoscopic adjustable Gastric Banding Surgery. The normal hospital stay for Lap-Band patients is one day with a return to most activities in seven days.

Regardless of the procedure, it requires a team approach to solving a patient’s weight problem. This includes a comprehensive evaluation, as well as psychological and emotional support before and after surgery for the greatest chance of weight loss success. The operation itself is not the whole answer. A multidisciplinary approach—surgeon, internist, dietician and psychiatrist—is needed to help the patient lose and keep weight off. The goal is not only weight loss, but the reversal of serious medical conditions.