National Institute of Health consensus conference has concluded that surgery is the only effective treatment for long-term and sustained weight loss which results in improvement and/or resolution of co morbid conditions, improved quality of life and self-esteem, and increase in longevity.
The most common question people ask is - what is Obesity surgery? Is it same as liposuction?
No! Liposuction is a surface surgery performed to remove extra unwanted fat from different part of body; this is basically a surgery for body sculpturing not weight loss, where as obesity (Bariatric Surgery) gives options for the treatment of this disease evolved into three categories, restrictive procedures, e.g. Gastric band, sleeve Gastrectomy, malabsorptive procedures, eg. Bilio-pancreatic diversion with or without duodenal switch and combined procedures, e.g. Roux-en-Y-gastric bypass (RYGB). Hence, selection of the procedure has to be individualized based on the age, BMI, presence or absence of co morbidities, patient's preference and compliance, surgeons experience etc. However, the experience of the bariatric surgeon is the most crucial in selecting the right procedure for an individual.
Starting from the top we will explain the anatomy of the digestive system to understand how the operation works:
Mouth: Entry point for food; teeth and tongue chew food and move it to the back of the throat for swallowing. The enzyme amylase starts digestion of starches and sugars (carbohydrates).
Esophagus: Carries food to the stomach. It has no digestive function.
Stomach: Holds food and mixes it with acid and saliva. It has no absorptive function.
Pylorus: The valve that controls the emptying of the stomach. It helps to prevent "dumping syndrome".
Small Bowel: This tube, 5 meters (15-30 feet) in length, lies in between the pylorus and the large bowel (the colon). 95% of digestion is carried out here and it is the most important part of the digestive system. It is divided in 3 parts:
Duodenum: Two feet long (60 cm). Bile from the liver and pancreatic enzymes (the digestive juices) enters this segment.
Jejunum: The middle portion of the small bowel.
Ileum: The lower portion.
The jejunum and ileum are the sections where carbohydrates, proteins and fats are absorbed, as well as vitamins and minerals. Iron and Calcium are absorbed in the duodenum.
Large bowel: Starts at the end of the small bowel. Its main function is absorption of water and holding the stools. Nutrients are not absorbed here. The appendix joins the bowel at its beginning.
Liver: Nutrients absorbed from the small bowel go to the liver via the portal veins. Secretes the bile necessary for fat digestion.
Pancreas: Secretes the enzymes necessary to digest carbohydrates, proteins and fats.
Digestion stars in the mouth with saliva's amylase. Food travels to the stomach where it is held, and mixed with acid. It starts to break down here. Stomach emptying is regulated by the pylorus. Digestion and absorption happen in the small bowel when food is acted upon by bile from the liver and pancreatic enzymes. Water is absorbed in the colon and waste is excreted through the rectum.
Restrictive and Malabsorptive Procedures
There are two basic mechanisms of weight loss surgery.
Restrictive procedures decrease food intake by creating a small upper stomach pouch to limit food intake.
Malabsorptive procedures alter digestion, thus causing the food to be properly digested and completely absorbed. There are several procedures that combine the restrictive and malabsorptive mechanisms of weight loss surgery.
"The only way you can truly get more out of life for yourself is to give part of yourself away."
The actual weight a patient will lose after the operation depends upon several factors. These include:
Weight before Surgery
Overall Condition of Patient's Health
Ability to Exercise
Commitment to Maintaining Dietary Guidelines and other Follow-up Care
Motivation of Patient and Cooperation of Family, Friends and Associates
A recent study established the following criteria for successful bariatric surgery: "the ability to achieve and maintain loss of at least 50 percent of excess body weight without having significant adverse effects".
Clinical studies show that, following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Patients may lose 30 to 50 percent of their excess weight in the first six months, and 77 percent of excess weight as early as 12 months after surgery. Many patients with Type II Diabetes, while showing less overall excess weight loss, have demonstrated excellent resolution of their diabetic condition, to the point of having little or no need for continuing medication.
A comprehensive clinical review of bariatric surgery data showed that patients who underwent a bariatric surgical procedure experienced complete resolution or improvement of their co-morbid conditions including diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea etc.
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