Weight Loss Surgery to Reduce Obesity

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Surgical procedures that are used to treat obesity include gastric bypass and gastric partitioning (also called stomach stapling).

These are both drastic measures that are normally used only when more conventional weight loss methods have failed and the patient’s health is compromised by his/her weight.

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The gastric bypass procedure involves stitching or stapling across the entire width of the stomach, closing off the bottom portion of the stomach and leaving only a fraction of the upper part of the stomach open to receive food. A small opening is made in this remaining “pouch” of stomach; the jejunum (a part of the small intestine) is brought up and attached to this small opening. As a result, all food and fluids ingested by the patient must now pass through this small opening in the top of the stomach and then directly to the attached small intestine.

The stomach stapling surgery also uses staples or stitches to close off part of the stomach, but in this procedure, the staples or stitches are not placed across the entire width of the stomach. A small opening, about 1/8 to 1/4 inch (.3-.7 cm) in diameter, is left through which food can pass into the lower portion of the stomach and then into the small intestine as usual.

Both of these procedures reduce the size of the stomach so that only very small amounts of food can be stored in it at any given time; the patient feels full after eating tiny portions of food. Because the opening into the remainder of the digestive tract is also reduced in size, food must be chewed very thoroughly (or pureed) so that it will pass through the opening. Attempting to eat too much at one sitting, or failure to chew food slowly and thoroughly can result in upset stomach and vomiting.

Weight loss following surgery is dramatic: 26-44 lb. (12-20 kg.) in the first month, with total weight losses of 50 lb. (23 kg.) or more being quite common.

However, neither of these surgical procedures should be viewed as a quick or easy fix to a lifetime of obesity. Because the surgery drastically decreases the amount of food that the patient can eat, special care must be taken following the surgery to ensure that the patient consumes a nutritious diet which is low in fat and has adequate amounts of vitamins, minerals, and fiber.

The patient must also accept the necessity of eating small meals and chewing food completely to prevent regurgitation. Some patients find themselves unable to tolerate the discomfort created by gas-producing foods such as carbonated beverages.

Neither procedure is without risks. As in any major surgery, bleeding, infection, and anesthesia-related complications are possible. Increased occurrence of gallstones, vitamin deficiencies, and occasional stomach ulcers have also been reported, although patients who have undergone the stomach stapling procedure seem to be affected by these complications less often than are gastric bypass patients.

Neither operation is foolproof, either – the size of the upper “pouch” of stomach can increase with time, as can the size of the opening left following stomach stapling. Either of these occurrences can allow the patient to eat more without feeling bloated or experiencing vomiting, and can result in gradual weight regain.

It is also possible for patients to regain weight by consuming high-calorie foods such as milkshakes which will pass through the opening.

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