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 San Antonio Weight
Loss Surgery
The idea of weight loss surgery,
or bariatric surgery, was developed in the 1950's and has
been revised over time to be a safe and effective treatment
for morbid obesity. The first laparoscopic gastric bypass
in history was performed by Dr. Alan Wittgrove of San Diego,
California (mentor to Dr. Cavazos, our medical director) in
1993. In 2005, an estimated 175,000 people in the United
States underwent bariatric surgery, according to the
American Society for Bariatric Surgery.
Currently, there are three basic approaches to weight loss
surgery: restrictive operations, malabsorptive operations,
and operations that are a combination of the two.
Restrictive procedures (such as a LapBand®)
simply restrict the amount of food that one can eat.
Malabsorptive procedures (such as an intestinal bypass)
allow patients to eat as much as they want, but the amount
of food that is absorbed by the intestine is decreased.
Combination procedures (such as a gastric bypass) are
partially restrictive and partially malabsorptive. Some
procedures give patients the feeling of satisfaction after
eating just a small amount of food.
Open vs. Laparoscopic
Procedures
Bariatric surgery may
be performed using an open technique (larger incision) or by
a laparoscopic technique. The laparoscopic technique is the
preferred method for most patients. It is a "minimally
invasive" approach that involves several very small
incisions.
It generally results in less scarring, less
pain, and a quicker recovery from surgery.
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Laparoscopy
Surgery |
Open
Surgery |
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Types of Weight Loss Surgery
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Risks
of Weight Loss Surgery
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Risks
include a small incidence of wound infection,
respiratory problems, blood clots, ulcers, spleen
injury, complications from anesthesia and medications,
gallstones, or stenosis.
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Nutritional deficiencies (i.e. anemia, osteoporosis,
metabolic bone disease) can occur, but they can be
avoided by taking vitamins and minerals regularly after
surgery.
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A very
small percentage of patients may develop a pulmonary
embolism (a blood clot that travels to the lungs),
respiratory failure, or a gastrointestinal leak. Our
surgeons and nurses take every possible step before,
during, and after surgery to prevent these
complications, but they can still occur in rare cases.
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A very small percentage of
patients may require follow-up operations in the future.
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The approximate risk of
death is 0.5% of patients undergoing weight loss surgery
in the United States.
What to Expect from Surgery
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According to long-term studies (those with at least 5
years of follow-up with patients), expected weight loss
after surgery is between 50 to 80% of the excess body
weight.
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A 2004
study in the Journal of the American Medical
Association found that bariatric surgery improved or
resolved type 2 diabetes, hypertension, sleep apnea and
high cholesterol in the vast majority of morbidly obese
patients. Key findings from the study include:
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Type
2 diabetes was resolved in more than 76 percent of
patients.
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Hypertension was resolved in more than 61 percent of
patients.
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Obstructive sleep apnea was resolved in more than 85
percent of patients.
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High
cholesterol levels decreased in more than 70 percent
of patients.
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Key
findings from a May 2004 Consensus Conference,
"Gastrointestinal Surgery for Severe Obesity," and
published in the April 2005 issue of the Journal of
the American College of Surgeons include:
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A study in
the September 2004 issue of the Annals of Surgery
found an 89 percent reduction in the risk of death in
patients who had bariatric surgery, compared to those who
did not, as well as a reduced risk for developing
cardiovascular disease, cancer, and endocrine, infectious,
psychiatric, and mental disorders, compared to those who did
not have bariatric surgery.
Am I a Candidate for Surgery
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Weight Loss surgery should be considered if a
person is morbidly obese and has failed weight loss through
diet and exercise. You are considered morbidly obese if you
are:
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More
than 100 pounds overweight
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Or, your
BMI (Body Mass Index) is 40 or greater
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Or, your
BMI is 35 or greater and you have severe obesity-related
co-morbidities.
Co-morbidities are serious medical conditions that are
associated with obesity. They include type 2 diabetes,
sleep apnea, hypertension, coronary heart disease, stroke,
osteoarthritis, asthma, high cholesterol, gastroesophageal
reflux disease (GERD), infertility, some types of cancer,
and many others.
Calculate your BMI
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The Body
Mass Index (BMI) is a calculation derived from your height
and weight. It is commonly used to categorize weight as
follows:
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Normal : |
BMI 18.0-24.9 |
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Overweight : |
BMI 25.0-29.9 |
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Obese : |
BMI 30.0-39.9 |
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Morbidly Obese : |
BMI 40.0 or
higher |
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Calculate your BMI
Prior Weight Loss
Surgery
If you have
had a weight loss surgery in the past and are still morbidly
obese, you may qualify for a "revision." Some revision
operations can be performed laparoscopically and some
cannot, due to scarring from the prior operation. You would
need to meet with one of our surgeons to discuss whether or
not this would be an option for you.
Smoking
Smoking can
increase your risk of having complications after an
operation. If you smoke, our program internist can help you
through the cessation process.
Age
There is not
necessarily an upper age limit for who is a potential
candidate for weight loss surgery. The risks and benefits
of having an operation will need to be considered on an
individual basis by your surgeon.
The youngest patients
to be considered for surgery are in their teens. Studies have demonstrated
that adolescents have excellent results after weight loss surgery.
Careful consultation with a pediatrician and perhaps other specialists,
as well as the involvement of parents, is a definite requirement.
Again, the surgeon will make the determination after consideration of
your medical history and input from all parties involved.
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