Surgeons first began to recognize
the potential for surgical weight loss while performing operations
that required the removal of large segments of a patient's stomach
and intestine. After the surgery, doctors noticed that in many cases
patients were unable to maintain their pre-surgical weight. With
further study, surgeons were able to recommend similar modifications
that safely could be used to produce weight loss in morbidly obese
patients. Over the last decade these procedures have continually been
refined to improve results and minimize risks.
Today's bariatric surgeons have access to a substantial body of
clinical data to help them determine which surgeries should be used
and why.
Today, the American Society for
Bariatric Surgery describes two basic approaches that weight loss
surgery takes to achieve change:
-
Restrictive procedures that
decrease food intake.
-
Malabsorptive procedures that
alter digestion, thus causing the food to be poorly digested and
incompletely absorbed so that it is eliminated in the stool.
::
Restrictive Procedures
::
Malabsorptive Procedures that Alter
Digestion
Restrictive Procedures
The theory is simple. When you feel full, you are more likely to
have reduced feelings of hunger and will no longer feel deprived.
The result is that you are likely to eat less. Restrictive weight
loss surgery works by reducing the amount of food consumed at one
time. It does not, however, interfere with the normal absorption
(digestion) of food. In a restrictive procedure, the surgeon creates
a smaller upper stomach pouch. The pouch, with a capacity of
approximately 1/2 to one ounce (15 to 30 ml), connects to the rest of
the stomach through an outlet known as a "stoma." In a cooperative
and compliant patient, the reduced stomach capacity, along with
behavioral changes, can result in consistently lower caloric intake
and consistent weight loss.
During recovery, patients must adhere to the strict specific dietary
guidelines and restrictions their surgeon prescribes. While these
guidelines may vary from one surgeon to the next, it is important
for each patient to follow the surgeon's guidelines. When the time
comes to resume eating "regular" food, the patient must learn to
adapt to a new way of eating. At each meal, they are restricted to
consuming approximately 1/2 to a full cup of food before feeling
uncomfortably full. Patients who see the best results from a
restrictive procedure are those who learn to eat slowly, eat less,
and avoid drinking too many fluids, particularly carbonated
beverages. If the patient fails to follow these guidelines, they can
stretch the stomach pouch and/or the stoma outlet and defeat the
purpose of the surgery. The effectiveness of a restrictive procedure
is reduced by constant snacking or by drinking high-calorie,
high-fat liquids. Failure to achieve the expected level of weight
loss is usually the result of a patient failing to comply with the
recommended dietary and behavior modifications, such as increased
exercise and regular support group attendance.
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Malabsorptive Procedures that Alter
Digestion
It can be said that some of the restrictive approaches discussed
above have not always achieved the excess weight loss surgeons and
patients anticipated. For this reason, procedures that alter
digestion, known as malabsorptive procedures, were developed to work
in conjunction with restrictive approaches. Some of these techniques
involve a bypass of the small intestine, thus limiting the
absorption of calories. On balance, malabsorptive or malabsorptive/restrictive
procedures have resulted in an overall increase in the loss of
excess weight. The risk of complications and side effects generally
increases with the lengthening of the small intestine bypass. You
and your surgeon must determine the risks and benefits over your
lifetime with the type of weight loss surgery you choose.
Basically, weight loss operations fall into three categories:
-
Restrictive procedures make the
stomach smaller to limit the amount of food intake.
-
Malabsorptive techniques reduce
the amount of intestine that comes in contact with food so that the
body absorbs fewer calories.
-
Combination operations take
advantage of both restriction and malabsorption.
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