Surgical Treatment of Obesity: |
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Post-operatively, the patient must be followed by physicians who are familiar with the long term complications and required long term treatment; the effectiveness of the surgery is fair, with loss of 40 to 50% of excess body weight with generally 50% of the weight loss being maintained after 5 years; though, it is common for the body weight to slowly increase after the first or second year. The surgery requires a modified diet to prevent Nausea and Vomiting and to help prevent other long term side effects; additionally, one can partially bypass the restriction by eating calorie dense liquids such as ice cream or regular soda, but long term changes in eating habits must take place in order for the surgery to be successful. |
Gastric 'Stomach' Restrictive Procedures (GRP) - Laparoscopic Gastric Banding (LGB):
Another restrictive gastric approach is LGB; this procedure, which was approved in the US in June 2001, is popular since it is high tech and utilises a Laparoscope, an instrument which is inserted into the abdominal cavity, and recovery time is only a few days; basically, an adjustable band is placed around the upper portion of the stomach, essentially resulting in a much smaller stomach; which restricts the amount of food that can be eaten, similar to the VBG. Weight loss and complications are similar to that seen with VBG, but with added complications such as Band Slippage, Erosion of the Band into the stomach, Dilation of the Esophagus and Infections, many of which require removal of the device. |
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Combination Restrictive/Malabsorptive Procedures - Roux-en-Y Gastric Bypass: The Roux-en-Y Gastric Bypass procedure involves both a Restrictive procedure by decreasing the size of the stomach by stapling across the top of it and a Malabsorptive component, achieved by bringing up and attaching a portion of the small intestine directly to the stomach, thus bypassing part of the small intestine; this surgery often results in significant long term Nutritional Deficiencis. This procedure usually results in mild malabsorption of nutrients and causes Gastrointestinal Hormonal Changes, which result in decreased hunger and improved satiety or fullness; patients undergoing this surgery will lose significant amounts of weight, mainly body fat as opposed to lean body mass or muscle tissue; weight maintenance is generally excellent with small increases in weight occurring over subsequent years. However, like any obesity surgery, the patient will require lifelong medical follow up and treatment of the medical complications that usually occur, like those listed earlier, especially the Vitamin B12 Deficiency and Anemia. |
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Sleeve Gastrectomy: This Laparoscopic procedure, which is not reversible, reduces the stomach to about 25% of its original size, by the surgical removal of a large portion of the stomach, which follows the major curve; the open edges are automatically stapled together as the stomach is cut to form a sleeve or tube with a banana shape; the procedure permanently reduces the size of the stomach. This surgery is a proven method of weight loss when combined with a supervised diet, increased activity and behaviour modifications; it can lead to long term weight loss and the associated health benefits; however, it results in a severe restriction of your capacity to eat solid food and the patient must remain under medical follow-up for the rest of their life, with several visits in the first year and at least an annual visit thereafter. |
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Biliopancreatic Bypass Procedures & Similar Extensive Intestinal Bypass Procedures: In these procedures, the digestive juices from the liver and pancreas are diverted to the distal small intestine near the entrance to the large intestine; thus, food that enters the stomach, rapidly transverses the distal small intestine, where the absorption of nutrients primarily occurs, and is then delivered to the large intestine, where the excess water from the stool is removed. This bypass results in a marked malabsorption of nutrients with a subsequent marked weight loss of up to 80% of excess body weight; since there is a marked malabsorption of essential nutrients, the probability of Vitamin, mineral, and protein-calorie malnutrition is significant; these procedures are generally best avoided since the marked nutrient malabsorption can result in severe long term complications. These procedures are normally performed laparoscopically; Laparoscopic surgery, also called minimally invasive surgery, bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions, usually about 0.5 to 1.5 cms. |
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