Three Surgeries
Bariatric surgery, an umbrella term for several types of weight loss surgery, has evolved during the 50 years it has been available. No longer performed are the 1950s-era intestinal bypass, 30,000 of which had to be reversed due to liver failure and kidney stones, and the 1960s-era stomach stapling technique, which made bile back up into the esophagus.
When researching her options, Paige looked at three types of procedures currently available today: one that restricts the amount of food that can be eaten, one that alters the digestive process so that not all calories are absorbed, and one that is a combination of both. Although some procedures induce more weight loss than others, overall, people who have bariatric surgery lose an average of 62 percent of their excess weight, according to a 2004 review of 136 studies and more than 22,000 patients published in the Journal of the American Medical Association (JAMA).
All three procedures can be done laparoscopically, which requires only a few small incisions for the surgical tools, including a small video camera, to be inserted, giving the surgeon a close-up view on a video screen. Because there’s no need for a large abdominal incision with laparoscopic surgeries, there is less healing time and fewer infections and other complications. What were Paige’s options? Here’s an overview:
1. Laparoscopic adjustable gastric banding (lap-band surgery)
Type of procedure: Restrictive
How it’s done: An adjustable plastic band is placed around the top portion of the stomach, leaving a small golf-ball-sized pouch. A port lying just under the skin of the abdomen allows saline solution to be injected into or withdrawn from the band to tighten or loosen it. Restricting the size of the stomach requires people to eat far less than they normally would.
Risks: The band may slip or move, and the port may leak or twist, which could make another surgery necessary. The band may also grow into the stomach tissue, causing complications that require the band to be surgically removed.
2. The “duodenal switch” procedure
Type of procedure: Malabsorptive
How it’s done: This procedure changes the stomach from a pouch-like structure to a tube and connects the duodenum, the first part of the small intestine, to the lower part of the small intestine. With this procedure, more food can be eaten than with gastric banding; weight loss occurs because food bypasses a portion of intestine, causing malabsorption. Of the three procedures, this one can cause the greatest weight loss.
Risks: Chronic malabsorption means blood levels of nutrients, such as protein, and minerals, such as iron and calcium, must be monitored for life to prevent muscle loss, anemia and osteoporosis.
3. The Roux-en-Y (“roo-on-Y”) gastric bypass
Type of procedure: Combination of restrictive and malabsorptive
How it’s done: A portion of the stomach is removed and, using staples or a plastic band, a small pouch is created at the top of the stomach that is then connected to the middle of the small intestine, bypassing the duodenum altogether. Not only is less food eaten, but also less of the intestine is available to absorb nutrients, so weight is lost.
Risks: Anemia, bone disease or osteoporosis may occur if the patient does not take vitamin and mineral supplements. Intestinal irritation or ulcers may occur. Diagnosing an ulcer or bleeding can be difficult because parts of the stomach and intestines aren’t visible by X-ray.
