Bariatric Surgery
Bariatric surgery is the technical term for
operations that are designed to help people lose weight where
diet and exercise alone have failed. Surgical therapy has
been shown to be effective over both the short-term and long-term
in achieving weight loss. However, surgery should be considered
as part of an overall plan of weight management – it
is not an option for all people who are overweight, and surgery
alone without dietary or lifestyle modifications may not be
successful.
There are several operations which are currently performed
to achieve rapid weight loss. Each has its own risks and complications.
Although this should not be seen as a substitute for a thorough
conversation with a medical professional, we have listed here
some of the highlights for various operations that you may
hear of while investigating obesity surgery.
Procedures may be broadly classified into one of two categories.
First, the so-called restrictive procedures,
produce weight loss by limiting the amount of food that may
be ingested. The second category is the malabsorptive
procedures, which interfere with the body’s normal process
of nutrient uptake and digestion so that ingested food is
not properly absorbed. Some procedures incorporate elements
of both restriction and malabsorption, and will be discussed
more fully below.
History of Bariatric Surgery
Contrary to popular opinion, surgery for obesity has been
performed for decades.
The jejunoileal bypass (JIB) was one of the first
operations for the treatment of morbid obesity. These operations
had their beginnings at the University of Minnesota in the
1950s. In this procedure, the stomach was left intact, but
the intestinal flow was diverted past most of the small intestines.
As such, it was a prototypical “malabsorptive”
procedure.
Although effective in producing weight loss, JIB led to more
complications than expected. Since the small intestine is
where most of the body’s nutrients are absorbed, and
was no longer accessible, patients experienced diarrhea, osteoporosis,
kidney stones, and night blindness all of which were related
to vitamin deficiencies. An overwhelming growth of bacteria
also developed in the bypassed intestines. This led to the
most disturbing complications of arthritis, an assortment
of skin problems, and liver failure. Some of these patients
required reoperation to reverse the JIB, whereas others had
progressive liver failure and required liver transplantation.
Currently, the JIB is not routinely performed and is not a
recommended weight loss procedure. However, it does serve
as a historical lesson that the consequences of bariatric
surgery may be significant. Both patients and their doctors
need to maintain a close relationship during the post-operative
period to ensure that problems can be prevented or quickly
addressed.
Current Bariatric Surgery Procedures:
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