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This Week's Topic

Surgical Procedures Series - Learn about Stomach Stapling & Lap Band surgery

7 May 2007
Current estimates suggest that around 10 per cent of the adult Australian population is obese. The associated health risks of 'morbid obesity' (unhealthy weight) include diabetes, heart disease, hypertension, sleep apnoea, arthritis, and reduced mobility and life expectancy. Obesity surgery is the last resort, when all other attempts at weight loss have failed and the person's health is at risk. Even then, this type of surgery needs careful consideration by balancing the risks of obesity against the chances of success and possible side effects of such procedures. It is not a form of cosmetic surgery, nor an alternative to good eating habits and regular exercise.

Obesity surgery can offer rapid weight loss but, to be successful, it must
* 40 to 50 - morbidly obese
* More than 50 - super-obese.

An example of a BMI measurement
If you weighed 110kg and were 1.55m tall, this is how you would calculate your BMI:

* Determine your height in metres squared (1.55m x 1.55m = 2.4m)
* Divide your weight by your height in metres squared (110kg 2.4m = 45.8)
* Your BMI would be 45.8.

Surgical techniques
The various techniques of obesity surgery include:

* Stomach stapling
* Gastric banding
* Bowel bypass
* Jaw wiring.

Gastric stapling and gastric banding (lapband)
Gastric stapling and gastric banding involve procedures where a small pouch is formed at the top part of the stomach. This allows only a small amount of food to be consumed at a sitting. This results in a feeling of satisfaction and the loss of hunger after a small, solid meal is eaten. If more food is eaten in the next hour or two, an overfull and bloated feeling will be experienced and regurgitation may occur.

Stomach stapling is usually done through an abdominal incision, while banding can usually be done with laparoscopic or 'keyhole' surgery. Banding has the advantage that it can be 'adjusted' - if there are problems with eating, the band can be loosened by an injection through the abdominal wall or, if insufficient weight is lost, the band can be tightened.

Both operations may result in early complications (such as infection, leakage from the stomach, thrombosis or embolism, or even death), although these are fortunately uncommon. In the longer term, staple lines can break down or the band may slip or become infected. Both operations are reversible.

Bowel bypass
Food is normally digested and absorbed by the small intestine. A bowel bypass operation reduces the length of the small intestine by bypassing about three quarters of its length and allowing less food to be digested and absorbed. The consequence of this is that undigested food passes into the large bowel. This has the side effect of producing diarrhoea in the early months after surgery, which may be severe. Other problems in the early months can be nausea, abdominal cramps, a lot of wind and, sometimes, mineral deficiencies. There are several types of bypass surgery and they are not frequently performed, as they are more major than the stomach operations.

Jaw wiring
The jaws are kept virtually closed and immobile with surgically implanted screws and wires. Foods have to be pureed and consumed slowly, often through a straw. The person is given a set of wire-cutters, in case the jaws have to be opened in an emergency. The long term results of jaw wiring are very poor and it is very rarely used except in unusual circumstances.

Stomach balloon
This technique involved inflating a balloon inside the stomach to offer a feeling of fullness. Success rates in terms of weight loss are poor, and there is risk of stomach ulcer and bowel blockage. It is no longer recommended.

Surgery isn't a long term solution
Obesity surgery is only part of a solution to unwanted weight gain. The surgery cannot control the type of food the person eats, the type of liquid intake, how often they eat or how much they exercise. The responsibility for these factors rests with the patient. Weight loss may be disappointing if these factors are not carefully controlled. Typically, a person can expect to lose around 50 to 75 per cent of their excess weight in the first 12 months after surgery.

Where to get help

* Your doctor
* Obesity Surgery Society of Australia and New Zealand Tel. (03) 9421 1166

Things to remember

* Obesity surgery is the last resort when all other attempts at weight loss have failed.
* There is no perfect operation, and surgeons differ in which operation they will suggest, but gastric banding, gastric stapling or a form of bypass are all accepted techniques.
obesity operations - melbourne obesity surgery

Rating: 3
Description: This is an excellent web-site on obesity surgery or lap band surgery. It presents a short description of the techniques, suitability and applicability, results, complications, and side effects.

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