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Types of Bariatric Surgery | Considerations | Risks of Surgery | Laparoscopic or Open Surgery

         Types of Surgery

All operations to secure weight loss are directed at reducing the entry of food energy (calories) into the body. This may be by

• Making it mechanically difficult to eat much
• Interfering with appetite
• Interfering with the adsorption of food from the intestine
• A combination of the above

A variety of operations are available. The main ones are

• Adjustable Gastric Banding
• Gastric Bypass
• Biliopancreatic Diversion (incl. Duodenal Switch)

The particular risks vary from one operation to another, as do the costs.

For any individual person one operation may offer a greater or lesser chance of effectiveness.

Most operations can nowadays be undertaken by keyhole surgery (laparoscopy). This approach has the benefits of, amongst others; the avoidance of a large incision and therefore scar, a shorter hospital stay and a quicker return to normal activities. For some patients this is less suitable.

The final choice of operation should be made jointly between yourself and your chosen surgical team, after they have had a chance to get to know you and you have received further information from them.

At this stage we would advise you keep an open mind about the best option for you.

         Considerations before obesity surgery

The surgeons endeavour to give the best advice. It is beneficial for you to keep an open mind regarding your procedure choice prior to your consultation. It is their aim to help you make informed decisions as to which procedure you are best suited.

An operation commits to follow-up appointments, which will vary in number and purpose according to procedure. It is important for your safety and for the result that you take this seriously and give it high priority.

For all of the above reasons, if you are not clear that your overweight is related to your food intake, you may wish to consider re-consulting your doctor or seeking advice elsewhere.

Patients who are currently/recently dependent on alcohol or other substances are not recommended to seek surgery. In addition, alcohol may occasionally represent a significant source of calories that are beyond the control of surgical procedures.

If you have a mental health condition such as schizophrenia or are recently/currently severely self-harming, it may not be appropriate to offer surgery. You may be best advised to seek advice from a suitably specialised psychiatrist first. The surgeons will be happy to correspond with him/her.

By contrast, depression and eating disorders are often closely tied up with weight problems. They may not be a reason against surgery, but may need to be treated as well.

         Risks of Obesity Surgery

Indications

Bariatric surgery is typically reserved for those individuals 100 pounds or more overweight (Body Mass Index [BMI] of 40 or higher) who have not responded to other less invasive weight loss therapies such as diet, exercise, medications, etc.
 
In certain circumstances, less morbidly obese patients (with BMIs between 35 and 40) may be considered for bariatric surgery (patients with high-risk co-morbid conditions and obesity-induced physical problems that are interfering with quality of life).

Important Considerations

Bariatric surgery should not be considered until you and your doctor have evaluated all other options. The proper approach to bariatric surgery requires discussion and careful consideration of the following with your doctor:

1. These weight loss procedures are in no way to be considered as cosmetic surgery.
2. The surgery does not involve the removal of adipose tissue (fat) by suction or excision.
3. A decision to elect surgical treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure.
4. The success of bariatric surgery is dependent upon long-term lifestyle changes in diet and exercise. Problems may arise after surgery that may require reoperations.

Success of surgical weight loss treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.

Complications and Risks of Bariatric Surgery
 

As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures that should be discussed with your doctor. Possible risks include, but are not limited to:

• Bleeding*
• Complications due to anesthesia and medications
• Deep vein thrombosis
• Dehiscence
• Infections
• Leaks from staple line breakdown
• Marginal ulcers
• Pulmonary problems
• Spleen injury*
• tenosis

*Removal of the spleen is necessary in about 0.3% of patients to control operative bleeding.

         Open or Laparoscopic Obesity Surgery

In some patients the laparoscopic method does not work effectively. Factors that may increase the possibility of choosing or converting to the "open" procedure may include:

• a history of prior abdominal surgery causing dense scar tissue
• inability to visualize organs
• bleeding problems during the operation

If bariatric surgery is performed laparoscopically and complications occur during the operation, your doctor may choose to perform open surgery.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open (conventional) procedure is strictly based on patient safety.