Surgery for Obesity: What Are My Choices?
It is helpful to have a basic understanding of the digestive process in order to comprehend how surgical procedures enable people who are extremely overweight to lose weight.
After we swallow, the meal travels through our digestive tract, where digestive juices and enzymes break it down so our bodies can absorb the calories and nutrients. The process of digestion proceeds in the stomach, which has the capacity to hold three pints of food, with the assistance of powerful acids. After that, it travels into the duodenum, where pancreatic and bile juices expedite digestion. Most of the iron and calcium in diet are absorbed by the body at this stage. The last 20 feet of the small intestine, which includes the jejunum and the ileum, are responsible for completing calorie and nutrient absorption. Any food particles that are not used are subsequently sent into the large intestine for evacuation.
In order to lose weight, some people use methods that do not involve the digestive system at all. They vary from minor dietary restrictions to complete elimination of food from the body. Many of these procedures require patients to be considered "morbidly obese," defined as having a weight that is 100 pounds more than what is considered healthy for their height and body type.
Reflux Surgery
Dr. Edward E. Mason found in the mid-1960s that women who had peptic ulcers treated with partial stomach resection did not have weight gain following the procedure. This finding led to the experimental procedure of stapling the upper part of the stomach, which limited its capacity to approximately three tablespoons. As is customary, the digestive process was completed when the stomach was filled and then emptied into the lower part. The procedure eventually became the Roux-en-y Gastric Bypass after it underwent several revisions. Staples are used to split and separate the stomach from the remainder, rather than to partition it. The "new" small stomach is connected to the small intestine after a cut is made about 18 inches below the stomach. The next step is to consume smaller meals more frequently so that the digestive process can go more smoothly. Overall, this is one of the safest weight loss surgeries that can help with obesity for a long time.
Banding the Bowel
A "restrictive" surgical treatment that yields effects similar to those of stomach stapling or bypass. In the initial procedures, a non-flexing band was applied to the upper abdomen, just behind the esophagus, to form an hourglass shape; the upper abdomen was then decreased to a capacity of three to six ounces. The band evolved into a more versatile device with an inflatable balloon that could be inflated to shrink the stoma or deflated to make it larger in response to a reservoir that was implanted in the belly. Reduced gastrointestinal invasion and smaller scars are two benefits of laparoscopic surgery.
Diverting Biliopancreatic Fluid
The risk of malabsorption increases when gastric bypass and Roux-en-y re-structuring are performed simultaneously because they bypass a large portion of the small intestine. The procedure involves reducing the size of the stomach and then attaching a longer Roux-en-y anastomosis to it, this time lower on the small intestine than is typical. Because of this, the patient can consume more without gaining weight due to malabsorption. The method was created by Professor Nicola Scopinaro of Italy's University of Genoa, and the initial long-term findings were published last year. The finest long-term results of any bariatric surgery treatment to date were demonstrated by them, with an average weight loss of 72% that was sustained over 18 years. Follow-ups for calcium and vitamin consumption in BPD patients should continue throughout their lives. The potential side effects of protein deficiency, flatus, stomal ulcers, loose or foul-smelling feces, and increased appetite suppression outweigh the benefits of increased caloric intake and weight loss.
The Jejuno-Ileal Scaffold
An early approach for severely obese people to lose weight and prevent further gain was created in the 1960s; it was a strictly malabsorptive method. The jejuno-ileal bypass drastically altered nutrient and calorie absorption by shortening the lower digestive system from its normal 20 feet of small intestine to just 18 inches. After severing the upper intestine just below the stomach, the end-to-end technique "cut out" much of the intestine by reattaching it to the small intestine far lower down. A variant called the end-to-side bypass was developed as a result of malabsorption of carbohydrates, proteins, lipids, minerals, and vitamins. This variation joined the upper and lower portions without severing at that time. In the post-operative period, patients experienced more nutritional absorption due to feces refluxing into the non-functioning upper part of the small bowel, but they also experienced less weight loss and more weight gain. Chronic diarrhea is the final outcome of the bypass's dumping of fatty acids into the colon, which irritates the lining of the bowel and leads to an overflow of water and electrolytes. Because of malabsorption and excretion of bile salts, the bile salt pool that is essential for maintaining cholesterol solubility is diminished. Consequently, the likelihood of gallstones increases due to the elevated cholesterol concentration in the gall bladder. Worryingly, multiple vitamin deficits can lead to discomfort, bone weakening, and fractures. An change in the size and thickness of the remaining active small intestine occurs in around a third of patients. This adjustment promotes nutrient absorption and counteracts the weight loss. All patients who undergo this bypass, however, run the risk of developing hepatic cirrhosis in the long run. About 20% of patients who had JIB in the early 1980s needed to be switched to a different bypass option, according to a research. Due to the high number of potential complications, the treatment has been mainly shelved.
Surgery to reduce excess fat is an effective treatment for severe obesity, but it is not risk-free. An increased risk of blood clots may occur if patients are required to remain in bed for longer periods of time after surgery. Reduced depth of breathing and consequences like pneumonia can also be caused by pain.
In order to make an informed decision about their future health, a person who is extremely overweight should research the pros and cons of fat/weight reduction surgery. The chronic sugar eater will continue to "graze" on high-calorie sweets even if their stomach gets smaller. Drinking sugary sodas, strong juices, and milkshakes on the regular also doesn't help cut calories. Certain foods can worsen side effects from various bypass surgeries, but they don't have to be too bad if people follow sensible diet plans. A "shortcut" to weight loss may be surgery, but if you can't stick to the regimens that come with it, your quality of life may suffer.
