SURGICAL CONDITIONS

General Surgery

Obesity

Current scientific information tells us that obesity is partially a hereditary disease, passed down through the genes. The expression of obesity varies with social, environmental, cultural, economic and psychological influences. Probably there are many people who have this genetic tendency. In previous generations it was probably an advantage when food was scarce and life was physically demanding. As society has changed, with decreased need for physical exertion and unlimited food supply, the adverse effects of this genetic tendency to store fat are seen. These adverse effects of obesity on health and longevity are many, and include (but are not limited to):

Diabetes mellitus – approximately 90% of people with Type 2 (maturity onset diabetes) are obese. Furthermore Type 2 diabetes often resolves if substantial weight loss can be achieved

Hyperlipidaemia – high triglycerides and cholesterol

Heart disease – is more common in obese individuals due to hypertension, high lipids and excess strain on the heart

Cancer – the risk of breast, colon and uterus cancer is increased with obesity

Hypertension – many people take blood pressure medication which would not be required if weight loss was achieved

Gallbladder disease – gallstones are more common in obese people – but also occur with increased frequency with substantial weight loss

Sleep apnoea – many people with this problem can “cure” it with substantial weight loss

Reflux – most people will develop some degree of reflux as obesity increases as a result of increasing intra-abdominal pressure.

Menstrual irregularities and fertility problems – many obese women struggle to conceive. Before considering IVF, weight loss should always be tried. Polycystic ovarian syndrome occurs as a result of obesity in some women. It resolves or improves in most who lose weight

Arthritis – degenerative arthritis of the knees, hips and spine in particular is more common in obese people as our joints are simply not designed to carry excess weight. Weight loss should always be tried prior to considering joint replacement surgery, if you are obese.

Dementia - has now been shown to be more common in obese people as they age

Depression – is more common in obese people. Whilst depression (and many antidepressant drugs) may lead to obesity, weight loss often improves depression

Obesity is seldom the result of a glandular or hormonal problem, or a psychological disorder. Despite the numerous attempts at weight loss, many people just cannot get the excess weight off and keep it off. Less than 5% of people with significant obesity can maintain substantial weight loss with diet and exercise programs. Current weight loss drugs also do not result in long term weight control. Because the non-surgical methods of weight control used by the morbidly obese person have failed us miserably (with many initially losing weight and then gaining back the original weight plus some more) some people choose to have bariatric (weight loss) surgery.

Obesity is defined as a body mass index (BMI) over 30 kg/m2. Morbid obesity is defined as a body mass index more than 40 kg/m2, but to be considered for surgery one must generally have a body mass index of greater than 35. However, it has recently been shown that people with a BMI as low as 30, but who have complications of their obesity will also benefit from surgery.

Types of Obesity Surgery

There are 3 types of obesity surgery:

Restrictive: These operations create a reduction in the effective size of the stomach so that a small amount of food creates a sense of fullness. Appetite is reduced. Food must be chewed carefully and eaten slowly. These operations include:

Gastric Stapling
Gastric Bypass
Adjustable Gastric Banding

Malabsorptive: The first operation done for obesity was designed to lose weight by reducing the effective length of the small intestine. Normally we have 5 to 7 metres of small bowel. In this operation, all but 45cm were bypassed. Patients lost weight, but there were many side effects and this surgery is now rarely performed. The name of this procedure is

Ileojejunal Bypass

Combined Procedures These operations combine a small amount of reduction in the size of the stomach with some degree of malabsorption, especially for fats. They are probably the most effective weight loss procedures currently available. They include:

Scopinaro Procedure
Duodenal Switch, with Bilio Pancreatic Diversion
Long limb Roux Y Gastric Bypass

LAP-BAND® System.

The Lap-Band is one of about 6 adjustable gastric bands now on the market. More Lap-Bands have been inserted than any other adjustable gastric band up to this time. There is more data about this device than any of the others. It is the band that I use exclusively.

Click here to find out more about LAP-BAND System.

The BioEnterics® LAP-BAND® System Patient Book (detailed booklet) 1194 KB

This BioEnterics® LAP-BAND® System Patient Book will provide you with detailed information on the BioEnterics® LAP-BAND® System surgical solution for the treatment of severe obesity, including the following:

• The concept of obesity
• Causes of obesity
• The risks inherent in obesity
• Treatment options
• Advantages of the BioEnterics® LAP-BAND® System
• Basic patient selection criteria, indications and contraindications
• Possible risks, complications and adverse events
• The operation
• Eating and drinking just after the operation, and ten important rules
• Frequently asked questions
• Your diet for the rest of your life
• BMI charts

Click here to download the booklet.

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