A fantastic, and open-access, review paper just came out on the subject of surgical solutions to obesity which answered a lot of my questions regarding this growing area of treatment. Written by Kral and Naslund, who are both professors of surgery, it begins with the terse opener “Obesity is very prevalent.” Well, in America at least, you can say that again. Obesity is often the result of many different factors, but eventually it becomes clear that our bodies did not evolve in an environment of constant, abundant, and caloric-rich food. Human bodies are designed to want to eat, to love to eat rich and fatty foods, and to store this energy as fat, sometimes in excess.
When these trends become unmanageable, surgical intervention is often considered as an option. What exactly does this involve, and is it safe and effective over the long term? The next few posts will cover this topic, this first one will describe types of bariatric surgery.
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Techniques In Bariatric Surgery
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“Adjustable gastric banding” (A) consists of a stretchy silicone band which can be inflated to constrict the upper stomach into a pouch with a volume of about 30 mL. This pouch remains connected to the rest of the stomach but the connection is narrow, giving the person the feeling of being full when the pouch fills up. The person eats less, and loses weight as a result.
“Gastric bypass” (B) surgically divides the stomach into a permanent pouch (also about 30 mL) seperate from the rest of the stomach which is now renedered non-functional. The new pouch is directly connected to the jejunum of the small intestine, creating a Y formation called a Roux-en-Y limb. This approach both restricts the stomach size and diverts food away from absorptive mucosa in the small intestine.
“Billopancreatic diversion” (C) limits the normal absorption of food since pancreatic secretions and bile are diverted farther down the small intestine. This means that absorption will only occur in the distal part of the small intestine. The stomach can be resized or left as is.
Generally, about 75% of patients who receive bariatric surgery go on to lose a significant amount of weight permanently. I’ll continue in the next few posts to discuss the benefits and risks of the surgeries as well as the neuropeptides involved in hunger, eating, and feeling full. Stay tuned!
Prefereably bariatric surgery should be preformed laparoscopically