B
Bariatric surgery
Definition
Bariatric surgery is a surgical weight-loss proce-
dure that reduces or bypasses the stomach or small
intestine so that severely overweight people can
achieve significant and permanent weight loss.
Purpose
Bariatric surgery, is performed only on severely
overweight people who are more than twice their ideal
weight. This level ofobesityoften is referred to as
morbid obesity since it can result in many serious,
and potentially deadly, health problems, including
hypertension, Type IIdiabetes mellitus(non-insulin
dependent diabetes), increased risk for coronary dis-
ease, increased unexplained heart attack,hyperlipide-
mia, and a higher prevalence of colon, prostate,
endometrial, and, possibly, breastcancer. In 2003,
researchers concluded that obesity surgery could cure
Type II diabetes in many people who were not yet
morbidly obese. Therefore, this surgery is performed
on people whose risk of complications of surgery is
outweighed by the need to lose weight to prevent
health complications, and for whom supervised
weight-loss and exercise programs have repeatedly
failed. Obesity surgery, however, does not make peo-
ple thin. Most people lose about 60% of their excess
weight through this treatment. Changes in diet and
exercise still are required to maintain a normal weight.
The theory behind obesity surgery is that if the
volume the stomach holds is reduced and the entrance
into the intestine is made smaller to slow stomach
emptying, or part of the small intestine is bypassed
or shortened, people will not be able to consume and/
or absorb as many calories. With obesity surgery the
volume of food the stomach can hold is reduced from
about four cups to about 1/2 cup.
Insurers may consider obesity surgery elective sur-
gery and not cover it under their policies. Documen-
tation of the necessity for surgery and approval from
the insurer should be sought before this operation is
performed.Precautions
Obesity surgery should not be performed on peo-
ple who are less than twice their ideal weight. It also is
not appropriate for people who have substance addic-
tions or who have psychological disorders. Other con-
siderations in choosing candidates for obesity surgery
include the general health of the person and his or her
willingness to comply with follow-up treatment.Description
Obesity surgery is usually performed in a hospital
by a surgeon who has experience with obesity surgery
or at a center that specializes in the procedure. General
anesthesia is used, and the operation takes 2–3 hours.
The hospital stay lasts about a week.
Three procedures are currently used for obesity
surgery:
Gastric bypass surgery. Probably the most common
type of obesity surgery, gastric bypass surgery has
been performed in the United States for about 25
years. In this procedure, the volume of the stomach
is reduced by four rows of stainless steel staples that
separate the main body of the stomach from a small,
newly created pouch. The pouch is attached at one
end to the esophagus. At the other end is a very small
opening into the small intestine. Food flows through
this pouch, bypassing the main portion of the stom-
ach and emptying slowly into the small intestine
where it is absorbed.
Vertical banding gastroplasty. In this procedure, an
artificial pouch is created using staples in a different
section of the stomach. Plastic mesh is sutured into