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Bariatric Surgery

Obesity is a health concern of epidemic proportions worldwide. The estimated current prevalence of obesity in the U S A is about 30% of the population, with Australia and Europe showing a similar magnitude all demonstrating an almost 3-fold increase over the last twenty years. Malaysians have adopted Western lifestyle practices and are similarly beset by an increased prevalence of obesity.

There is little question that obesity affects health and increases mortality. There is a strong association of obesity and Type 2 diabetes, coronary heart disease, hypertension, heart failure, other endocrine disorders,sleep disorders such as obstructive sleep apnoea syndrome, osteoarthritis, gout, lumbar pain, prolapsed disc, menstrual disorders and infertility in women, development of gallstones, gastroesophageal acid reflux (GERD) , venous thrombosis and to several cancers such as breast, colorectal and uterine cancers. There is also an association to depression and a poorer quality of life. This translates to a significant burden to health care. Obesity is identified as serious public health problem and certainly not simply a cosmetic issue.

The objectives of bariatric surgery are to attempt to reduce morbid obesity, maintain normal weight, halt the progress of established obesity-related medical conditions and prevent their development, improve the quality of life and personal self image. While non-surgical means of weight loss can be achieved, it is usually unsuccessful long term, and long term benefits are what we are aiming for.

Bariatric surgery techniques are based on surgical restriction of dietary intake, deliberate gastrointestinal malabsorption with surgical manipulation, reducing satiety (appetite) or a combination of all of these. S ome are reversible such as the placement of a restrictive gastric band at the upper part of the stomach while others are permanent, entailing permanent ‘short-circuiting’ the digestive tract such as gastric bypass and bilioenteric bypass.

These procedures used to be performed at open surgery but modern advances have enabled us to perform all of these procedures through minimally invasive or keyhole (laparoscopic) surgery with equal efficacy, much faster recovery and reduced complications particularly to wound healing.

Some of the more common procedures are explained in more detail below.

The ideal candidates for bariatric surgery must be motivated and are realistic in understanding how their lives and dietary intake will change after surgery. In other words, bariatric surgery is really the beginning of a change in their overall lifestyle.

We have an experienced bariatric team that understands the need of our local and overseas patients in a well equipped modern hospital in the centre of Kuala Lumpur . The choice of the type of operation is based on a preoperative assessment of the degree of obesity, patient compliance, psychological makeup, expectant magnitude of weight loss and its rate and of course, the patient’s choice after our counseling and recommendations. Proximity of and ease for outpatient follow-up may also be considered in establishing our recommendations. The cost between individual types of surgery is similar and is not a major issue.

Adjustable Gastric Banding or Lap Band

Adjustable gastric banding is a restrictive type of weight loss surgery. The procedure is usually performed laparoscopically or via ‘keyhole’ surgery. It involves placing a silicone band with an inflatable inner collar around the upper stomach to restrict food intake. This creates a small pouch and a narrow passage to the lower stomach. This small passage delays the emptying of food from the pouch and causes a feeling of fullness. The silicone band can be tightened or loosened over time to change the size of the passage.

The band is connected to a small port that is placed in the abdominal wall. The inner diameter of the band can be adjusted by injecting saline through this port. Your surgeon makes periodic adjustments based on your weight loss and symptoms after surgery.

Sleeve Gastrectomy or Gastric Sleeve Surgery

During this procedure about 80-85 percent of the stomach is removed so that it takes the shape of a tube or sleeve. This operation is also performed laparoscopically. The tube-shaped stomach that is left is sealed closed with staples.

The indications for the sleeve procedure are the same as other bariatric procedures uch as gastric bypass or adjustable gastric banding. It is particularly useful for patients who can’t return as often for the follow-up visits as required by the gastric or lap band procedure.

Following surgery, you will need to become re-accustomed to eating solid foods. Normally this starts with two weeks on a liquid-only diet, two weeks of semi-solid, pureed foods and then solids.

As far as weight loss goes, most people who have gastric sleeve surgery lose 50 to 80 percent of their excess body weight over the first six months to one year after surgery. Studies have shown that after the gastric sleeve resection procedure people show improvement in diabetes, high blood pressure, high cholesterol and sleep apnea within one to two years. These improvements are comparable with those seen after other weight loss surgeries.

The procedure has several advantages over gastric banding because no foreign objects are left in the body during the procedure. With gastric banding, the band may slip, erode or become infected. Unlike gastric bypass or duodenal switch, there is no bypass of the small intestines with the gastric sleeve, so all nutrients are absorbed and very little chance exists of absorption issues.

Roux-en-Y Gastric Bypass (RYGB)

RYGB works by restricting food intake and by decreasing the absorption of food. Food intake is limited by a small pouch that is similar in size to the adjustable gastric band. In addition, absorption of food in the digestive tract is reduced by excluding most of the stomach, duodenum, and upper intestine from contact with food by routing food directly from the pouch into the small intestine.

This procedure creates a faster feeling of fullness and allows for less absorption of calories from food. It does restrict the absorption of nutrients, such as iron, calcium and vitamin B12, so vitamin supplements are essential. Dumping syndrome is also frequently experienced following Roux-en-Y procedures.

A person may experience multiple symptoms, including nausea, weakness, sweating, lightheadedness and diarrhea after eating sweets or large amounts of food. This reinforces adherence to healthy eating practices.

Gastric bypass is one of the more invasive types of bariatric surgery and has a higher risk of complications and side effects. Gastric bypass can be performed laparoscopically and patients usually lose between 60-80% of excess body weight .

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