What Is Bariatric Surgery?
By David Johnson, Thu Dec 8th
Bariatric surgery, derived from the Greek word "baros" meaningweight, is designed to reduce obesity indirectly by restrictingthe amount of food calories a person can digest. Some bariatricoperations (eg. lap band) achieve this by reducing the size ofthe stomach size. Other operations (eg. roux-en-Y gastricbypass) go one step further. As well as reducing stomach volume,they also reduce the length of the small intestine. Thisconstitutes a more permanent alteration of the digestive tractand makes it more difficult for the patient to cheat.
How To Qualify For Bariatric Surgery?
According to the National Institutes of Health ClinicalGuidelines on the Identification, Evaluation, and Treatment ofOverweight and Obesity in Adults, you may be a candidate forobesity surgery only if: (1) you have a body mass index (BMI) of40+ (about 100 pounds overweight), or (2) your BMI is 35+ andyou suffer from severe weight-related health problems such ashypertension, high cholesterol, type 2 diabetes, heart diseaseor severe sleep apnea.
Are You a Suitable Candidate for Bariatric Surgery?
Meeting the above criteria does not guarantee your eligibilityfor weight loss surgery. Most bariatric clinics operate ascreening policy and only approve candidates who are (a) readyto make appropriate long-term behavioral changes; and (b)committed to long-term (even lifelong) medical follow-up. Thisis because weight loss surgery can only be successful if you arewilling to change your existing eating and exercise habits, on apermanent basis.
What Are The Main Types of Bariatric Operation?
There are two main types of obesity surgery: gastric bandingand gastric bypass. These operations may be performed usingtraditional "open" surgical techniques, or minimally invasivelaparoscopic techniques using instruments connected to videomonitors, which allow the surgeon to "see inside" the patientwithout having to make large incisions. Patients who undergolaparascopic surgery suffer fewer perioperative andpost-operative health complications, and typically remain inhospital for 2-3 days, compared to 4-5 days for open surgery.They return to work within 2-3 weeks, compared to 4-6 weeks fortraditional surgeries.
Gastric banding is sometimes referred to as "restrictivesurgery". This is because it works by restricting calorie intakeonly. During a gastric banding operation, the surgeon shrinksthe stomach from melon to egg size using special staples, or asilicone band. These procedures are more easily reversible asthey do not fundamentally alter the anatomy of the digestivesystem. The drawback is, patients find it easier to "cheat".Thus stomach banding is not as effective for weight reduction asstomach bypass. Examples of gastric banding procedures include:adjustable gastric banding such as lap band, and vertical bandedgastroplasty.
Gastric bypass, sometimes called "malabsorptive" surgery sinceit restricts the absorption of calories and nutrition, is a twostage process. First, the surgeon reduces the size of thestomach. Second, the first part of the small intestine (duodenumand jejunum) is bypassed. This causes food to pass much morerapidly through the digestive tract and significantly reducesthe amount of nutrients and calories that can be absorbed. Soeven if patients overeat, they will absorb less. As a result,weight loss after gastric bypass is typically greater than aftergastric banding. Examples of stomach bypass procedures include:roux-en-Y, biliopancreatic diversion, and duodenal switch.
What Can You Eat After Bariatric Surgery?
As a bariatric patient, you must expect a drastic change ofeating habits following your operation. In general, due to thesmall size of your new stomach pouch, you will feel full afteronly a very small amount of food. Over-eating or eating too fastcan cause extremely unpleasant nausea, referred to as "dumpingsyndrome". The typical post-operative diet regimen comprisesfour stages. Immediately after surgery, you may ingest clearliquids only. After 2-3 days this broadens to include anyliquids. After about 2 weeks semi-solids may be consumed,leading to a low-fat solid diet after 5-6 weeks. Progressdepends upon the individual circumstances of each patient.
What About The Problem of Loose Skin?
During the 12-24 months following a successful bariatric bypassor banding operation, you may lose as much as 50-80 percent ofyour pre-operative excess weight. As a result, you may develop asignificant amount of loose skin. In addition, as your weightloss may not occur evenly throughout your body, you may sufferfrom unsightly pockets of excess fat. Generally speaking theonly solution for these problems is plastic surgery. Commonprocedures include: tummy tuck, thigh-lift, panniculectomy,breast-lift, male breast reduction, arm-lift and neck lift.Liposuction is not generally considered to be a weight-relatedprocedure as it only removes fat. It does not excise loose skinor tighten loose muscles. One point to note, is that, unlikebariatric surgery, this type of plastic surgery is not coveredby medical insurance as it is deemed to be a "cosmetic"procedure.
What is The Cost of Bariatric Surgery?
The costs of bariatric surgeries vary according to the surgeon,the type of procedure performed, and the range of supportservices offered. Basic prices range from $25,000 to $35,000.
Is Bariatric Surgery Covered By Insurance?
Medical insurance coverage varies by state and insuranceprovider. Several states have passed legislation requiringinsurers to offer weight loss surgery for patients, providing itmeets health criteria laid down by the National Institutes ofHealth. However, getting insurance approval by yourself can be atime-consuming process. Ideally, work with your surgeon/doctorand get him/her to explain to your health insurance providerthat the proposed surgery is not a cosmetic procedure but anoperation which will help you minimize major health problemslater in life. Once your insurance company understands that thesurgical operation is a money-saving procedure, they often agreeto provide cover. Some bariatric clinics claim an 80 percentsuccess-rate for obtaining insurer-approval in this way.
More Information
BariatricSurgery
Gastric Weight Loss Surgey
About the author:David Johnson, LLb., is the senior researcher atwww.bariatric-surgery.info which offers a range of informationabout gastric banding, stomach bypass and other weight-relatedsurgeries to more than 2 million unique visitors per year.
BariatricSurgery
Gastric Weight Loss Surgey
