W-Loss - Weight Loss Surgery and Support Group

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All surgery carries risks. Insertion of a gastric band has the lowest risk in comparison to other weight loss surgical procedures. The main early risks for this operation are deep vein thrombosis (clots in legs) and clots in your lungs (pulmonary embolism). The risk of death from the operation is 1 in 200 and the majority of these are from clots in the lungs. Because of this you will receive blood-thinning injections to reduce these risks. Longer-term problems occur in about 1 in 10 people. These include problems with the injection port and the band when the band erodes into the stomach and the band slipping into a wrong position. It is important to remember that the majority of people do not have any problems with this procedure.

Results of Gastric banding
Weight loss after gastric band is gradual and you will not be expected to reach the target until about two years after the operation. The expected weight loss after this type of surgery is 50% of your excess weight. This translates to losing between 30 to 100lbs (13 to 45kg) or an average of 70lbs (32kg). With regards to medical problems gastric band will completely cure diabetes in 48% of people and improve high blood pressure and high cholesterols in 70-80% of cases.


Gastric Bypass
Also known as gastric Roux-en-Y bypass. This procedure is preferred in people with higher BMI (greater than 50) and is performed laparoscopically (keyhole). It is a complex procedure that combines a restrictive component by creating a small gastric pouch and small bowel diversion by attaching a section of the small intestine to the pouch to allow food to bypass a part of the small intestines resulting in malabsorption. Though not impossible to reverse, this operation is extremely difficult to reverse and should be treated as irreversible.

This operation like gastric band will restrict the volume of food you eat by making you feel full with smaller meals. In addition to this the food consumed will only be partly absorbed and therefore further reduce the amount of food (energy) you consume.

Due to its complexity, gastric bypass carries slightly higher risks than for gastric band insertion. The risk of deep vein thrombosis and clots in the lungs are doubled (1 in 100) that of gastric banding. In exchange for this slight increase in short-term risk, this procedure has far less long term problems compared with gastric
banding. Some patients may require supplements to
correct vitamin deficiencies with an otherwise normal diet.

Results of Gastric bypass
Excess weight loss is far quicker and more effective. Target weight loss is typically achieved at one year following surgery with an average excess weight loss of about 60-70%. This translates to losing between 40 to 140lbs (21 to 63kg) or an average of 100lbs (47kg). In addition many of the medical problems are cured or greatly improved. The majority of people (84%) with diabetes are cured by gastric bypass and between 90% to 95% of people with high blood pressure and high cholesterol improve or be cured following surgery.

Laparoscopic Sleeve Gastrectomy
Laparoscopic sleeve gastrectomy is a new restrictive procedure that was developed in 2003. This is a restrictive procedure like gastric banding without using any foreign body. The stomach is divided using staples along the inside leaving a narrow banana shaped stomach tube. Unlike gastric bypass the excess stomach (85%) is removed completely thereby eliminating the main source of the Ghrelin hormone (appetite hormone) and reduce hunger. This procedure is reserved for people who have a BMI of over 55 and can be done as a sole procedure although it is often done as a 2-stage BPD-duodenal switch procedure for high risk patients.

The new stomach tube holds approximately 100ml. The
weight loss mechanism is much like gastric banding where
the amount of food consumed is limited by the reduced
stomach volume and feeling of fullness. The advantages of
this procedure over gastric band are no foreign body and
therefore there are no problems with band erosion, slippage.
The disadvantage of this is irreversibility, leak and greater
risk with deep vein thrombosis, bleeding, damage to spleen and insufficient weight loss in the very obese patient..

Results of Sleeve gastrectomy
The rate and amount of weight loss is similar to gastric band (50-60% of excess body weight). By virtue that this procedure is used in super and super obese people (BMI >50), the absolute weight loss is in the region of 90 to 130lbs (40 to 60kg) in about 12 to 18 months after surgery.

Biliopancreatic diversion-Duodenal Switch
This procedure was created in 1988 by combining two operations, the biliopancreatic diversion first performed by Dr Scopinaro in 1976 and the duodenal switch developed by Dr DeMeester to treat bile gastritis. It combines sleeve gastrectomy and dividing the intestines to separate food from the digestive enzymes. Food and digestive enzymes travel down the intestines separately before finally mixing together in the last 100cm of small intestines where the food is digested and absorbed. It causes weight loss by restricting the amount of food that can be eaten (sleeve gastrectomy) and induces malabsorption by intestinal bypass (biliopancreatic diversion-duodenal switch). Of all the procedures that are currently performed for the treatment of obesity, this is the most powerful and effective, but it also have more complications associated with it. This procedure can be by open surgery and is often performed laparoscopically in 2 stages following sleeve gastrectomy. It is particularly suited for patients with BMI over 60.

Results of BPD-DS
The average expected excess weight loss is 70-75% which translates to about 170lbs (77kgs). Because of its significant malabsorptive characteristic this procedure often leads to anaemia, protein deficiency and metabolic bone disease in up to 5% of patients. Other problems include chronic diarrhoea and foul smelling stools and flatus. Counterbalancing the higher operative risk and malabsorptive complications, this procedure cures 99% of diabetes and high cholesterol, over 80% of high blood pressure.

Information on duodenal switch

Nutritional requirements following weight loss surgery
Nutritional problems following weight loss surgery is uncommon with the appropriate follow-up and dietary monitoring. Dehydration, protein deficiency, vitamin and mineral deficiencies may occur following restrictive procedures (gastric bypass & BPD-DS) and rarely after gastric banding and sleeve gastrectomy. This is usually caused by a combination of poor nutrition before the operation, reduced food intake, change of diet and reduced food absorption after the surgery. These usually settle with time and with supplements. Chronic dehydration is usually caused by or exacerbated by chronic diarrhoea especially following BPD-DS. Protein deficiency is more of a problem in BPD-DS and less so for gastric bypass. Iron, folate, calcium vitamin B12, D and E deficiencies and raised parathyroid hormone can occur with malabsorptive procedures. These can be easily treated by using appropriate supplementation and careful monitoring.

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