Morbid obesity is a complex, medical disease, which affects possibly as many as 30 million people in the United States. It is not a moral problem due to a lack of will power. Studies have shown that diets, medications, behavioral modification or exercise programs have a 95% failure rate in this population, due to underlying physiologic, chemical and genetic factors.
Morbidly obese patients have a very high risk of associated health problems and early death; therefore the National Institutes of Health (NIH) has endorsed two procedures as effective in the treatment of obesity: Vertical Banded Gastroplasty (VBG) and Roux-en-Y Gastric Bypass (RnY). Either of these operations, depending on the circumstances, can be accomplished by an open or laparoscopic technique. However, since the endorsement, the Adjustable Lap-Band (ALB) has replaced the Vertical Banded Gastroplasty in most Bariatric Surgeons’ opinions. They both work on the same principle, and that is they are both restrictive only.
Surgery is an aid to dieting and assists individuals alter their eating habits by restricting food intake or limiting absorption of ingested food or both.
So, Dr. Hall offers the following surgical procedures: the Roux-en-Y Gastric Bypass (RnY) and the Adjustable Lap-Band (ALB) for weight loss. These procedures assist a patient in reducing food and caloric intake, and in addition, the RnY decreases food absorption. Each procedure is associated with medical risks and varies in the anticipated chance of success in losing weight.
Roux-en-Y Gastric Bypass (RnY)
Roux-en-Y Gastric Bypass (RnY) is a more complex operation, to provide more consistent and successful weight loss. The small upper pouch is completely separated from the distal stomach which is left in place. A “Y” shaped segment of small bowel is attached to the pouch with a narrow opening. This bypasses the mixing of food and digestive juices from the distal stomach resulting in poorer absorption of calories and nutrients. This both restricts food intake and interferes with absorption resulting in more consistent weight loss, but has a higher risk of complications or side effects. It does not interfere with taking liquids. 80% of patients lose at least half their excess weight with the RnY procedure. This operation can be done open or laparoscopic.
The laparoscopic RnY averages a 2-3 day hospitalization with a return to full activity in 2-3 weeks. A liquid and soft diet high in protein is suggested for 6 weeks after surgery, and then the patient is placed on a solid diet.
The open RnY averages a 3-4 day hospitalization with a return to full activity in 3-4 weeks. The open version is safer than the laparoscopic version and the success rate and diet are the same.
Adjustable Lap-Band (ALB)
The Adjustable Lap-Band is a simpler operation. It consists of placing a band around the stomach in such a way as to make a small (1-2 oz) pouch at the top of the stomach with an adjustable diameter outlet that drains into the rest of the stomach. It is designed to prevent the patient from eating a large amount of solid food at one sitting. Drinking fluids is not interfered with. It is done laparoscopically and is a very safe operation. It can be done on an outpatient basis but sometimes requires an overnight stay. You can be back at work in a week or two. Unfortunately, it has a lower success rate than the RnY. The diet for the first 6 weeks after surgery is the same as the RnY. After the first 6 weeks and for the rest of your life you will be restricted to low calorie foods. |