| To understand how surgical procedures aid the grossly | | | | of Genoa, Italy, developed the technique, and last year |
| overweight person to reduce their body fat, it helps to | | | | published the first long-term results. They showed an |
| first understand the digestive process that is | | | | average 72% loss of excess body weight, maintained |
| responsible for handling the food we take in. | | | | over 18 years, the best long-term results of any |
| Once food is chewed and swallowed, it's on its way | | | | bariatric surgical procedure, to date. BPD patients |
| through the digestive tract, where enzymes and | | | | require lifelong follow-ups to monitor calcium and |
| digestive juices will break it down and allow our | | | | vitamin intake. The advantages of being able to eat |
| systems to absorb the nutrients and calories. In the | | | | more and still lose weight, are countered by loose or |
| stomach, which can hold up to three pints of material, | | | | foul smelling stools, flatus, stomal ulcers, and possible |
| the breakdown continues with the help of strong acids. | | | | protein malnutrition. |
| From there it moves into the duodenum, and the | | | | Jejuno-Ileal Bypass |
| digestive process speeds up through the addition of | | | | One of the first weight loss procedures for the grossly |
| bile and pancreatic juices. It's here, that our body | | | | obese, was developed in the 1960s, a strictly |
| absorbs the majority of iron and calcium in the foods | | | | malabsorptive method of reducing weight, and |
| we eat. The final part of the digestive process takes | | | | preventing gain. The jejuno-ileal bypass reduced the |
| place in the 20 feet of small intestine, the jejunum and | | | | lower digestive tract to a mere 18" of small intestine, |
| the ileum, where calorie and nutrient absorption is | | | | from the natural 20 feet, a critical difference when it |
| completed, and any unused particles of food are then | | | | came to absorption of calories and nutrients. In the |
| shunted into the large intestine for elimination. | | | | end-to-end method, the upper intestine was severed |
| Weight loss procedures involve bypassing, or in some | | | | below the stomach, and re-attached to the small |
| way circumventing the full digestive process. They | | | | intestine much lower down, which had also been |
| range from simple reduction of the amount you can | | | | severed, thereby "cutting out", the majority of the |
| eat, to major bypasses in the digestive tract. To qualify | | | | intestine. Malabsorption of carbohydrate, protein, lipids, |
| for many of these surgeries, a person must be termed | | | | minerals and vitamins, led to a variation, the end-to-side |
| "morbidly obese", that is, weighing at least 100 lbs. over | | | | bypass, which took the end of the upper portion, and |
| the appropriate weight for their height and general | | | | attached it to the side of the lower portion, without |
| body structure. | | | | severing at that point. Reflux of bowel contents into |
| Gastric Bypass | | | | the non-functioning upper portion of small bowel, |
| In the mid 1960s, Dr. Edward E. Mason discovered that | | | | resulted in more absorption of essential nutrients, but |
| women who had undergone partial stomach removal | | | | also less weight loss, and increased weight gain, |
| as the result of peptic ulcers, failed to gain weight | | | | post-surgery. As a result of the bypass, fatty acids |
| afterwards. From this observation, grew the trial use | | | | are dumped in the colon, producing an irritation that |
| of stapling across the top of the stomach, to reduce | | | | causes water and electrolytes to flood the bowel, |
| its actual capacity to about three tablespoons. The | | | | ending in chronic diarrhea. The bile salt pool necessary |
| stomach filled quickly, and eventually emptied into the | | | | to keeping cholesterol in solution is reduced by |
| lower portion, completing the digestive process in the | | | | malabsorption and loss through stool. As a |
| normal way. Over the years, the surgery evolved into | | | | consequence, cholesterol concentration in the gall |
| what is now known as the Roux-en-y Gastric Bypass. | | | | bladder rises, increasing the risk of stones. Multiple |
| Instead of partitioning the stomach, it is divided and | | | | vitamin losses are a major concern, and may result in |
| separated from the rest, with staples. The small | | | | bone thinning, pain and fractures. Approximately one |
| intestine is then cut at approximately 18" below the | | | | third of patients experience an adjustment in the size |
| stomach, and attached to the "new", small stomach. | | | | and thickness of the remaining active small intestine, |
| Smaller meals are then eaten, and the digested food | | | | which increases the absorption of nutrients, and |
| moves directly into the lower part of the bowel. As | | | | balances out the weight loss. However, over the long |
| weight loss surgeries are viewed overall, this is | | | | term, all patients undergoing this bypass are susceptible |
| considered one of the safest, offering long-term | | | | to hepatic cirrhosis. In the early 1980s, one study |
| management of obesity. | | | | showed that approximately 20% of those who had |
| Gastric Banding | | | | undergone JIB, required conversion to another bypass |
| A procedure that produces basically the same results | | | | alternative. The procedure has since been largely |
| as the stomach stapling/bypass, and is also classed as | | | | abandoned, as having too many risk factors. |
| a "restrictive" surgery. The first operations, involved a | | | | While surgical methods of reducing weight are valuable |
| non-flexing band placed around the upper part of the | | | | to the morbidly obese, they are not without risks. |
| stomach, below the esophagus, creating an hourglass | | | | Patients may require more bed rest post-surgery, |
| shaped stomach, the upper portion being reduced to | | | | resulting in an increased chance of blood clots. Pain |
| the same 3-6 ounce capacity. As technologies | | | | may also cause reduced depth of breathing, and |
| advanced, the band became more flexible, | | | | complications such as pneumonia. |
| incorporating an inflatable balloon, which when triggered | | | | Before undergoing any fat/weight reduction surgery, a |
| by a reservoir placed in the abdomen, was capable of | | | | severely overweight person needs to thoroughly |
| inflating to cut down the size of the stoma, or deflating | | | | understand the benefits and risks, and must make a |
| to enlarge it. Laparoscopic surgery means smaller | | | | commitment to their future health. Having a smaller |
| scars, and less invasion of the digestive tract. | | | | stomach is not going to stop the chronic |
| Biliopancreatic Diversion | | | | sugar-snacker, from "grazing" on high calorie sweets. |
| A combination of the gastric bypass, and Roux-en-y | | | | Nor does a steady supply of pop, concentrated sweet |
| re-structuring, that bypasses a significant section of the | | | | juices and milk shakes, reduce the calorie intake. With |
| small intestine, thereby creating the probability of | | | | some bypass surgeries, certain foods can aggravate |
| malabsorption. The stomach is reduced in size, and an | | | | side-effects that need not be that severe, if common |
| extended Roux-en-y anastomosis is attached to the | | | | sense diets are adhered to. Surgery can be a |
| smaller stomach, and lower down on the small intestine | | | | "shortcut" to weight loss, but it can also reduce your |
| than is normal. This permits the patient to eat larger | | | | enjoyment of life, if you are unable to adhere to the |
| amounts, but still achieve weight loss through | | | | regimens that go with it. |
| malabsorption. Professor Nicola Scopinaro, University | | | | |