FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

WEIGHT-LOSS SURGERY FOR SEVERELY OBESE, “AT RISK” PATIENTS, ONLY

Question: What is the difference between the two different types of weight-loss surgery that I’ve heard about -- gastric bypass and lap-band surgery? What are the benefits of each? Is one better than the other?

Answer: You’ve correctly identified two common surgical procedures for weight loss. The first surgery of this type was developed in the 1950s, and since then a number of procedures have been used with varying degrees of success and risk.

Gastric bypass surgery usually means the surgeon has performed a “Roux-en-Y Gastric Bypass,” or RGB. The most common weight-loss surgery in the United States, it combines a Roux-en-Y procedure with some form of “stomach reduction.” The Roux-en-Y technique -- developed by a French surgeon, Dr. Phillibart Roux, in the 19th century -- involves rerouting the small intestine so that food empties into it instead of the stomach.

A complete RGB involves several steps. First, a small stomach pouch is created to restrict food intake. This can be done either by stapling or vertical banding. Next, a section of the small intestine is attached to the pouch to allow food to bypass the lower stomach and the first two segments of the small intestine (duodenum and jejunum). The end result is a reduction in both the amount of food a person is able to eat and the percent of calories and nutrients the body absorbs. RGB can be done both by opening the abdomen or using a less-invasive laparoscopic approach.

The lap-band surgery is short for laparoscopic banding. In this surgery, a scope is used to enter the abdominal cavity. A restrictive band is place high on the stomach. This limits the amount of food that can be eaten. The lap-band is also adjustable by the patient. The band has an inner surface that can be inflated and deflated using saline. This procedure is relatively new to the United States, but has been used in Europe, Asia and Australia for several years, with good results. For some reason, weight loss results so far have not been as impressive in the United States as in other parts of the world.

Both of these surgeries have risks and benefits. Surgeons usually explain these to prospective patients before any surgical procedure is agreed upon. The recommendation as to which is best depends on the patient’s medical history, current health status and other factors unique to the individual. Please keep in mind, however, that weight loss surgery is not for everyone. Most physicians will only perform the surgery on people who are severely obese, with at least one other risk factor, like diabetes.

It should be pointed out that there is a group in the United States, the National Association to Advance Fat Acceptance (NAAFA), that feels all gastrointestinal weight loss surgeries should be discontinued as they are hazardous, and in many cases, ineffective in the long-term.

The decision to have weight loss surgery should be undertaken with a medical team that carefully lays out all of the risks, benefits and possible complications of this major procedure. They should also help you to develop realistic expectations for your life after surgery and weight loss. Many people think being thinner will solve all of their problems. It does not.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.