Bariatric Surgery

Building A Healthier Community, One Individual At A Time

The Roux-en-Y Gastric Bypass is generally considered to be the best surgical procedure for the treatment of morbid obesity. Weight loss is achieved by reducing the functional portion of the stomach to a pouch one ounce or less in size, and by creating a stoma, a small opening between the stomach and the intestine.

Key Features Of Bariatric Surgery

50-65% is the average excess body weight people will lose 18 months after surgery

May reduce hunger because of the reduced amount of GLP-1 and ghrelin which is a hormone found in the stomach that induces hunger

Benefits of Bariatric Surgery

Bariatric surgery usually results in the loss of 50-80% of one’s excess weight. Most of this takes place within one year of surgery. In addition to this, surgery has also been found to either put into remission or greatly reduce the need for medication for some of the following health problems. It is from helping patients with these problems below that the greatest clinical benefits of bariatric surgery arise.

Hypertension

Hypertension, or high blood pressure, causes a number of problems, most of which are associated with damage to blood vessels. These vessels are not fixed plumbing, but rather dynamic passageways that actively expand or contract upon the proper stimulus.

Persistent hypertension damages their ability to function and, along with high cholesterol, makes them more susceptible to plaque formation. These plaques can break off to form emboli which can flow downstream and lodge elsewhere, causing heart attacks and stroke.

Hypertension can also lead to chronic heart failure, where the heart attempts and ultimately fails to cope with an increased workload. Obesity makes it harder for individuals to exercise, an important blood-pressure lowering activity. Obesity is also associated with higher levels of cholesterol and lipids in the blood. These interfere with the ability of blood vessels to expand and contract at the proper times, leading to higher baseline pressure levels.

Weight loss is a major factor in the control of hypertension.

Diabetes Mellitus

Overweight persons are 10 times more likely to develop Type II Adult-Onset Diabetes than those who are not overweight. Diabetes is the condition of insulin not working well.

The body needs insulin in order for cells to take up glucose. After eating a meal, your digestive system breaks carbohydrates in the meal down into sugar which enters the bloodstream. Insulin is also released into the blood.
Insulin acts as the key to allow glucose into the cells. To work, it must bind to insulin receptors on the cell surface, which act like a lock. Diabetes Type II (about 95% of all diabetes) results from cells not being able to maintain enough functioning insulin receptors to bind with insulin. Another name for this is insulin resistance. For reasons not fully understood, obesity is strongly associated with insulin resistance.

Diabetic persons losing weight experience a strong reduction in diabetic symptoms.

Sleep Apnea

Apnea means “without breathing” Overweight individuals (more likely men than women), may develop fatty deposits in the neck that restrict breathing during the night. Individuals with sleep apnea may go many seconds without breathing. They may typically wake up, gasping for air, and then return to sleep, sometimes repeating the process hundreds or even thousands of times during an evening.

The most prominent result of this is chronic daytime fatigue and drowsiness. People with sleep apnea may lack the energy to function normally and are much more likely to fall asleep while driving. Sleep apnea of often but not necessarily associated with snoring.

Sleep apnea generally vanishes in individuals who return to normal body weight.

Pickwickian Syndrome

This syndrome was named after a character in one of Charles Dickens’ works (Dickens was a 19th century English writer who wrote Great Expectations and other works). One character of his, Mr. Pickwick, had a particular type of labored breathing which 20th-century clinicians recognized as being associated with sleep apnea.
The three clinical components of Pickwickian syndrome are daytime sleepiness, lack of oxygen and excess carbon dioxide in the blood.

This disorder, if left unchecked, can eventually lead to heart failure.

Obesity Hypoventilation Syndrome

This condition occurs primarily in the very severely obese — over 350 lbs. It is characterized by episodes of drowsiness, or narcosis, occurring during awake hours and is caused by abnormalities of breathing and the accumulation of toxic levels of carbon dioxide in the blood.

It is often associated with sleep apnea and may be hard to distinguish from it because it presents with the same effects, but is a non-obstructive disorder of ventilatory drive.

Respiratory Insufficiency

Those who are obese find that exercise causes them to be out of breath very quickly. The lungs are decreased in size, and the chest wall is very heavy and difficult to lift. The demand for oxygen is greater with any physical activity.
This condition prevents normal physical activities and exercise and often interferes with usual daily activities Respiratory insufficiency can be completely disabling.

Weight loss cures this condition.

Heart Disease And Stroke

Heart disease and stroke are the leading causes of death and disability for both men and women in the United States. Severely obese persons are approximately 6 times as likely to develop heart disease as those who are normal-weighted.
Coronary disease is predisposed by increased levels of blood fats, and the metabolic effects of obesity. Increased load on the heart leads to early development of congestive heart failure. Severely obese persons are 40 times as likely to suffer sudden death, in many cases due to cardiac rhythm disturbances.

Being overweight also contributes to angina (chest pain caused by decreased oxygen to the heart) and sudden death from heart disease or stroke without any signs or symptoms.

The good news is that losing a small amount of weight can reduce your chances of developing heart disease or a stroke. Reducing your weight by 10 percent can decrease your chance of developing heart disease by lowering your levels of blood cholesterol and triglycerides and improving how your heart works.

High Blood Cholesterol

Cholesterol levels are commonly elevated in the severely obese — a factor predisposing to the development of heart and blood vessel disease. Cholesterol is a waxy, fat-like substance that is present in every cell in your body. Some cholesterol is needed for your body to function. Your liver produces enough cholesterol for your body.

Certain foods provide additional amounts of cholesterol, which may be more than your body needs. While some cholesterol in your blood is essential to your health, too much can be harmful. A healthy artery has a smooth, even surface.

When too much cholesterol builds up on the walls of your arteries, however, thick deposits, called plaque, form. The buildup of plaque narrows the artery, so your heart must work harder to force blood through.

Plaques can limit or block the blood flow in the artery. They can also rupture and form blood clots. When either happens in a major artery supplying the heart or in a major artery supplying the brain, the blood flow can be completely blocked. The result can be a heart attack or stroke. There are many reasons for a high cholesterol level.

These include diet and family history and obesity.

With weight loss, cholesterol levels decrease.

GERD – Gastroesophageal Reflux Disease (Heartburn) and Reflux Nocturnal Aspiration

Acid belongs in the stomach, and seldom causes any problem when it stays there. When it escapes into the esophagus the result is called “heartburn”, or “acid indigestion”. One of the leading causes is obesity, where the weight presses on the valve at the top of the stomach, causing dysfunction of that valve.

The problem is not with digestion, but with the burning of the esophagus by the powerful stomach acid. When one belches, the acid may bubble up into the back of the throat, causing a burning feeling there as well. Often this occurs at night, especially after a large or late meal. If one is asleep when the acid regurgitates, it may actually be inhaled, causing burning of the airway.

GERD is dangerous, because of the possibility of pneumonia or lung injury. The esophagus may become scarred and constricted, causing problems with swallowing.

Approximately 10 – 15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett’s esophagus, which is a pre-malignant change in the lining membrane of the esophagus, and may lead to esophageal cancer.

Asthma and Bronchitis

Asthma is a breathing problem which results from spasm (bronchospasm) of the muscles surrounding the walls of the lung airways (bronchi). Airways are breathing passages that allow air to move in and out of the lungs. Alveoli are tiny sac-like structures at the end of the airways where oxygen enters the bloodstream.

Bronchospasm causes narrowing of the airways which leads to shortness of breath, wheezing, coughing, and congestion. Airways can also be narrowed in asthma from accumulated mucus and swelling that is caused by inflammation of the bronchi.

Asthma is a respiratory disorder affecting an estimated 10-15 million people. More than 4,000 people in the U.S. die of asthma each year. Asthmatics have difficulty exhaling. Obesity does not itself cause asthma, or bronchitis, directly. However, it does interfere with breathing, aggravating any attack of asthma and may cause severe bronchitis.

Gallbladder Disease

Gallbladder disease occurs several times as frequently in the obese, in part due to repeated efforts at dieting, which predispose to this problem. When stones form in the gallbladder and cause abdominal pain or jaundice, the gallbladder must be removed.

Gallstones are formed by cholesterol and pigment (bilirubin) in bile. Bile is produced in the liver and stored in the gallbladder. Risk factors for cholesterol gallstones include age, obesity, female gender, multiple pregnancies, birth control pills, and heredity.

The most common symptom of gallstones is pain in the upper abdomen. Diagnosis of gallstones is usually made with an ultrasound of the abdomen. Cholecystitis (inflammation and infection of the gallbladder) is a complication of gallstones.

Some patients with gallstones have no symptoms and need no treatment. Patients with mild and infrequent symptoms may consider oral medication to dissolve gallstones. Surgery (standard or laparoscopic) is considered for patients with severe symptoms and for those with cholecystitis.

Stress Urinary Incontinence

A large heavy abdomen, and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing.

This condition is strongly associated with being overweight and is usually relieved by weight loss.

Degenerative Arthritis of Weight-Bearing Joints

The hips, knees, ankles, and feet have to bear most of the weight of the body. These joints tend to wear out more quickly or develop degenerative arthritis much earlier and more frequently, than in the normal-weighted person.

Eventually, joint replacement surgery may be needed to relieve severe pain. Unfortunately, the obese person faces a disadvantage there too — joint replacement has much poorer results in the obese. Many orthopedic surgeons refuse to perform surgery in severely overweight patients.

Venous Stasis Disease

The veins of the lower legs carry blood back to the heart, and they are equipped with an elaborate system of delicate one-way valves, to allow them to carry blood “uphill”.

The pressure of a large abdomen may increase the load on these valves, eventually causing damage or destruction. The blood pressure in the lower legs then increases, causing swelling, thickening of the skin, and sometimes ulceration of the skin.

The loss of weight brought by WLS can improve or cure venous stasis disease.

Weight loss surgery is a tool that can lead to increased energy, confidence, and an improved quality of life.

Is Bariatric Surgery Right For You?

While the risks of surgical treatment of obesity are comparable to those of other major surgeries, surgery for weight loss should be used only after all other attempts have failed. Patients must have a Body Mass Index (BMI) of 40 or higher, or possibly 35 or higher if other health problems such as diabetes, sleep apnea, arthritis or heart disease are present.

Over the years, weight loss surgery has evolved. The method we primarily use is called the RNY gastric bypass (Roux-en-y), the current “gold standard” of bariatric surgery techniques.

To find out if you are a candidate for bariatric surgery, schedule an appointment with one of our patient representatives today by calling 907-929-4263

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