| ||||||||||||||
| |||||||||||||||
Training Treatment Resources Support
Download Prospectus
Books of R K Mishra
Get Admission
Laparoscopic DVDs |
Frequently asked questions about laparoscopic obesity surgery
Laparoscopic Surgery for Severe Obesity (Morbid Obesity Surgery)Laparoscopic surgery for obesity is for people who are severely overweight. Laparoscopy involves using a specialized telescope (laparoscope) to view the stomach, which typically allows smaller abdominal incisions. This brochure will explain:
WHAT CAUSES SEVERE OBESITY? The cause of severe obesity is poorly understood. There are probably many reasons involved. In obese persons, the set point of stored energy is too high. This altered set point may result from a low metabolism with low energy expenditure, excessive caloric intake, or a combination of the above. There is scientific data that suggests obesity may be an inherited characteristic. WHAT DO YOU MEAN BY SEVERE OBESITY? Severe obesity, sometimes known as “morbid obesity”, is defined as being approximately 100 pounds (45.5 kg) or 100% above ideal body weight. This is determined according to the Metropolitan Life Insurance Company height and weight tables. Between 3-5% of the United States adult population has severe obesity. This condition is associated with the development of life-threatening complications such as hypertension, diabetes and coronary artery disease, to name a few. WHAT ARE THE TREATMENT OPTIONS? SURGICAL TREATMENT A number of weight loss operations have been devised over the last 40-50 years. The operations recognized by most surgeons include: vertical banded gastroplasty, gastric banding (adjustable or non-adjustable), Roux-en-Y gastric bypass, and malabsorbtion procedures (biliopancreatic diversion, duodenal switch). The vertical banded gastroplasty involves the construction of a small pouch that restricts the outlet to the lower stomach. The outlet is reinforced with a piece of mesh (screen) to prevent disruption and dilation The gastric bypass procedure involves dividing the stomach and forming a small gastric pouch. The new gastric pouch is connected to varying lengths of your own small intestine constructed into a Y-shaped limb (Roux-en-Y gastric bypass). MEDICAL TREATMENT In 1991, the National Institutes of Health Conference concluded that non-surgical methods of weight loss for patients with severe obesity, except in rare instances, are not effective over long periods of time. It was shown that nearly all participants in any non-surgical weight-loss program for severe obesity regained their lost weight within 5 years. Although prescriptions and non-prescription medications are available to induce weight loss, there does not appear to be a role for long-term medical therapy in the management of morbid obesity. Medications that reduce appetite can result in 11 to 22 pound weight reduction. However, weight gain is rapid once medication is withdrawn. Various professional weight loss programs use behavior modification techniques in conjunction with low caloric diets and increased physical activity. Weight loss of one to two pounds per week has been reported, but nearly all the weight loss is regained after 5 years. WHAT ARE THE ADVANTAGES OF THE LAPAROSCOPIC OBESITY SURGERY? Advantages of the laparoscopic approach include:
WHO SHOULD BE CONSIDERED FOR LAPAROSCOPIC OBESITY SURGERY? The following guidelines for selecting patients for obesity surgery were established by the National Institute of Health:
In some instances, a patient who is not quite 100 pounds or 100% above the ideal body weight is a candidate for surgical intervention. This patient should have a significant medical problem(s) that could benefit from weight reduction. HOW IS LAPAROSCOPIC OBESITY SURGERY PERFORMED? In a laparoscopic procedure, surgeons use small incisions (1/4 to 1/2 inch) to enter the abdomen through cannulas (narrow tube-like instruments). The laparoscope, which is connected to a tiny video camera, is inserted through the small cannula. A picture is projected onto a TV giving the surgeon a magnified view of the stomach and other internal organs. Five to six small incisions and cannulas are placed for use of specialized instruments to perform the operation. The entire operation is performed inside the abdomen after expanding the abdomen with Carbon dioxide (CO2) gas. The gas is removed at the completion of the operation. WHAT PREPARATION IS REQUIRED?
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED BY THE LAPAROSCOPIC METHOD? In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the "open" procedure may include a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety. WHAT ARE THE EXPECTATIONOF PATIENTS ON THE DAY OF SURGERY?
WHAT ARE THE OUTCOMES AFTER LAPAROSCOPIC OBESITY SURGERY? Weight loss The success rate for weight loss is reported as being slightly higher with gastric bypass operation than the gastroplasty or gastric banding, but all techniques show good to excellent results. Most reports show a 40-50% loss of excess weight for the gastric banding and vertical banded gastroplasty and a 65-70% loss of excess body weight for the gastric bypass after 1 year. The malabsorbtive operations generally achieve an average body weight loss of 70-80% after a year. Weight loss generally continues for all the procedures for 18-24 months after surgery. Some weight gain is common about two to five years after surgery. Effect of surgery on related medical conditions Weight reduction surgery has been reported to improve conditions such as sleep apnea, diabetes, high blood pressure and high cholesterol. Many patients report an improvement in mood and other aspects of psychosocial functioning after surgery. Because the laparoscopic approach is performed in a similar manner to the open approach, the long-tern results appear to be similarly good. WHAT COMPLICATIONS CAN OCCUR? Although the operation is considered safe, complications may occur as they may occur with any major operation. Gallstones are a common finding in the obese patient. Symptoms from these gallstones are a common occurrence with weight loss. Many physicians either treat patients with bile lowering medication (Actigall or URSO) or recommend gallbladder removal at the time of the operation. This should be discussed with your surgeon and physician. After gastric bypass, nutritional deficiencies such as Vitamin B-12, folate, and iron may occur. Taking necessary vitamin and nutrient supplements can generally prevent them. Another potential result of gastric bypass is “Dumping Syndrome”. Abdominal pain, cramping, sweating, and diarrhea characterize dumping Syndrome after eating drinks and foods that are high in sugar. Avoiding high sugar foods can prevent these symptoms. After the malabsorbtive operations, the same nutritional deficiencies that occur after gastric bypass may occur, as well as protein deficiencies. Diarrhea or loose “stools” are also common after malabsorbtion operations depending on fat intake. Women who become pregnant after any of these surgical procedures need special attention from their doctors and clinical care team. In general, complication rates of the laparoscopic approach are equal to or less than the conventional, open operations. Following obesity surgery, patients must re-orient themselves and adjust to the effect of a changing body image.As with any operation, there is a risk of a complication. However, the risk of one of these complications occurring is no higher than if the operation was done with the open technique. WHAT TO EXPECT AFTER SURGERY You will usually be in the hospital 1 to 3 days after a laparoscopic procedure. You may have a tube through your nose and not be permitted to eat or drink anything until it is removed. You should be out of bed, sitting in a chair the night of surgery and walking by the following day. You will need to participate in breathing exercises. You will receive pain medication when you need it. After the operation, it is important to follow your doctor’s instructions. Although many people feel better in just a few days, remember that your body needs time to heal. You will probably be able to get back to most of your normal activities in one to two weeks time. These activities include showering, driving, walking up stairs, and work and light exercise. WHEN TO CALL YOU DOCTOR Be sure to call your doctor if you develop any of the following complications:
|
| ||||||
|
|
| ||||
| ||||||
Next FAQ
