Operations on the digestive tract to reduce weight

A dietician is someone who educates patients about eating properly after any operation and will provide all the information patients need in a straightforward manner.

There are some colleagues who are in favour of such operations. Personally I am opposed to them and I have quite a few scientific arguments to back up that view. Of course, I have many clients who have undergone surgery and I help them using all my scientific knowledge and skills.

A few words about the operations:

These are operations that reduce the size of the stomach by 60-70% by removing the large rounded section of the stomach. This laparoscopic intervention is a form of keyhole surgery and leaves very small scars on the abdomen. This operation is the only gastric operation which removes a part of the stomach and it is irreversible.

Weight loss is achieved in two ways:
1. The reduced size of the stomach results in the patient eating less food.

2. Reduction in the size of the stomach removes that part which produces the hormone ghrelin that causes hunger.

By causing the stomach to feel full earlier, the patient is more easily able to lose weight. A gastric sleeve can expand over time leading to a return to initial weight. The total weight loss is equal to the excess weight lost in the first two years augmented by 40-60%. There is no poor absorption of nutrients. If weight comes back a duodenal switch or gastric bypass can be added by laparoscopic surgery.

• The gastric sleeve is a safer method than the gastric bypass for individuals with a difficult medical history.
• The gastric sleeves reduces the likelihood of ulcers compared to the gastric bypass.
• Although the size of the stomach reduces, the openings remain unaffected thereby allowing for normal digestion.
• The patient’s body remains free of foreign objects.

• Additional surgery may be needed such as a gastric bypass or duodenal switch to allow the patient to get to the desired weight.
• Gastric operations increase the risk of gall stones or problems with the gall bladder occurring.
• Eating habits may cause a sense of ill ease, sickness or nausea after the operation.
• The patient will not lose weight or maintain a stable weight if he/she does not eat properly and exercise regularly.

The adjustable gastric band was invented by Kuzmak in 1983 and has been improved open over the last decade. The most important advantage of this technique is that it can be easily installed during laparoscopic surgery with minimal tissue damage. The difference from the vertically banded gastroplasty surgery is that in the case of the band there is no need for sutures and separation of the stomach into compartments. The stomach acquires an hour-glass shape with a gastric sack with about 15-20 gr capacity. The band is made of biocompatible silicon and has an airbag that can increase or reduce its internal diameter. The first setting on the band is normally applied one month after it is installed via a special port that is implanted under the skin in the abdomen or thorax. The port is connected to the airbag on the band via a fine silicon tube. The airbag is filled with an x-ray visible fluid or natural serum and the inner diameter decreases pressing and narrowing the stomach. In most cases the band is tightened gradually over time.

After the band is installed, some complications or side-effects can occur:

• Gastritis
• Pain in the back of the chest
• Acid reflux (usually with the perigastric technique)
• Burping and retching
• Dysphagia (using the pars flaccida technique)
• Frequent vomiting
• Constipation
• Contamination of the device and infection
• Leakage from the device

These complications can be addressed by suitably adjusting the band, by adjusting the diet, pharmaceutical treatment or sometimes with a second surgery. If the device malfunctions or leaks, the device must be repaired or replaced with new surgery.

Weight loss is highly dependent on whether the patient follows specific dieting rules. The operation restricts the quantity of food per meal but does not solve the problem of bulimia on its own.