Bariatric Surgery –
who is a candidate for what types?

With the growing epidemic of obesity, many Americans are encouraged to get on track with healthy eating habits and a consistent exercise regimen. However, for those who are morbidly obese, there is another tool available to help achieve health goals. More than 65 million Americans suffer from obesity, and for over 200,000 people annually, bariatric surgery has become a means to achieve improved health.

Bariatric surgery is known as the most effective way to provide enduring weight loss. The procedures work by restricting food intake and limiting calorie consumption. They can also resolve, improve or prevent obesity-associated medical conditions such as high blood pressure, high cholesterol, diabetes and cancer. The different surgical procedures are: Laparoscopic Gastric Bypass, Laparoscopic Adjustable Gastric Band and Laparoscopic Sleeve Gastrectomy. The choice of which operation to undergo is tailored to the specific characteristics of each patient. To be a candidate, one must have at least one obesity-related medical condition and a body mass index between 35 and 39, or have a body mass index greater than 40. All three operations have different results:

Laparoscopic Gastric Bypass
This is the most tried and true method of surgery. Patients with a BMI (body mass index) of more than 40 and who suffer from diabetes are the prime candidates for this type of surgery. The procedure is done by making the stomach smaller by creating a small pouch at the top. This pouch is connected directly to the middle portion of the small intestine. The food bypasses the rest of the stomach and the upper portion of the small intestine. This procedure is most often done with small laparoscopic instruments. Good Shepherd Hospital is one of a select few hospitals in the nation who performs this procedure with the da Vinci surgical robot. Patients lose approximately 75 percent of their excess weight within the first 1 to 2 years after surgery.

Laparoscopic Adjustable Gastric Band
This operation has been used more often in Europe. Patients with a BMI between 35-50 are candidates for this procedure. An adjustable band is placed around the upper portion of the stomach. A tube is connected from the band to a port beneath the skin of the abdomen. After surgery, the band is filled with saline solution to mimic the feeling of fullness. To maintain optimal weight loss, saline solution is added or removed. This method can take several years to work and allows patients to typically lose up to 50 percent of their excess weight.

Laparoscopic Sleeve Gastrectomy
This bariatric operation has only been performed for the past seven years. Sleeve gastrectomy can be used for patients who are super-morbidly obese, with a body mass index greater than 50. In this procedure, weight loss is achieved by removing more than 85 percent of the stomach. In some cases, the sleeve gastrectomy can be later converted to a gastric bypass in order to achieve greater weight loss. The Sleeve Gastrectomy can typically result in 60 percent of excess weight loss in the first year post-operatively.

Although bariatric surgery may be extremely successful, it is important for patients to realize that surgery is not a simple fix. The surgery is a tool to help reduce appetite and limit caloric intake. Regular exercise is recommended. Proper screening procedures are necessary to decide if bariatric surgery is the right method of weight loss for each individual patient.