Weight Loss Surgery: The Best Options. - Colorado Bariatric Surgery Institute
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It’s the start of a new year, and that means it’s time to look at how to make changes for a better 2020. With obesity rates reaching 21% in Colorado (one of the leanest states in the US) many are looking for weight-loss opportunities. For those of you who are approximately 100 pounds overweight, weight loss surgery may be the single best option. To help you, let me review some surgical weight loss options. These will include the status of the Lap-Band and duodenal switch surgery. As well as some of the newer and more effective procedures—the gastric sleeve and gastric bypass.

The Lap-band.

During the 1990’s ,The Lap-Band was developed in Australia. It was approved for use in the US during 2001. After this time, it quickly became the most common weight loss procedure. Lap band surgery consists of placing a donut size band around the upper part of the stomach. This creates a pouch that restricts the amount of food one can eat. Results were good, with many patients experiencing a 50% loss of excess weight with low complication rates.

Over time, however, it became apparent that this procedure was only effective for about one-third of patients. A third of patients had fair results, and the final third did not see any improvement. Complications of slips, prolapses, and erosion of the band became increasingly more common than the original studies had indicated. As a result, the Lap-Band is not a good long-term weight loss option. Surgeons like myself have stopped placing them in new patients. For the few patients who have had success with the Lap-Band, we continue to fill their bands periodically, and monitor their progress.

The Duodenal Switch.

The biliopancreatic diversion with duodenal switch. Also referred to as the duodenal switch or D.S. This operation was developed in the 1980’s. It consists of two parts. The first part is a sleeve gastrectomy, making a tube from the end of the esophagus to the end of the stomach. This is the restrictive portion of the operation that limits food intake. The second part of the operation is a bypass from the duodenum (the first part of the small intestine) to the end of the small intestine, by passing the majority of the small intestine. This is recognized as the malabsorption component of the operation.

This procedure results in about 90% excess weight loss. However, the duodenal switch (BPD/DS) limits the absorption of calories and nutrients. This can lead to chronic diarrhea and significant nutritional deficiencies. Today, only a few bariatric centers offer this operation. It requires extensive long-term follow-up with patients to monitor for vitamin and mineral deficiency.

Single anastomosis duodenal switch procedure (SADI), is a new operation introduced in 2007. It is designed to replace the D.S. with less bypass of the small intestine, making the operation less difficult. It results in good weight loss with good resolution of co-morbidities. However, long-term results regarding nutritional deficiencies are yet to be determined. I am not ready to recommend this procedure until we learn more definitive long-term results.

The Gastric Bypass.

This brings us to the two most common weight loss operations done today—the gastric sleeve (sleeve gastrectomy), and the Roux-en-Y gastric bypass. Both of these operations have been around for over 25 years, and moreover, provided long-term weight loss results with few complications.

The gastric bypass was first developed in the late 1960’s. It consists of two parts. The first part is making a small pouch out of the upper stomach. The pouch is small to restrict food intake. It will slowly stretch out to be about 25% of a normal size stomach at about 1 year. After that time it will stop getting larger. The second part of the operation is a bypass to the second part of the intestine. This bypass is much shorter than the D.S, but still leads to less absorption of food.

It results in good weight loss (70% of excess weight at 1 year) and good resolution of co-morbidities. Resolution or improvement in these obesity-related illnesses and health problems such as type II diabetes, hypertension, obstructive sleep apnea, GERD, knee and back pain, can be maintained long-term greatly impacting overall quality of life. Keep in mind, the gastric bypass can lead to nutritional problems. Therefore, supplements for vitamins, calcium, and iron may be required post-operation.

The Gastric Sleeve.

Finally, the gastric sleeve procedure is the most common operation for weight loss. It is the first part of the duodenal switch operation. The D.S. operation was only performed on very obese patients during the 1990’s. However, this operation was considered high risk. To make the operation safer, it was split into two procedures.

The first performed was a sleeve gastrectomy. The patient was required to lose weight before the second operation could be performed. The second procedure was an intestinal bypass.

Surgeons began to recognize that often the second procedure was unnecessary, as patients lost sufficient weight with the sleeve gastrectomy alone. Consequently, the sleeve is now the most common weight loss operation with good weight loss outcomes. It provides resolution or improvement in co-morbidities, such as type II diabetes, hypertension, obstructive sleep apnea, GERD, and knee and back pain.

Conclusions.

In conclusion, I hope this review helps those who might be contemplating weight loss surgery. If you have a BMI of 35 and a serious obesity related medical problem like type II diabetes, hypertension, obstructive sleep apnea, or a BMI of 40 or greater you are a candidate for weight loss surgery. Moreover, if you are looking for a more subtle approach to weight loss, but with very effective results, you should try Peak Medical Weight Loss Clinic.

At the Colorado Bariatric Surgery Institute, we perform over 300 successful weight loss procedures a year. I use state of the art technology, the DaVinci Robot, to expertly perform these procedures. This provides unsurpassed precision and visibility that translates into less bleeding and pain, and fewer complications and discomfort. The robot helps to make these surgeries minimally invasive, with very positive outcomes. Committing to weight loss surgery might just be the right thing to make your 2020 better than 2019. If you have any questions regarding weight loss surgery, please call us at 303-861-4505, and we can help you get answers.

Here’s to a happy and healthy 2020 to you and yours!

Dr. Tom Brown, MD

Colorado Bariatric Surgery Institute

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