Once the decision has been made to opt for Weight Loss Surgery, several factors come into play. There is a huge amount of recorded misinformation about the procedures that comes about through hearsay, misunderstandings, and exaggeration. Unqualified sources may have heard so called horror stories and tell lurid tales, but generally, there are only a tiny percentage of procedures which are problematic, or need additional surgery.
An experienced and independent bariatric surgeon is the best and most qualified person to consult, and on the whole, they know how to handle most medical needs before, during, and after weight loss surgery.
There are two types of common weight loss surgery:
1. Restrictive procedures that reduce food intake.
2. Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed, so that it is eliminated in the stool.
Gastric Restrictive Procedure – Vertical Banded Gastroplasty (VBG) is a purely restrictive procedure which decreases the flow of digested food from the stomach, making the patient feel full for longer periods. The advantages are that they have a reduced amount of well chewed food entering and passing through the digestive tract. Also, patients tend to maintain their weight loss many years after the surgery. The risks are that the method of stapling the stomach carries a tiny risk of staple-line disruption and infection. It has been found that approximately 40 per cent of patients lose less than half of their excess body weight.
Malsbsorptive Procedures – Biliopancreatic Diversion (BPD)
These operations also reduce the size of the stomach, but to a lesser degree. The idea is to restrict the amount of food consumed and alter the normal digestive process. These procedures adjust the way that digestive and intestinal juices regulate the amount of absorption of protein, fat, and fat-soluble vitamins.
The advantages of BDP type procedures are that patients are able to eat bigger meals than with a purely restrictive bypass procedure, and as these operations provide the highest levels of malabsorption, they tend to produce the greatest weight loss. Long term maintenance of excess body weight loss is more successful if the patient keeps to their dietry and exercise programme. There are risks of course, mainly abdominal bloating, gall bladder problems, and lifelong vitamin supplementation.
Post surgery, there are several guidelines that must be absolutely adhered to. Bariatric surgeons will have various recommendations, which depend upon which type of surgery took place. It may take a little while before soild food feels comfortable, and alcohol, carbonated drinks, milk shakes and high fat/high fibre foods are to be avoided.