The concept of surgery to control obesity grew out of the results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine. Because patients undergoing these procedures tended to lose weight after surgery, some physicians began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was the intestinal bypass.

This operation, first used more than 40 years ago, produced weight loss by causing something called “malabsorption” (failure of intestines to properly absorb nutrients from food). The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. Even though this surgery is no longer used in its original form, surgeons now use modified techniques that produce weight loss by limiting how much the stomach can hold. These restrictive procedures are often combined with modified malabsorbtive procedures that limit calorie and nutrient absorption and may lead to altered food choices.

Two ways that surgical procedures promote weight loss are:

1. By decreasing food intake (restriction). Gastric banding, gastric bypass and vertical-banded gastroplasty are surgeries that limit the amount of food the stomach can hold by closing off part of the stomach. These operations also delay emptying of the stomach.
2. By causing food to be poorly digested and absorbed (malabsortion). In the gastric bypass procedure, a surgeon makes a direct connection from the stomach to a lower section segment of the small intestine, bypassing the duodenum (the first part of the small intestine) and some of the jejunum (the second segment of the small intestine).

There are two “bariatric” or surgical weight-loss procedures that are offered at the MemorialCare Center for Obesity. The procedures are known as Gastric Bypass which is normally performed laparoscopically and the Adjustable Gastric–Band procedure. With your input, your MemorialCare Center for Obesity surgeon will select the medically-appropriate procedure for you. Each procedure is designed to limit the amount of food that can be eaten during a meal by reducing the size of the stomach. With a smaller stomach, you will feel full quickly and for a longer period of time, eliminating the need to eat larger quantities in more frequent intervals. The lower intake of calories will satisfy your appetite and will cause you to lose weight at the same time. 

For those who remain severely overweight when non–surgical approaches to weight loss have failed, or for people who have obesity–related diseases, surgery may be the next step. Answers to the following questions can help in your decision to undergo weight-loss surgery.

Are you:

• Unlikely to lose weight successfully with (further) non–surgical measures?
• Well informed about the surgical procedure and the effects of treatment?
• Determined to lose weight and improve your health?
• Aware of how your life may change after the operation (adjustment to the side effects of the surgery, including the need to chew well and inability to eat large meals)?
• Aware of the potential for serious complications, the associated dietary restrictions and the occasional failures that are associated with surgical weight-loss procedures?

Do you:

• Have a BMI of 40 or above, or 35 above with co-morbidities?
• Have an obesity–related physical problem such as body size that interferes with employment, walking or family function?
• Have high–risk, obesity–related health problems such as diabetes, severe sleep apnea or obesity–related heart disease?

Though surgery may be a viable option for you, success is only possible with your fullest cooperation and commitment to behavioral change and medical follow–up for the rest of your life. 

Any surgery entails a certain amount of risk, and complications cannot always be avoided. Therefore, before making the decision to undergo surgery, it is important to consider all the potential risks. Your surgeon will explain the risks of each procedure with you. Some of the potential complications are listed below:

Immediate Risks

• An obese person has a higher risk of complications from anesthesia than a non–obese person. An anesthesiologist will most likely want to meet with you prior to surgery to discuss possible complications.

Risks During Surgery

• Possible bleeding.
• Pulmonary embolism, or blood clots to the lungs. Prevention of this occurrence is made with the administration of certain medications that prohibit blood clotting.
• Pulmonary atelectasis, or partial collapse of some segments of the lungs may occur and can develop into pneumonia if not treated properly.

Delayed Complications

• Wound infection.
• Staple line disruption leakage.
• Vomiting.
• Abdominal abscess.
• Small bowel obstruction.
• Weight loss failure.

It should be noted that the above listed complications are rare. However, if they do occur, a revision operation may be necessary. Other unforeseen complications, including death, are a possibility. Bariatric surgeries are not miracle procedures or an “easy way out.” It is possible to “eat through” the operation and fail to lose/regain weight at a later time.

No. Like nutrition and exercise, a supportive network is important to the weight-loss effort. The team at the MemorialCare Center for Obesity includes not just our skilled surgeons, but also internists, psychologists, counselors and dietitians to help you develop a program to achieve your weight-loss goal. In addition, there are support groups for those who have undergone surgical weight-loss, and patients are automatically linked into this network. In addition to a supportive group environment, regular meetings feature guest speakers who will discuss topics that deal directly with the daily issues you will face as you progress with your weight loss.