Weight Loss Surgery
11/04/2014 08:11AM ● Published by Aimee Cormier
by Thomas A. Borland M.D.
With the growth of obesity there has been a similar growth of weight loss surgery. Over the past 32 years there has been an evolution of surgery designed to treat obesity.
The early Jejunal-Ileal bypass caused severe malabsorption. The vertical banded gastric partition caused severe restriction. Both operations were initially thought to be very effective but were flawed. The gastric bypass, which combined restriction and mal-absorption, has been used extensively to treat obesity in the U.S. with considerable success. But the long term effects of vitamin and mineral deficiencies and the development of marginal ulceration have led the search for better weight loss operations.
The lap band has become popular because of its low short-term complication rate, but it is just purely restrictive, which we learned from the vertical banded gastric partition led to initial weight loss, then weight gain as a result of the patients becoming ravenous. Also, it is predicted that about 1/3 of all the bands will have to eventually be removed because of complications secondary to erosion or slippage.
Since 2007, the laparoscopic sleeve gastrectomy has grown in popularity because it causes weight loss without the usual restriction or malabsorption. Unlike the previous surgeries, the sleeve involves removing about eighty percent of the stomach. The remaining banana-shaped stomach is less distensible, so you can’t eat as much; you can’t eat as fast, and you are less hungry, because many cells that produce the appetite stimulating hormone Ghrelin are removed. Americans seem to do a lot better if they eat small portions of solid foods and are not ravenous. They can go about their business with a smaller stomach for the rest of their lives.
The risks for complications are a little higher for the sleeve than the band, but the weight loss is superior for the sleeve. Until a better operation is developed or a better drug is developed that stops the physiologic forces that are causing obesity, Laparoscopic Sleeve Gastrectomy gives Americans their best chance of obtaining durable reduction in obesity.