National Institutes of Health recommend that surgery be held at the following levels of human and weight:
* In patients with a BMI> 40 kg/m2
* In patients with a BMI of 35 and 40 kg/m2, which is also a serious health problem (such as diabetes, use of common conditions such as arthritis, or obstructive sleep apnea), which improves and weight loss.
This discussion focuses on the surgical treatment of obesity. Surgical treatment options will be considered separately. (See "Patient information: Weight loss treatments").
WORKING surgery - most patients in the United States, which have been made to weight loss surgery must meet a number of healthcare providers before surgery. This is often also the nutritionist and mental health experts. Some patients require these providers work for several weeks or months before surgery.
* Nutritionist to ensure that the patient understands and can follow the strict dietary guidelines necessary after surgery. Some patients are asked to lose a small amount of weight before surgery.
* Mental health experts to help the patient to identify the factors in response to stress, coping, and lifestyle.
Other health care professionals can also participate in pre-operative evaluation, as the cardiologist, a specialist in internal medicine or a specialist in sleep medicine. Cardiologist will help to ensure that the patient's heart is healthy enough to surgery. Provider of internal medicine may be necessary to assess the general health of the patient. Specialist in sleep medicine can determine if the patient is a common condition linked to obesity, sleep apnea. Sleep apnea can cause difficulty in breathing during sleep and may result in the time of surgery.
Types of surgery - weight loss surgery can be divided into the following categories: restrictive, malabsorption, and mixed or combined. The comparison of these procedures is available in Table 2 (shown in Table 2). All of these procedures performed with general anesthesia (patient is given drugs to cause sleep).
Restrictive - Restrictive procedures reduce the stomach, limiting the amount of food can be consumed at one time. There are several types of restrictive measures.
Lap banding - laparoskooppinen gastric (LAGB), or the lap band is a restrictive procedure that uses a silicone sides of the entrance to the stomach (Figure 1). This procedure is performed laparoscopically, which means that the surgeon makes small incisions to insert a tool to carry out a small camera cut without cutting open the abdomen. The band is connected to a narrow tube that extends from the port of entry under the skin, the healthcare provider may limit or expand the entrance to the stomach by injecting or removing saline through the door. Surgery the patient will feel full after eating small amounts of food.
Lap banding is a popular choice for weight-loss surgery, because it is relatively easy to make, can be changed or removed, and has low complications.
Effectiveness of the procedure varies, excess weight loss ranges from 45-75 percent in two years. Using the above example, a person who is 120 pounds overweight could expect to lose about 54-90 pounds within two years of Lap banding.
Sleeve gastrectomy - Sleeve gastrectomy is sometimes performed in patients with a BMI above 50 This procedure requires the removal of most of the stomach to create a smaller, tubular (sleeve-shaped) and the abdomen that holds less food and take a warm-down.
Although sometimes done without plans for further surgery, sleeve gastrectomy is often performed not going to do another procedure, such as gastric bypass and bilio-pancreatic diversion later. It is often difficult to do well in obese patients, and the sleeve gastrectomy performed through the patient to lose excess weight before proceeding through the second, closer (see "Gastric Bypass" below and see the "biliopancreatic diversion" below).
The expected loss for the excess weight is about 33 percent after two years. Using the above example, a person who is 120 pounds overweight could expect to lose 40 pounds within two years after surgery.
Malabsorption syndrome - malabsorption surgical goal is to reduce the length of the small intestine through the food must pass in order to reduce the absorption of nutrients and calories and cause weight loss. Biliopancreatic diversion, with or without a duodenal switch, is the most common procedure for malabsorption.
Biliopancreatic diversion - In biliopancreatic abuse (BPD), part of the stomach is removed, and the remainder is surgically attached to the bottom of the small intestine. Weight loss occurs mainly because of the large intestine before the food moves most of the nutrients and calories can be absorbed in the small intestine.
Mixed - Mixed or combination procedures are both part of the restrictive and malabsorption, which means that limiting food intake and decreased absorption of nutrients in the body. Gastric bypass is the most commonly confused with the surgical treatment of weight loss in the United States.
Gastric bypass - Roux-en-Y gastric bypass (RYGB) is primarily a restrictive procedure, but also a part of malabsorption, which is more effective than the act only narrowly.
The surgeon creates a small stomach pouch by dividing the stomach, small intestine, and keep (Figure 2). Housing may contain about one gram of food (roughly the equivalent slice of bread or 1 / 2 cups of cooked rice or pasta), caused a sensation of fullness after consuming a very small amount of time, the bag will stretch to around the cup. In addition, fewer calories are absorbed because the food passes the stomach and most of the upper small intestine (duodenum). This type of new contract bowel (Roux-en-Y) seem to cause loss of appetite and metabolism improved by changing the number of free hormones.
RYGB can be performed as open surgery (through a large incision in the stomach), or laparoscopically. Laparoscopic procedure, if technically possible, it is preferable, as patients usually require less time to recover and fewer complications.
RYGB has a high success rate, and patients lose an average of 62-68 percent of their excess weight during the first year. Weight loss usually the plains of one or two years, the overall loss of excess weight between 50 and 75 per cent. A person who is 120 pounds overweight, on average, 60-90 kg of weight loss should be expected.
Operative Complications - complications can occur in a number of surgical procedures, and weight loss. Specific risks depend on the procedure used in the past and diseases. In addition, problems are less likely if the cut is made centers with extensive experience in Bariatric surgery. Common potential complications of Bariatric Surgery in pulmonary embolism, hemorrhage, infection, reduction of sales outlets, and hernias are incisions.
EFFICIENCY surgery - the objective of all surgical weight loss is to reduce illness or death associated with obesity and improve your immune system and the functioning of organs. Studies have shown that Bariatric surgery effective in achieving these objectives, and also other benefits such as reducing the resources used in medicines, reducing sick days and improving quality of life.
Bariatric surgery research results showed that, overall, patients lost an average of 61 percent of their excess body weight, weight loss varies from a special run [2]. Other conditions cause or exacerbate obesity also improved so much that needs less or no treatment, and these included diabetes (86 per cent of patients), hyperlipidemia or high blood cholesterol (70 percent), hypertension (79 percent), and obstructive sleep apnea ( 84 per cent).
In addition, to achieve weight loss, patients undergoing Bariatric surgery is much less likely to develop heart disease, cancer, endocrine, infectious and psychiatric disorders, although they are likely to develop gastrointestinal illnesses.
After surgery
Hospital - Post-operative pain is controlled by medication. Many patients who Bariatric surgery is "patient-controlled analgesia" while still a hospital, this medicine is given through the pain intravenous line (IV) of the hand or arm. Patients can monitor the number of pre-limits when the dose is given.
Patients usually remain in hospital a day or two after surgery, during which the pain, mobility and eating will be monitored. After surgery, patients work with a healthcare provider and dietician to prepare guidelines on eating and activity after discharge from hospital.
Home - Dietary fluids and soft food (eg, yogurt, scrambled eggs and cottage cheese) must adhere to some six weeks after surgery, nutrition therapist may recommend a soft or puréed foods that provide adequate nutrition. It is important to follow the instructions on eating during the weeks, months and years after surgery, in order to maintain a healthy weight and to ensure that a sufficient number and type of nutrients you eat.
Instructions generally include slowly increasing energy intake up, eat small meals, chew slowly and deeply, separation of food and fluid intake of at least 30 minutes, and avoid high fat or sugar. Vitamin supplements may also be imposed.
Most patients are encouraged to get out of bed and begin walking the day after surgery to prevent blood clots in the body, but strong action is not recommended before the incisions have healed. The guide is avoided if the patient takes no pain medication stronger than acetaminophen (Tylenol). The patient is invited to start a regular exercise program as soon as possible thereafter improved, health-care provider can help recommend appropriate and beneficial forms of use.
Results of surgery - It usually takes one to two years maximum weight loss occurs. Once in largely balanced by a healthy body weight, some patients have plastic surgery (also called "Body contouring") to remove excess skin of the body, especially the stomach area.
Although Bariatric surgery can produce dramatic results, it is important that the patient is committed to maintaining a healthy lifestyle, such as the monitoring of the health care professional to monitor progress. It can be difficult lifestyle changes after surgery, and patients should be aware that, should seek to develop and stick to new habits.
After the recovery and the weight management can be stressful and emotional, and it is important to support the family and friends. Professional advice and a social worker or therapist must consider the patient's anxiety or depression.
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