Sunday, April 24, 2016

By Martha Foster


Lifestyle changes are one of the most effective approaches in achieving weight loss. While their effect can be clearly appreciated in a majority of New York residents over time, there is a smaller group of people in whom these lifestyle changes alone cannot achieve the desired results. These people form the bulk of potential candidates for surgical weight loss procedures which include gastric banding and sleeve gastrectomy. The two operations are examples of bariatric surgery.

Bariatric surgeries are also known as restrictive surgeries. This is because they are designed to reduce the capacity of the stomach which effectively reduces the amount of food that is held at any given point in time. Since, the stomach fills a lot faster than before, there is early satiety and by extension, reduced food intake. The weight loss that is seen in subsequent weeks and months is mainly due to reduced food intake.

Gastric banding is achieved by use of a silicon band using laparascopic approach. When the band is slipped onto the upper part of the stomach (the fundus), it squeezes it to leave just a small outlet. The estimated capacity of this pouch is one ounce of food. Laparascopic procedures, use small entry points (ports) that result in smaller scars later on. This is in contrast to open surgeries in which large incisions have to be made.

To retain control on the band, the surgeon connects it to an area just below the skin using a plastic tube. Sterile water or saline can be injected into this tube or drawn from it to increase or reduce the squeeze. The final effect is increased or reduced capacity. Increasing the capacity may be necessary if there are unwanted side effects. Reducing it, on the other hand, is necessary if the benefits are not being realized.

Gastric banding has been shown to cause up to 50% in weight loss in a couple of months. The procedure is largely safe but a few side effects may be experienced. Such may include nausea and vomiting, wound infections or minor bleeding. Adjusting the tube often resolves the nausea and vomiting but removal of the tube may be needed if these effects are severe.

Sleeve gastrectomy (or gastric sleeve) refers to the surgical removal of a part of the stomach. This may be as much as 80%. The remaining stomach is a tubular pouch which closely resembles a banana. This method helps reduce weight in two ways: reduced capacity of the stomach and faster movement of food (hence less absorption). The shape is also believed to influence gastric hormone production such that one feels less hungry.

Sleeve gastrectomy may be used in adolescents and children. Studies have ruled out any major effects on growth in children less than 14 years. The side effects that one should anticipate include nausea, aversion to food, leakage of food, infections and esophageal spasms among others. After some years, the stomach may dilate slightly but this is hardly a cause for worry.

These two surgeries are performed as day cases. One can, therefore, be released to go home on the same day. Resumption of the normal daily routine can occur within a day or two. As for the diet, one needs to be on liquid diet and mashed foods for at least two weeks. The food to be eaten for the first two weeks should be either liquid diet or mashed foods.




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