Bariatric surgery (weight-loss surgery) includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device or through removal of a portion of the stomach or by resecting and re-routing the small intestines to a small stomach pouch.
Traditional "open" weight loss surgery requires a single large incision extending from the lower edge of the breastbone down to the belly button, typically 10 to 14 inches in length. In contrast, the laparoscopic technique requires five or six small incisions ranging from 1/4 to 3/4 inches in length.
It is important to keep in mind that any bariatric surgical procedure is a tool to help the individual, not a cure. In order to have the best outcomes possible, it is critical to make significant changes in diet and lifestyle following surgery.
Some side effects may include bleeding, infection, leaks from the site where the intestines are sewn together, diarrhea, and blood clots in the legs that can move to the lungs and heart.
Two kinds of hernias may occur after a patient has bariatric surgery. An incisional hernia is a weakness that sticks out from the abdominal wall's connective tissue and may cause a blockage in the bowel. An internal hernia occurs when the small bowel is displaced into pockets in the lining of the abdomen. These pockets occur when the intestines are sewn together.
Along with the obesity epidemic in America has come an explosion in weight-loss surgery, with about 220,000 operations a year — a sevenfold leap in a decade, according to industry figures — costing more than $6 billion a year.
The National Bariatric Surgery Registry said type 2 diabetes fell by 50% and on average patients lost nearly 60% of their excess weight a year after surgery, based on 1,421 operations.
One in 2,000 gastric banding patients, or 0.05 percent, and 1 in 900 gastric bypass patients die during or immediately after surgery, according to William Encinosa, a senior economist at the federal Agency for Healthcare Research and Quality who analyzed 161,000 surgical records for 2009. For open — not laparoscopic — bypass surgeries, studies have put the death rate within 30 days as high as 2 percent. About 1 percent of banding patients and 3 percent of bypass patients develop major complications, like blood clots or perforation of the bowel, Dr. Encinosa said.
Ms. Gofman’s procedure, called laparoscopic adjustable gastric banding, constitutes about 39 percent of all bariatric surgeries. The other two main types are Roux-en-Y gastric bypass, which involves stapling the stomach into a tiny pouch and rearranging the bowel, and sleeve gastrectomy, which involves removing most of the stomach and turning what is left into a thin tube.
Bariatric surgery may be performed through "open" approaches, which involve cutting the stomach in the standard manner, or by laparoscopy. With the latter approach, surgeons insert complex instruments through 1/2-inch cuts and guide a small camera that sends images to a monitor. Most bariatric surgery today is laparoscopic because it requires a smaller cut, creates less tissue damage, leads to earlier hospital discharges, and has fewer problems, especially hernias occurring after surgery.
In 2006, the ASMBS reports an estimated 177,600 people in the U.S. had bariatric surgery. Less than 1 percent of those who meet the criteria for surgery actually have surgery. About 15 million or 1 in 50, adults in the U.S. have morbid obesity, which is associated with more than 30 other diseases and conditions including type 2 diabetes, heart disease, sleep apnea, hypertension, asthma, cancer, joint problems and infertility. The direct and indirect costs to the health care system associated with obesity are about $117 billion annually.