Obesity:
- Complications of obesity
- Medical treatment
- Surgery for obesity
- Outcomes of surgery
- Complications of surgery
- NICE guidelines
- Life after surgery
Laparoscopic surgery for obesity:
Restrictive - The restrictive operations serve to reduce the capacity of the stomach to hold the size of meal required by the person to maintain the current body weight.
The most common procedures performed today are:
Adjustable gastric band - A collar is fitted to the upper part of the stomach to create the pouch. The pouch is calibrated to hold 30 - 50ml of food. This has the advantage of being adjustable as the weight loss progresses. Side-effects include continued sensations of hunger, and nausea if too much food is taken at one sitting. It is often associated with a low level of patient satisfaction and many are removed at the patient's request for this reason.
It is reversible by removal of the device if required.
Sleeve gastrectomy - This procedure involves the removal of the greater part of the stomach (up to 80%), leaving a tube. This may be combined with a malabsorptive procedure in two stages if the degree of weight loss is insufficient or reverses at a later point. It is thought that the remaining stomach may enlarge with time, reducing the effectiveness of this procedure on its own.
It is an irreversible procedure as part of the stomach is excised and cannot be replaced.
The theory behind the success of this procedure is the restriction it places upon the person to ingest food at each meal. It has little effect on the person's sense of hunger and forces them to adapt their eating habits to avoid the unpleasant sensations associated with eating more than a few mouthfuls at a time.
It has been put forward that the reduced stomach bulk reduces the level of a hormone ghrelin which is associated with satiety and sensation of hunger.
Eating small volumes of calorie dense foodstuffs such as chocolate will severely reduce or reverse the weight loss effects of this procedure.