Bariatric Surgery

Bariatric surgery for treatment of morbid obesity was pioneered in the 1950s with the development of the jujuno-ileal (or small bowel) bypass which is rarely used today because of frequent medical complications. Since that time there have been significant advances and improvements in surgical options for morbid obesity.

Two different general bariatric surgery approaches are available today: (a) gastric restriction involves reducing the capacity of the stomach to a small pouch by partitioning it with a surgical stapler; and (b) gastric bypass entails stapling the stomach across the top to create a small pouch to which a part of the small intestine is sewed.

A more radical bariatric surgery, pancreatobilary bypass involves removing 75% of the stomach and bypassing 50% of the small intestine, producing weight loss through both gastric restriction and malabsorption. Two of the most recent refinements in bariatric surgery are the use of laparoscopic methods and adjustable gastric bands.

Although gastric bypass is associated with greater weight loss compared to gastroplasty, initial weight loss following bariatric surgery is typically quite impressive. Average weight loss in the 12 months following surgery is between 25% and 35% of preoperative weight, which corresponds to approximately 100 pounds and approximately 50% of excess weight.

Although most patients remain at least mildly obese, the medical risks of obesity are reduced greatly. In addition, many clinicians have reported positive psychological changes following bariatric surgery including reduced depression, improved self-image, increased social activity, and improved social relationships. Weight loss following bariatric surgery also appears to be associated with improved feeling and attitudes about one's body, although the perceptual overestimation of the body size may remain.

Research suggests that maintenance of weight loss following bariatric surgery may be better than that associated with other treatments for morbid obesity. In a recent study of gastroplasty versus VLCD in 60 morbidly obese patients, the maximum weight losses did not vary significantly. But the group that underwent gastroplasty regained less weight over the course of 2 years following treatment compared to the VLCD group.

Longer-term studies show a trend toward gradual weight gain. In a study of over 150 bariatric surgery patients, the average weight loss at 1 and 5 years was 48kg and 37kg respectively. In a long term study of over 50 vertical-banded bariatric surgery patients, over 30% had returned to or were above the preoperative weight at follow-up approximately 10 years after surgery. Only 40% maintained their initial weight loss. A 10 year outcome study of 119 patients showed mean weight losses of only 9kg, 31kg, and 25kg, respectively for horizontal gastroplasty, transected gastric bypass, and stapled gastric bypass procedures.