Honey, I have shrunk the flab
GUESS WHICH surgery will be most widely performed in the United States in a few years time. You are ignorant if you still think it will be open-heart surgery or the like. With 64 per cent of the population being obese, a quick way to shave off the extra weight has been found by the burgeoning populace. Like bees attracted to honey, the biggies are flocking in thousands to operation theatres to cut themselves down through bariatric surgery (gastric or stomach bypass surgery and stomach banding)
A recent article published in The New England Journal of Medicine sees the spawning of bariatric surgery as an epidemic, thanks to obesity. The numbers are chilling — from 16,000 per year in the early 1990s, number of surgeries shot up to 1,03,000 in 2003. This is bound to increase further as more and more severely obese people with failed dieting and exercising regimens are ever willing to lie on the operating table.
But what exactly is stomach bypass surgery? "In simple terms, the stomach is reduced to 100 ml capacity by separating the `top pouch,' now called the stomach, from the remaining part of the stomach with staples," explained Dr. J.S. Rajkumar, Chairman and Chief Surgeon at the Lifeline Rigid Hospital, Chennai. "In addition to reducing the stomach capacity, the intestine is connected to the pouch. And in doing so, the first 60 cm of the intestine is left bereft of gastric juice and bile, without which digestion of the food is not possible."
In another procedure called gastric banding, a band is placed around the stomach near its upper end, creating a small pouch as in the bypass procedure. But the only difference is that the small pouch is not totally cut off from the rest of the larger remaining portion of the stomach. Instead, it is connected through a restricted passage.
But will a sudden reduction in stomach capacity not make the person feel perennially hungry? "No, not at all," assured Dr. Rajkumar, "the feeling of satiation comes when the stomach is filled to capacity. After the surgery, very little food is required to get this feeling of satiety." Till date Dr. Rajkumar has done 14 bypass and stomach banding surgeries.
Little wonder then that the stomach bypass results in more weight loss (as much as 50 per cent) and is more likely to reverse the medical problems associated with severe obesity. But weight reduction comes at a cost. Vomiting is a common risk associated with both procedures, and patients who have gastric bypass are at greater risk for nutritional deficiencies and the dumping syndrome.
"Though the benefit is immediate, potential candidates are those with morbid obesity with a body mass index (BMI) of more than 40 or those with a BMI of 30-40 with serious coexisting conditions like cardiopulmonary problems and type 2 diabetes.
Again, the patient should be suffering from morbid obesity for at least five years and should have tried all other traditional methods like dieting, exercising," he said.
By definition, people with a body mass index (the weight in kilograms divided by the square of the height in metres) of 25 or higher are called overweight; those with BMI of 30 or higher are obese; and those with MBI of 40 or higher are morbidly obese. Men with a BMI of 40 or higher are on an average overweight by 50 kg and women by 40 kg.
Although the Technology Evaluation Center of the Blue Cross and Blue Shield Association certifies that bariatric surgery improves health outcomes for patients with morbid obesity, bariatric surgery is no cosmetic surgery.
According to The New England Journal of Medicine, major complications arising from bariatric surgery include pulmonary embolism, respiratory failure, gastrointestinal leaks from the breakdown of the staple or suture line, stomal obstruction or stenosis, and bleeding.
"Till date none of the 14 patients who have undergone stomach bypass or stomach banding has faced any serious complication," stressed Dr. Rajkumar.
R. Prasad
in Chennai
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