While weight loss is one of the most important mantras for the management of sleep apnea, the time and effort it takes to do so for seriously obese patients often push doctors to consider surgical methods for achieving weight loss goals. This is often the last and final resort for medical experts when they find that lifestyle alterations, diet changes and physical exercises are not providing the desired results within a realistic time frame.
Before we learn more about bariatric surgery, let us update ourselves regarding the various concerns of both the patients as well as doctors regarding this type of surgery for weight loss:
- Bariatric surgeries sometimes entail serious complications. Since these surgeries are irreversible, the patient and the doctor must be in complete agreement regarding the expected aftermath of such surgeries.
- The surgeries have impact not just on the body weight but also on the body shape and future eating habits.
- Post surgery period involves strict maintenance of diet and exercising routines.
Bariatric surgery: basics
Way back in 2005, the Centers for Disease Control and Prevention had estimated that obesity would be a leading cause of death in the US with a rough estimate of 500,000 deaths annually. With 11 to 15 million Americans being obese, it is easily understandable that the demand for bariatric procedures would be on the rise. In 2005, 170,000 bariatric surgeries were performed in the US.
Bariatric weight loss surgeries can be of two types: Laparoscopic adjustable gastric banding and gastric bypass.
Working principle of bariatric surgeries
To put it in layman’s’ terms the working principle behind bariatric surgeries is making the digestive system including the stomach and small intestine smaller in capacity so that food intake is restricted without experiencing any untoward side effect of less eating. This in turn puts a major limitation on calorie intake, which results in weight loss.
Description of the types of bariatric procedures:
Gastric bypass surgery
The principle behind this most common type of bariatric surgery is dividing the stomach into two segments where the upper part of the stomach receives food from the esophagus followed by emptying into the intestines, surgically brought up and connected to it.
Some variants are roux-en-Y, biliopancreatic diversion, duodenal switch or fobi pouch. This 2-stage procedure consists of: reducing the stomach size; bypassing the first part of the small intestine. This results in the food moving faster through the digestive tract reducing the amount of calories that can be absorbed.
What this means essentially is that even if the patient overeats, he or she would eventually absorb fewer calories. This is the reason, why gastric bypass surgeries result in more effective weight loss than gastric banding.
Laparoscopic Adjustable Gastric Banding
This surgery involves using an inflatable silicon band (or special staples) around the upper segment of the stomach. With the inflation
of the band, the stomach becomes a smaller sac with an opening for drainage. The band inflation can be adjusted according to patient needs, through a tube having an aperture outside the abdominal wall.
Some other variants of this form of surgery are lap-band, stomach stapling, or vertical banded gastroplasty. These procedures are reversible as they do not alter the anatomy of the digestive system in any way. However, patients may easily find ways to eat more than what is recommended.
Success rate of bariatric surgery
An average of 45 to 75% for gastric bypass and 40 to 60% for lap banding surgeries success rates are claimed by this type of weight loss surgery. More than anything else, success rate of bariatric surgeries is far more than conventional dieting or physical workouts, etc. Given this background, bariatric surgeries do not eventually work for more than 50% of patients. This is because of poor patient compliance of post-operative guidelines on diet control and exercise. This results in renewed weight gain after about 2 to 5 years after surgery.
However more committed patients can expect better outcome from the surgeries. Perhaps the biggest side benefits of this type of surgery is the rub off on several other health conditions like hypertension, lowering of cholesterol levels, type2 diabetes, sleep apnea (75% cure rate) and more.
References & Resources:
- Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea
- Obesity and Obstructive Sleep Apnea-Hypopnea Syndrome: the Impact of Bariatric Surgery