Sacrifice Part of Your Stomach To Lose Weight?
07 Aug 2007
"Desperate diseases require desperate cures", wrote the immortal bard, William Shakespeare. For grossly obese patients this means putting part of the stomach and small intestine out of commission (bariatric surgery). But this is not minor surgery and patients should know the risks before making this desperate decision.
This year 150,000 bariatric operations will be done in North America. These patients usually weigh 300 or more pounds and the surgery seems like the answer to a maiden’s prayer.
Proponents of the operation say it causes weight loss, helps to cure or reverse diabetes, hypertension and the risk of other complications of obesity. For some patients it can be a life-saving procedure.
Several surgical techniques are available to trim the stomach and intestine. One involves an adjustable band around the upper part of the stomach. The resulting smaller stomach allows less food to be consumed and decreases the hunger reflex. Other operations bypass part of the small bowel giving food less chance to be absorbed.
But patients never get anything for nothing. A smaller stomach may result in vomiting, abdominal cramps, an irregular heart rate and headache. Patients may suffer from constipation since there’s less food and fiber in the diet. They may also develop a vitamin B12 deficiency and have more trouble absorbing iron and calcium.
Removing part of the stomach also increases the risk of gallstones by 30 per cent. To prevent this problem some surgeons remove the gallbladder at the time of bariatric surgery.
Another major problem arises. Patients forget that obesity is a big surgical risk. A 300 pound patient makes surgery several times more difficult than that of the patient half this weight, with the chance of more complications during the procedure.
Following surgery there’s increased risk of wound infection, hernia, small bowel obstruction. There’s also a one to two per cent chance of blood clots developing in the leg and when this happens one-third of these patients die. A study of 16,555 patients who had bariatric surgery revealed that within one month two per cent had died, after three months 2.8 per cent and after a year 4.6 per cent.
As well the first operation may not be the last. Some authorities claim that up to 20 per cent of patients require more surgery to correct a complication. For instance, an ulcer may form at the operative site or the band may slip from its designated position.
How successful is the surgery? Most authorities indicate the goal is to have patients lose 100 pounds over a one to two year period. The International Bariatric Register followed 14,641 patients for 10 years and found an average weight loss between 48 and 74 per cent.
Patients considering this operation must realize that to be successful bariatric surgery demands a new lifestyle. You may still desire to eat a large pizza, but there’s no room in the stomach for it. And if you still can’t say no and overindulge the result will be vomiting.
But when obese patients have an overwhelming desire to eat they often find a way to do it. Some learn to counteract the surgery by consuming little bits more often. This undoes the effects of the operation.
With any new procedure there are pitfalls for unsuspecting patients. For instance, colleagues in the U.S. tell me that some hospitals have initiated major efforts to market bariatric surgery. So when "marketing 101" becomes involved in surgery, business interests take over patient interests. Unlike Canada, U.S. hospitals are very competitive, using every method to attract patients.
Another concern is that surgeons are performing these operations without adequate training. Some bariatric procedures are performed by laparoscopy through tiny incisions. This requires a steep learning curve for doctors.
Harvey Cushing, one of Harvard’s most famous neurosurgeons, once remarked that, "There is no such thing as minor surgery, but there are a lot of minor surgeons". So let the buyer beware and choose a surgeon well. Good plumbers get better results than incompetent ones and surgeons are no different.
