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It is a recognizable fact that obesity is undesirable and that morbid obesity is dangerous. Morbid obesity is associated with many serious health hazards such as diabetes, high blood pressure, heart disease and shortness of breath, irregular menstrual periods, infertility and high incidence of cancer of the uterus and degeneration of the joints of the lower extremities and the back. In addition, carrying around 100 pounds or more over the normal body function, interferes with enjoyable social and personal relationships creating severe emotional problems. Difficulty in finding employment and in coping with unusual expense for special clothing are also well known facts to the morbid obese.
Treatment is obviously necessary. Diet pills, hypnosis and numerous other modalities have not been helpful for most people. Maintaining weight loss, if any had been achieved, is particularly difficult. This is why surgical treatment came about.
SURGICAL TREATMENT
Many operations have been devised for the treatment of morbid obesity. Intestinal bypass proved to be associated with many complications and has been abandoned.
Gastric stapling refers to the stomach proper, the reservoir which receives the food after being swallowed. This stapling creates a stomach pouch 2-4 ounces in size which tends to get full with small size meals and reduces the food intake.
Bilio-pancreatic diversion is added to this gastric stapling. This is a special rearrangement of the small bowel and redirection of the liver bile and pancreatic juices which result in a decreased selective absorption of fatty foods, very high in calories. So, you lose weight because you eat less and your bowel absorbs less. This operation was started in Genoa, Italy by Dr. Scopinaro in 1976 and was adopted and modified in the United States.
WHO IS A CANDIDATE FOR THE OPERATION
The following conditions must exist to qualify for the operation:
1. At least 100 pounds over the normal weight or two times the normal weight.
2. Obesity should have existed for a number of years.
3. Failure to lose or maintain weight loss by previous serious efforts.
4. Absence of medical problems that make surgery too hazardous.
5. Sincere motivation toward weight loss and willingness to make necessary changes in eating habits and to follow instructions essential to the success of the surgery.
6. Age is a factor to be determined on individual basis (generally between 10 - 60).
7. Diabetes, high blood pressure, joint problems, shortness of breath, sleepiness are more reasons to have the operation.
EXPECTED RESULTS
The results of the operation have been satisfactory. The average weight loss in the first year is around 100 pounds. Gradually the rate of weight loss decreases and eventually the patient reaches a stable weight which is generally above the ideal weight. Several factors influence weight loss: compliance, age, weight at time of surgery, (patients who are extremely obese have more to lose and generally lose more.) This weight loss is expected to be permanent. There is however, no guarantee of how much you will lose and for how long you maintain this weight loss.
An added benefit of this operation is the lowering of cholesterol and triglyceride in the blood, which should help you against hardening of the arteries and other cardiovascular complications.
In order for the operation to be a success, it is imperative that you comply with the following:
1. Remain on liquid and blenderized foods for eight weeks after the surgery to prevent the staple line from disrupting.
2. Avoid frequent snacking, high calorie liquids, and sugars.
3. When you begin solid foods eight weeks after surgery, you should eat slowly and chew your food well. Eat nutritious high protein food, but avoid fried and fatty foods.
4. It is important that you take multiple vitamins, iron and calcium every day as it will be prescribed for you.
5. It is imperative that you keep your follow up appointments and we urge you to attend the Gastric Stapling Support Group Meetings.
POTENTIAL HAZARDS AND PROBLEMS
Gastric stapling with bilio-pancreatic diversion is a major operation and carries with it the hazards of major surgery in general, particularly in the obese patient. Examples: wound infection, pneumonia, phlebitis, pulmonary embolism (blood clots in the lungs), and a mortality of less than one percent. Diarrhea may occur if you indulge in eating fatty foods and stools are foul smelling. I do my best to help you avoid these complications, but your full cooperation is absolutely essential.
Although I strive to do the best I can, sometimes complications can occur which require revision by a second operation. You should consider these possible problems very carefully and discuss them with your family. If you decide to have this operation, you should be prepared to face these problems and to accept their treatment.
I hope that these outlines are clear enough and have been of some help to you. Please read them carefully and if you have any questions, I will be very happy to discuss them with you.
If you decide to go through with the operation, then you should think wisely. This is a very important decision that you will be making. Please make it very carefully and wisely.
The ASBP recommends that persons seeking medical treatment for overweight and obesity ask several questions of the practitioner:
1. Do you specialize in overweight and obesity treatment?
2. Have you received advanced training/education in the treatment of obesity?
3. Is your education in this area?
4. What kind of initial patient work-up do you do?
5. What is your policy on the frequency of follow-up visits?
6. If you prescribe medication, what should I look for as possible side effects?
7. Do you prescribe low calorie or very low calorie (VLCD) diets with supplements and, if so, have you received special training in monitoring patients on these diets?
