The Cosmetic and Plastic Surgery Section

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This type of surgery is called bariatric surgery from the Greek word for weight. These surgical procedures are considered to be quite extensive and are therefor reserved for people that are quite overweight. In the past people have been considered for these operations only if their is more than 40 or if they were more than 45 kg overweight. These procedures are all done under a general anaesthetic. With a general anaesthetic there is always a risk of complications incl. death. Other complications of the surgical procedure which applies to more or less to all these operations is the risk of lung, liver and kidney problems as well as a substantial risk of infections. There is also a chance that the surgery might not work or that once you loose the weight that it will not stay off.

Many people struggle with diets and exercise to loose weight but keep getting bigger or gaining the weight back. Sometimes these operations can be the only way out as more than 90% of people fail with diet and exercise alone. Surgery should not be considered the easy option out, and other methods should be tried before surgery. It is also important to realise that you still need to eat the right foods after the operation and that you will need to see a dietitian and other people specialised in the management of obesity after you surgery to get the best results.

There are a number of different procedures on the gastrointestinal system with the primary aim being weight loss. They can be divided into two broad categories. The operations that aim at reducing the amount of food or the operations that aim at reducing the absorption of the food that you eat.

Your GI system basically consist of 5 parts (excl. the oesophagus and mouth) relevant for this discussion. The first part the food enters into is the stomach, which acts as a reservoir, allowing you to eat a large quantity of food that later, gets digested. The stomach contains acid and enzymes that break down the food. After the stomach the food enters into the small intestine.

The small intestine consists of the duodenum (which is the first part and about 12 cm long), the jejunum which follows the duodenum and the final part being the ileum which connect the small intestine with the colon ( large intestine ). The duodenum has many functions, one of which is breaking down fat. Most of the protein, carbohydrates and fat that you eat get absorbed in the first part of the small intestine (the duodenum and the jejunum). The last part of the small intestine ( the ileum ) has a vital part to play in absorbing vitamin B12 and bile salts ( these are later used to break down fats ).

There are several different types of operation. Most of these operations have to be done under general anaesthesia and with a laparotomy (where the surgeon opens you abdominal cavity, usually in the midline). The exception to this is the gastroplasty operation, which can be done with laparoscopy ( where the surgeon uses a camera to look inside your abdominal cavity).

This is one of the first operations performed aimed at reducing weight. This procedure has largely been abandoned as it causes too many complications and nutritional problems. This operations basically took away part of the bowel and put the remaining two ends of the bowel together. This was also an irreversible operation.

This operation is also one of the older types of operations. It takes your jejunum ( see above ) and cuts it in two and the bit that is connected to the stomach is put to the side of the ileum close to its insertion to the colon. The other bit is simply sutured closed and hangs freely doing its own thing, this bit is still connected to the colon so there is no risk of it exploding ( as can happen if there is no exit point). Nearly all patients will loose weight with this method. The main problem is that there is a quite high complication rate, such as problems with body balance of different important components in your blood which may effect your liver, brain and muscles. This procedure may also cause profuse diarrhoea especially if you eat what you are not supposed to eat ( which is probably most of the time).

This operation is also not well accepted or highly used. The aim with this operation is to reduce fat absorption by bypassing some of the jejunum. It causes profound protein caloric malnutrition which is quite serious.

This is a variant of the bilopancreatic bypass. Its aims are similar but the result may be slightly more acceptable. The stomach is divided in half by surgical staples. The ileum is brought up and put into the part of the stomach that receives the food so that the stomach content has somewhere to go. After this operation it is very important that you prevent any vitamin or mineral deficiencies especially iron, calcium, thiamine, vitamin B12 and folic acid.

This is one of the more popular operations performed today. This is the type of operation that Rosanne had and can also be done with laparoscopy (peep hole surgery). Its aims are to preventing you from eating large amounts of food in one sitting. It has a good success rate of about 55-70%
Surgical staples are inserted into the stomach or a plastic ring is put around the stomach so as to make the exit point small. This in effect creates a small pouch that the food has to enter and once it's full you will not be able to eat any more.

These operations can be very helpful to reduce weight especially in people that are grossly overweight and have impending health problems. But as you have seen there are risks with the operations and quite a lot of discomfort after the operation. You may also suffer from some of the complications such as infection that may make this operation life threatening. There may also be long term complications with nutrition and these may be irreversible. There have also been studies in recent time that show that most patients gain back their weight 2 years after the operation. So take time in considering this surgery and go to a surgeon that has experience in doing them.