Surgical Treatment of Obesity

Surgical Options

Jejunoileal Bypass

In the mid-1960s the jejunoileal bypass, or intestinal bypass, procedure was introduced as a means for patients to lose weight. In this operation, most of the small intestine was excluded from the main stream of digestion so that only a small portion of the intestine was available to absorb nutrients and water.

The end result was that patients could eat as much as they wanted, but they would not absorb the food. Ultimately, the food would pass on in the stool undigested. Unfortunately, this operation was associated with significant complications after a period of time, the least of which was persistent and frequently disabling diarrhea. Some patients developed liver problems, including liver failure, and some died.

Patients also developed many other problems such as kidney stones, bloating and cramping syndromes and problems with absorption and metabolism of various vitamins and minerals. Ultimately, most of these patients have required their operations reversed for medical reasons.

Gastric Surgery

In the late 1960s and early 1970s, gastric surgery was also introduced as a means to achieve maintained weight loss. This surgery consisted of making the stomach smaller by dividing the stomach and making a connection to the intestine. Using this procedure, the stomach was reduced to a capacity of approximately 200 cc and the opening from the stomach into the intestine was reduced to about 1 inch. Over the course of time, it became apparent that the pouch and the outflow from the stomach should be made smaller and these operations today are made with a 1 oz. pouch and approximately a 1/2 inch exit from the stomach into the intestine. In addition, with the introduction of surgical stapling devices, it no longer became necessary to divide the stomach.

The concept of these operations is that an individual will eat less, feel full more quickly, remain full longer and, therefore, ingest fewer calories.

The gastric stapling operations can be performed in two ways:

One is a gastric exclusion procedure in which the stomach is stapled or divided and the small intestine is brought up to it.
The other, called a vertical banded gastroplasty, has no new connection to the small bowel. Instead, an opening is made in the stomach with a stapler. Next, staple lines are placed from this hole to the junction of the esophagus and the stomach.

The only study that has compared these two procedures in a randomized fashion has found that the gastric exclusion procedure is better in terms of achieved maximum weight loss and in the maintenance of that weight loss.

What are the risks and complications of gastric surgery for obesity? >>

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