The Basics of Bariatric Surgery (Continued)
Weight Loss Surgery: Adjustable gastric banding.
In this procedure, a hollow band made of silicone rubber is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the rest of the stomach (figure 2). The band is then inflated with a salt solution through a tube that connects the band to an access port placed under the skin. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution.
Weight Loss Surgery: Vertical banded gastroplasty.
VBG uses both a band and staples to create a small stomach pouch, as illustrated in figure 3. Once the most common restrictive operation, VBG is not often used today.
Advantages: Restrictive operations are easier to perform and are generally safer than malabsorptive operations. AGB is usually done via laparoscopy, which uses smaller incisions, creates less tissue damage, and involves shorter operating time and hospital stays than open procedures. (See below for more information on laparoscopy.) Restrictive operations can be reversed if necessary, and result in few nutritional deficiencies.
Disadvantages: Patients who undergo restrictive operations generally lose less weight than patients who have malabsorptive operations, and are less likely to maintain weight loss over the long term. Patients generally lose about half of their excess body weight in the first year after restrictive procedures. However, in the first 3 to 5 years after VBG patients may regain some of the weight they lost. By 10 years, as few as 20 percent of patients have kept the weight off. (Although there is less information about long-term results with AGB, there is some evidence that weight loss results are better than with VBG.) Some patients regain weight by eating high-calorie soft foods that easily pass through the opening to the stomach. Others are unable to change their eating habits and do not lose much weight to begin with. Successful results depend on the patients willingness to adopt a long-term plan of healthy eating and regular physical activity.
Risks: One of the most common risks of restrictive operations is vomiting, which occurs when the patient eats too much or the narrow passage into the larger part of the stomach is blocked. Another is slippage or wearing away of the band. A common risk of AGB is breaks in the tubing between the band and the access port. This can cause the salt solution to leak, requiring another operation to repair. Some patients experience infections and bleeding, but this is much less common than other risks. Between 15 and 20 percent of VBG patients may have to undergo a second operation for a problem related to the procedure. Although restrictive operations are the safest of the bariatric procedures, they still carry risk in less than 1 percent of all cases, complications can result in death.
Because combined operations result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis.
Sauteed Brussel Sprouts with Sweet Potatoes Ham Hash and Eggs Ginger Flavored Beef Stew and Vegetables Tofu Vegetable Salad Apple Onion Soup Fresh Fruit With Gingersnap Cookies Lemon Poppy Seed Muffins Veggie Stir-Fry with Tofu Stir-Fried Garlic Lettuce Almond Cookie Cups
Because I wear my Dexcom on my arm, I’ve slowly adjusted to the fact that people will ask me about it. Sometimes it’s the rude and inquisitive “What’s that?” and sometimes it’s somewhat sincere curiosity “Is that a (insert random type of medical device that they assume)?” Sometimes it bothers me more than others depending on how they ask and how they respond once I’ve told them what it is. I have limits to how much myth-busting I want to do in everyday conversation and how much rudeness I can...