Obesity Surgery Offered

Avon Obesity Service offers two different types of weight loss surgery (bariatric surgery):

• Restrictive - also known as gastric banding
• Malabsorptive - also known as gastric bypass

We believe, as do increasing numbers of specialists, that gastric banding should be the operation of choice for weight loss surgery with other more risky procedures being kept in reserve for special cases. Therefore gastric banding (sometimes referred to as AGB) is our preferred bariatric operation.

Who is this Surgery Available to?

The National Institute for Clinical Excellence (NICE) recommend that weight loss surgery be available as a treatment option for those people with morbid obesity.

Also, you can only be considered for obesity surgery if:

• You are generally fit enough to have an anaesthetic and surgery
• You are aged 18 or over
• You have been receiving treatment in a specialist clinic at a hospital
• You have suffered from obesity for more than 5 years
• You have tried all other appropriate non-surgical treatments to lose weight but have not been able to maintain weight loss
• You fully understand the procedure and the need for long-term follow-up care and changing your eating habits
• You are not dependent on alcohol or drugs
• You have no untreated endocrine disorder
• There is no specific medical or psychological reasons why weight loss surgery should not be performed

Restrictive Surgery

In this operation the size of the stomach is reduced using a band. This in turn limits how much food the stomach can hold and thus only small meals can be eaten. A short clip dramatising the procedure can be viewed by clicking on the picture of a gastric band on the right.

Its benefits are:

• It is the safest surgical procedure for weight loss
• It should result in a loss of at least 60% of excess weight gained
• There is no alteration of the digestive tract and therefore nutritional deficiencies are unlikely
• If necessary, the procedure could be reversed

However, the disdvantages of gastric banding surgery are:

• Historical data suggests that weight loss may not be as great as with malabsorptive surgery
• Although rare, it is possible for the band to slip out of place or erode the stomach wall. This may require its removal or a further operation
• The restricted diet may cause some shortages of nutrients

The main restrictive operation is Adjustable Gastric Banding (AGB). It is a keyhole procedure (laparoscopic), which involves placing an inflatable silicone band around the upper part of the stomach to create a much smaller 'pouch' with a narrow opening to the rest of the stomach. Avon Obesity Service uses the Midband® gastric band for all of its AGB obesity surgery.

The degree of restriction is determined by the size of the opening between the pouch and the rest of the stomach below. This in turn determines how fast food leaves the pouch and enters the rest of the stomach.

As an individual loses weight the degree of restriction decreases and the band is then inflated to increase the restriction again. The band is inflated by injecting fluid into a reservoir, which is connected to the band by a thin tube. This is called a fill.

Several fills may be needed to get the pouch emptying slowly. If it empties too fast you feel hungry quickly and eat again which in turn will slow down your weight loss. If the pouch empties too slowly you are likely to feel or be sick even when eating very small meals

Malabsorptive

In this operation some of the digestive system is bypassed so food passes through the gut without all its calorie content being fully absorbed. It may result in greater weight loss than gastric banding, but there are possible complications such as:

• Swapping the bowel around is major surgery with the risk of complications including the development of blood clots in the leg veins (DVT)
• There is a reported death rate of approximately 1 in 100 operations
• There is a risk of internal bleeding or accidental damage to other gut organs, and there is a risk of wound infection
• There is a risk that the digestive juices will leak from where the bowel has been cut or joined, which can be potentially life threatening
• About 1 in 20 people fail to lose sufficient weight or regain weight
• Some people may experience nausea and vomiting and are likely to be advised to eat pureed foods for a month after the operation
• This type of surgery may lead to deficiencies of vitamins and nutrients and thus permanent supplements are likely to be needed
• 'Dumping' may occur. This results in dizziness and sickness and is caused by the energy from food getting into the blood stream too quickly
• Rapid weight loss increases the risk of developing gallstones
• The operation should be considered to be irreversible

The most commonly performed procedure is a Gastric Bypass operation called the Roux-en-Y procedure. In this operation a small pouch is made at the top of the stomach using a line of staples and a new opening made in the pouch. The small intestine is then cut into two parts. The lower one is brought up and joined to the opening in the pouch. This is the Roux limb. The upper part of the small intestine, which carries the digestive juices from the stomach, is joined to the Roux limb close to its end.

The pouch at the top of the stomach means only small meals can be eaten. Then by bypassing a large part of the small intestine, where food is absorbed, fewer calories can be taken into the bloodstream - the malabsorption part of the procedure.