What Is It?
Morbid obesity is a disease where an individual is 100 pounds or more
overweight or has a body mass index of 40 or more.
Excess weight has many negative effects on a person's health. Morbid
obesity may cause or accelerate the development of diabetes, hypertension,
arteriosclerosis, heart attacks and strokes, lung disease, arthritis,
various types of hernias, gallstones, vericose veins and phlebitis,
skin conditions, infertility, and injuries. Morbid obesity may increase
the rate of complications in pregnancy, surgery, and injuries, and the
incidence of certain cancers in women (breast and endometrium). Morbid
obesity may also lead to sleep apnea and Pickwickian syndrome.
Requirements for Surgery
Although there are some exceptions, the following criteria generally
must be met before an individual is considered a candidate for weight
reduction surgery.
- Previous medically supervised efforts at weight loss through a diet
that was nutritionally and medically safe. Each insurance company
and/or health plan has their specific time period for weight reduction
efforts.
- Absence of other medical problems that would make surgery hazardous.
- At least 100 lbs. over the prescribed weight of the height-weight
chart of the Metropolitan Insurance company for medium framed individuals,
or a body mass index (BMI) of 40 or more.
- Individuals less than 100 pounds overweight or a BMI of 35-40, should
have other serious medical, obesity related conditions known to be
improved by weight loss.
Morbid obesity is a serious disease and only those individuals who
have made long term concerted efforts to lose weight should consider
surgery. It is the last step because you will required to change your
life style forever. You will need a strong support system because many
of the causes of morbid obesity will not go away simply because of surgery.
Bariatric surgery is a serious solution that should be undertaken only
by those who are truly committed to the life long changes that will
follow.
Treatment
After considerable review we believe that a combination of
two weight reduction procedures, the vertical banded gastroplasty
and the gastric bypass, offers the greatest chance for success.
Our procedure, vertical banded gastroplasty-gastric bypass
(VBG-gastric bypass) has proven to be a very effective weight
reduction operation. It combines the strengths of the vertical
banded gastroplasty and the gastric bypass. We perform this operation
exclusively and it is estimated that a substantial amount of weight
will be lost by 98% of our patients. This procedure is performed
with both the open and laparoscopic approach.
Gastric reduction surgery works by creating the sensation that
you are full, comfortable and satisfied. Filling the pouch with
a small meal feels the same as having your normal stomach full
with a large meal. The stretch on the pouch walls appears to send
signals to the base of the brain that generate a feeling of satisfaction.
The small pouch and rearrangement of the bowel also effectively
stop one from eating too much at any given meal. One bite beyond
satisfaction creates a "stuffed" feeling. One bite after that
causes nausea and yet another causes discomfort and vomiting.
The rearrangement of the bowel in VBG-gastric bypass plays an
important role in preventing patients from eating or drinking
high calorie foods. It is common for patients to experience an
unpleasant sensation when eating sweets and drinking high calorie
liquids. In medical jargon, this is called "dumping". This unpleasant
sensation is why VBG-gastric bypass patients lose more weight
in general than patients who have undergone vertical banded gastroplasty
alone.
Weight reduction surgery is a complicated procedure that is all the
more difficult because of the co-morbid conditions that most patients
have along with their morbid obesity. The most common risks and complications
include:
- Damage to major blood vessels or other organs causing hemorrhage,
requiring blood transfusion and additional surgery
- Injury to the bowel and/or intestinal blockage
- Pulmonary embolism (blood clots to your lung and/or legs)
- Development of gallstones, inflammation of the gallbladder and/or
pancreas as a result of weight loss
- Psychological reaction including depression as a result of
the inability to eat
- Persistent diarrhea because of the shortening of the bowel
- Incisional hernia requiring additional surgery
- Failure to lose weight by diet manipulation or technical failures
- Development of loose skin and excessive wrinkling sometimes with
rubbing that may cause infection
- Pneumonia or breathing problems causing temporary dependency on
a breathing machine (ventilator)
