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Morbid obesity is a major health problem to many countries. This is also true in Malaysia, where 12% of our population are obese. Many medical problems related to obesity, such as diabetes mellitus, hypertension, sleep apnea, and etc, are costing most healthcare system billion of dollars. Medical cure for these morbid obesity related co-morbidities remain elusive for century until now. And who would have thought surgery cures diabetes.

Surgical (Weight-Loss Surgery)

Does the end justify the means? You should ask yourself this question before deciding what to do with your weight problem. Some peoples may take higher risks than the others. Talk to your doctor to get professional opinions and search around for the best doctor to help you. These surgeries are just a tool to help you to lose weight, they still need your life-style changes and commitments to accomplish the goal. These are all elective procedures, you have all the time you need to decide and choose the best.

Laparoscopic Adjustable Gastric Banding procedure involves placing a silicone band around the top of the stomach using key-hole surgery (see picture). There is no cutting or stapling of stomach involve. It reduces the stomach opening where the food-pipe (esophagus) and stomach meet. The size of the opening can be adjusted or controlled to tailor for weight loss (see picture). Adjustment is done in the office during follow-up visit. Patients normally go home on day 1 or 2 after surgery. The complications involve bleeding, infection, injury to other organs, shoulder pain, tubing problem, nausea & vomiting, reflux problem, pouch dilation, blood clots, and etc. The risks of dying from this operation is less than 1 in 2000 or 3000, it is like undergoing any operation! The average weight loss is about 50% of excess weight in 1 to 2 years. This means if you are 50kg more than your ideal weight, you are expecting to lose 25kg in the 1st to 2nd year with good follow-up. The advantage of this procedure is it is not a bowel surgery, you still have your gastrointestinal tract intact. In order to have the restrictive effect, the band should be left in the body forever. However, should you want to remove it later, though it is not advisable, you may elect to do so. This is the only reversible weight loss surgery!

Laparoscopic Adjustable Gastric Banding Protocol
Laparoscopic Adjustable Gastric Banding

Laparoscopic Sleeve Gastrectomy is relatively new procedure as a primary surgery to lose weight. It is just like gastric banding but without the band. It involves cutting and stapling of your stomach into a tube-like structure (see picture). It provides the restrictive effect just like the band but it is not adjustable. The divided stomach (70% of your stomach) is removed. It is also done through key-hole surgery. Your will be in hospital for 2 to 3 days after surgery. The complications are about the same as gastric banding plus risks of leakage from the stapler line. The risk of dying from the operation is also very low, probably in the same range as in gastric banding. One of the major advantages of this surgery compared to gastric banding is there is no adjustment needed. It probably suits persons with difficulty to follow-up with their doctors. The weight loss is automatic, but it is also means you have no control over how the weight loss going to be like in few years time. The initial results were very promising with 50 to 60% of excess weight loss, i.e. 25 to 30kg for those who are 50kg overweight in one year. We expect the weight loss to level off after 2 to 3 years because the stomach will expand to certain degree with mild regain of weight. If target weight loss is not achieved, second operation is possible to further the weight loss by converting this to another operation, such as gastric bypass or bilio-pancreatic diversion. Luckily, most patients were happy with the results from this operation! Patients are normally follow-up every 3 months in the first 2 years.

Laparoscopic Sleeve Gastrectomy Protocol
Laparoscopic Sleeve Gastrectomy

Laparoscopic Gastric Bypass operation involves creating a small stomach pouch and bypass the 90% stomach remnant and part of small intestine, connected to small intestine from a lower location (see picture). This combines restriction of food and mal-absorption of food. The up-front risks are certainly higher compared to gastric banding and sleeve gastrectomy because it is technically more to do and takes longer in operating room. The risks are the same as gastric banding and sleeve gastrectomy plus bowel obstruction, anastomotic stricture or ulcer, leakage of anastomosis (2 connections), and etc. The risk of dying from this operation is higher, probably in between 1 in 1000 to 1 in 200. Despite the up-front risks, bypass represents the most common operation in United States, as opposes to gastric banding, which is more common in other parts of the world. This is partly due to insurance paying system and the late FDA approval of banding devices in US. The weight loss results are very good with bypass. Patients lose about 70% of excess weight in 1 year. Life-long vitamins and iron supplements are needed.

Lapaoscopic Gastrtic Bypass

Laparoscopic Bilio-pancreatic Diversion represents the “mother of all weight loss surgeries”. It is mal-absorptive procedure. It bypasses most of patient’s small intestine except the last 50cm for absorption of nutrients (see picture). It carries high risks of mal-nutrition, such as, vitamin deficiency, anemia, poor mental state, and may be blindness! It is technically challenging procedure with longer operation time than gastric bypass. The weight loss is impressive, 80 to 90% excess weight loss in 1 year.

Laparoscopic Bilio-pancreatic Diversion

Other articles

Weight Loss Surgery Malaysia Patient Support Group Weight Well Malaysia
(Disclaimer: weight loss results and experiences may vary from person to person)

Weight Loss Surgery, Laparoscopic Adjustable Gastric Banding, Laparoscopic Sleeve Gastrectomy, Laparoscopic Gastric Bypass, Laparoscopic Bilio-pancreatic Diversion