Diabetes Mellitus
Obese individuals develop a resistance to insulin. Resistance to insulin results in elevated levels of blood sugar or glucose. Elevated blood sugar levels result in damage to tissues and blood vessels throughout the body. Diabetes is the leading cause of adult-onset blindness and a major cause of kidney failure and heart disease. More than one-half of extremity amputations are the result of complications of the disease. It is the number three cause of death in the United States. Gastric bypass surgery in Arcadia can significantly decrease your chances of acquiring health problems related to morbid obesity.
Hypertension
The progressive elevation of blood pressure is much more common in individuals that suffer from morbid obesity. The increased blood pressure results in damage to the heart, blood vessels, and other body organs. This results in an increased risk of stroke, heart attack, and kidney disease.
Heart Disease
Excess body weight strains the heart. Morbid obesity can cause a person to be approximately six times more likely to develop heart disease than those of normal weight. The increased workload on the heart can lead to the early development of congestive heart failure. Increased levels of blood fats and other metabolic changes associated with obesity predispose the person to coronary artery disease. Sudden cardiac death is 40 times as likely in morbidly obese persons compared with their non-obese counterparts. Contact us today about morbid obesity surgery in the Los Angeles and Orange County areas today.
Respiratory Insufficiency
In obese individuals, the chest wall is heavy and difficult for the muscles to lift. The lungs are decreased in size, while the need for oxygen is increased. The person quickly becomes out of breath with even modest levels of exercise. This leads to a decreased level of conditioning. Ultimately, daily activities such as shopping, climbing stairs, or doing yard work become difficult or impossible for those suffering from morbid obesity.
Sleep Apnea
Fat deposits in the tongue and neck can cause intermittent obstruction of the upper airway. In obese persons, this commonly causes stoppage of breathing during sleep. The common scenario is loud snoring interspersed with periods of complete obstruction. Affected people often notice that they sleep poorly and awaken repeatedly during the night. They often awake feeling tired and fall asleep periodically throughout the day. This condition is often thought to be a relatively benign process; however, the reverse is actually true. Health effects may be severe, and the mortality rate of this condition is high. Gastric bypass surgery in Arcadia can help reduce sleep apnea in our patients.
Gastro Esophageal Reflux Disease
A weak or overloaded valve in the last part of the esophagus may allow reflux of stomach juices into the esophagus and even into the back of the throat. This is often called "heartburn" or "acid indigestion." The acid and alkaline fluid from the stomach can damage the lower esophagus and lead to the development of a pre-malignant condition known as "Barrett's esophagus." The stomach fluid may regurgitate high enough to allow the fluid to spill over into the airway and lungs. This often occurs at night when one is recumbent and asleep.
Asthma and Bronchitis
Obesity does not directly cause asthma or bronchitis; however, the gastro esophageal reflux associated with morbid obesity may seriously aggravate asthma and even cause bronchitis.
Degenerative Arthritis
Degenerative disease of the lumbo-sacral spine and the weight bearing joints is a common complication of morbid obesity. The entire weight of the upper body falls on the base of the spine. The increased weight causes the bone and cartilage to wear out or fail. The hips, knees, ankles, and feet also bear most of the weight of the body. The wear and tear on these joints is greatly accelerated by carrying excess weight. If you would like to find out if you would be a good candidate for morbid obesity surgery and you live in Orange County or Los Angeles, contact California Bariatric and General Surgery Associates for a consultation today.
Gallbladder Disease
Gallstone formation and complications from gallstones occur several times more frequently in obese persons compared with the non-obese. Gallstones can cause obstruction to bile outflow from the gallbladder. Bile is needed to promote absorption and digestion of fats by the small intestine. Obstruction of bile outflow causes upper abdominal pain, nausea, and vomiting. It can lead to severe infections and gangrenous changes of the gallbladder.
Infertility
Morbid obesity is associated with a decreased ability to produce offspring.
Increased Risk of Cancer
Obese women have a three times greater risk of cancer of the ovary and breast, as well as a five times greater chance of uterine cancer than normal weight persons. Obese men have a three times greater risk for cancer of the colon and prostate than the non-obese. The obese risk of dying from other types of cancer is greater by about one-third for men and over one-half for women as compared with the non-obese. If you suffer from morbid obesity, surgery for our Los Angeles and Orange County patients can help you lose weight and keep it off.
Venous Stasis Disease
The veins of the lower extremities are equipped with one-way valves to combat gravity and, combined with the muscles in the leg, allow blood to return to the heart. The increased pressure caused by obesity leads to failure of these delicate valves. The pressure in the veins of the lower extremities then increases, causing swelling of the legs, which can be severe. This swelling may result in damaged, ulcerated skin and an increased risk of venous thrombosis.
Understanding the Gastrointestinal Tract
The digestive tract is an assembly line in which food, digestive juices, and enzymes come together to allow digestion and absorption of nutrients.
The esophagus is a long muscular tube that carries food from the mouth to the stomach. The stomach stores food and mixes it with acids and digestive juices. The stomach churns food into tiny particles, which are passed through the stomach outlet valve (pylorus) into the first part of the small intestine (duodenum). Bile and pancreatic juices join the food stream in the mid duodenum via the bile and pancreatic ducts, respectively. The food traverses through the small intestine - approximately 15 to 20 feet in length - where digestion continues and most of the nutrients are absorbed. The intestinal contents are then passed into the colon (large intestine), where excess fluid is absorbed and a firmer stool is formed.
What Are the Procedures Available For Weight Loss?
Morbid obesity surgery can be thought of as either malabsorptive or restrictive. The malabsorptive procedures bypass a large segment of intestine, and weight loss is achieved by creating nutritional inefficiency. Restrictive procedures take advantage of inherent efficiency, and weight loss occurs as a result of lowered caloric intake.
Anatomical changes or arrangements that help surgical procedures achieve weight loss are as follows:
- decreased gastric volume (pouch)
- controlled outlet of the pouch
- length of small bowel in contact with food alone (alimentary channel)
- length of small bowel in contact with food and digestive juices (common channel)
Small pouch size with a controlled outlet provides restriction of intake. The shorter the common channel, the greater the degree of malabsorption. Pouch size and the length of the common channel are strongly interdependent.
The Roux-en-Y gastric bypass surgery achieves weight loss with an effective combination of restriction and malabsorption. The restrictive component is afforded by a 20 to 30 cc gastric pouch. The malabsorption component is achieved with the "bypass" of the stomach and the first part of the small intestine or duodenum. This combination has afforded good weight loss, minimal nutritional risks, and a high quality of life postoperatively. If you would like to find out who is a good candidate for gastric bypass surgery at our Arcadia office, contact the California Bariatric and General Surgery Associates today.
The Malabsorptive Procedures
Jejunoileal Bypass:
This older procedure severely shortened the amount of small intestine that was in contact with food. Weight loss was satisfactory, but metabolic complications were too high. Approximately 50 percent of patients developed some type of late metabolic complication. The operation was performed between 1963 and 1980. The morbid obesity surgery is no longer in use.
Biliopancreatic Diversion:
This operation consists of removing a part of the stomach, leaving a 200 to 500 cc pouch, and shortening the small intestine conduit to 250 cm, leaving a 50 cc common channel in which bile and pancreatic juices mix prior to entering the colon. Weight loss has been satisfactory, but malabsorptive complications have lead most surgeons in the United States away from this approach to morbid obesity surgery.
Duodenal Switch:
This procedure is similar to the biliopancreatic diversion but alters the stomach configuration to produce less dumping and diarrhea. The outer margin of the stomach is resected. A sleeve of stomach, the pylorus, and the beginning of the duodenum are preserved. The duodenum is divided so that pancreatic and bile drainage are bypassed. The ingested food meets the bile and pancreatic juice near the end of the small intestinal adaptation. Over time, bowel movements decrease to an average of three per day. Side effects of foul smelling stools and abdominal bloating are common. Weight loss is satisfactory and patients are able to eat larger meals than patients with pure gastric restriction or standard Roux-en-Y gastric bypass surgery.
Restrictive Procedures
Vertical Banded Gastroplasty:
Known commonly as the "Gastric Stapling" procedure. This procedure creates a small stomach pouch (30 to 60 cc) along the inner curvature of the stomach. The size of the opening is controlled by a plastic band. This is the most "physiologic" of the bariatric procedures. Weight loss is not as predictable as with the Roux-en-Y gastric bypass surgery, which is available in Arcadia at our facilities.
The Inflatable Gastric Band:
A silicon band is placed around the top of the stomach. This band effectively restricts oral intake. This device has recently completed FDA trials. The procedure was approved for the treatment of obesity in late 2001. The results of the U.S. trials are disappointing compared with published results from Europe and Australia. In view of the results of these trials, most gastric bypass surgeons in the U.S. have not adopted this procedure.
Primarily Restrictive, Small Component of Malabsorption
Laparoscopic and Traditional Roux-en-Y Gastric Bypass Surgery:
The Roux-en-Y gastric bypass surgery performed in Arcadia is our procedure of choice. A very small (20 cc) gastric pouch is created. The pouch is divided from the main body of the stomach. A portion of the small intestine is passed in front of the main body of the "bypassed" stomach and connected to the small pouch. Food therefore bypasses most of the stomach and duodenum and empties directly into the small intestine. Gastric juices, bile, and pancreatic juices join the food approximately 100 to 150 cm downstream. The gastric bypass surgery procedure is primarily restrictive; however, a small component of malabsorption results. The number of calories that one can take in is limited by the size of the stomach pouch. A small amount of food will give the feeling of "fullness.”
The major long-term nutritional consequences are due to decreased iron, calcium, and vitamin B12 absorption. These deficiencies can almost always be overcome with oral supplements.
The open Roux-en-Y gastric bypass surgery is the procedure of choice of most bariatric surgeons for patients. We are now able to offer the Roux-en-Y gastric bypass surgery at our Arcadia offices via a minimally invasive (laparoscopic) technique.
Advantages of the laparoscopic procedure over traditional surgery include less pain, faster recovery, less chance of hernia formation, and incisions that are more cosmetic.
The Laparoscopic Roux-en-Y gastric bypass surgery is performed through five half-inch incisions. The average hospital stay is one to two days. You can expect to return to work in one to three weeks following gastric bypass surgery.
The majority of our procedures for weight loss are now performed via the laparoscopic technique. Not all individuals are candidates for this method. You can discuss your individual case with your surgeon. If you suffer from morbid obesity and live in the Los Angeles or Orange County areas, contact us to learn about gastric bypass surgery at our Arcadia location.
Conversion or Revision of Previous Weight Loss Procedures:
Many of the morbid obesity surgery procedures for weight loss can be converted successfully to a Roux-en-Y gastric bypass surgery. At present, our revision procedures are performed through a standard open technique..
