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Restrictive operations

Restrictive operations make the stomach smaller. With a smaller stomach, you will feel full a lot quicker than you are used to. This means that you will need to make big lifelong changes in how you eat—including smaller portion sizes and different foods—in order to lose weight. The most common restrictive surgery is adjustable gastric banding.

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Stomach stapling (vertical banded gastroplasty)

In stomach stapling (vertical banded gastroplasty), an incision is made in the abdomen. Surgical staples and a plastic band are used to create a small pouch at the top of the stomach. This pouch is not completely closed off from the rest of the stomach. A small opening, about 0.25 in. (6.35 mm) across, allows the partially digested food to move into the rest of the stomach and then into the intestines. The size of the pouch is small enough that you can eat only 0.5 cup (118.3 mL) to 1 cup (236.6 mL) of food before feeling uncomfortable.

Gastric banding:

In this operation, a small band is placed around the upper part of the stomach, creating a small pouch. As with stomach stapling, the small size of the pouch means that you feel full sooner. But the band can be adjusted in size by inflating or deflating the band. This allows the health professional to adjust the size of the opening between the pouch and the stomach.

These procedures can be done by making a large incision in the abdomen (an open procedure) or by making several small incisions and using small instruments and a camera to guide the surgery (laparoscopic approach).

What To Expect After Surgery:

Most people can return to their normal activities within 3 to 5 weeks.

Preliminary studies note that gastric banding is associated with a short hospital stay, rapid recovery, and little risk of complications. However, follow-up studies are needed.

After these operations, you will be able to eat only 1 cup (236.6 mL) or less of food at a time. You must be careful to chew food well and to stop eating when you feel full. This can take some adjustment, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, the pouch may stretch. If the pouch stretches, you will not benefit from your surgery.

You may develop nutritional problems and need to take vitamins.

Why It Is Done:

Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher. Surgery may also be performed when your BMI is 35 or higher and you have a life-threatening or disabling condition that is related to your weight.

Your doctor may only consider doing surgery if you have not been able to lose weight with other treatments.

The following conditions may also be required or at least considered:

    * You have been obese for at least 5 years.
    * You have no history of alcohol abuse.
    * You do not have untreated depression or another major emotional disorder.
    * You are between 18 and 65 years of age.

All surgeries have risk, and it is important for you and your health professional to discuss your treatment options to decide what is best for your situation.

How Well It Works:

After a restrictive operation—stomach stapling (vertical banded gastroplasty) or adjustable gastric banding—you will generally lose about half of your excess body weight in the first year. After stomach stapling (vertical banded gastroplasty), you may regain some of the weight you lost in the first 3 to 5 years. After 10 years, only 1 out of 5 people have kept the weight off. A review of studies on stomach stapling (vertical banded gastroplasty) notes that 60% of excess weight (the weight above what is considered healthy) was lost, although a large portion of people regained the lost weight after 3 to 5 years.

Research in Europe on laparoscopic stomach stapling (vertical banded gastroplasty) notes that up to 63% to 75% of excess weight was lost during periods of time ranging from 1 year to 3 years.

Research in Europe on adjustable gastric banding notes that 40% to 60% of excess weight was lost during a 3-year period of time.

Risks:

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

Fewer than 3 in 200 people (1.5%) die after surgery for weight loss.

Stomach stapling (vertical banded gastroplasty)

After stomach stapling (vertical banded gastroplasty):

    * About 1 out of 5 people may need a second operation because the connection between the stomach and the intestines narrows (stomal stenosis), leading to nausea and vomiting, or because of an increase of gastroesophageal reflux after eating.
    * The staples pull loose in about 1 out of 3 cases.
    * The plastic band may slip or wear away.