The Surgical Way to a Smaller Stomach

By Tom Roseberry, DoctorMatch Medical Staff Writer

The high profile cases of bariatric surgery, including Roseanne Barr, Al Roker, and Carnie Wilson, have grabbed the American publics attention. The frequency of this stomach shrinking surgery is continually growing and attracting more and more of the medical profession with better technology and more experience.

In 1999 viewers across the nation logged on to the Internet to watch singer Carnie Wilson live. No, it was not a reunion concert of her band Wilson Phillips. What they were watching was a live feed of a surgery to reduce her stomach volume to about the size of a shot glass.

Wilson's surgery is just one of a number of high profile procedures of this type in the past few years. Roseanne Barr, Randy Jackson of American Idol fame, and weatherman Al Roker have all had the stomach shrinking operation that goes by the name of bariatric surgery. The results in weight loss were tremendous. All four went down several pant sizes, gained more confidence in themselves, and felt physically healthier after surgery.

The problem that Jackson, Wilson and company faced is the same problem facing an increasing number of Americans: obesity. More than simply being overweight, many bariatric patients suffer from diabetes, sleep apnea, and other diseases caused by their weight problem. Surgery is a proven way to combat these problems when diet and exercise have failed. Despite an average price tag of $25,000 (which can be covered under health insurance in many cases), Americans are choosing this option more and more frequently. Some 103,200 patients had the surgery performed in 2003, and Georgeann Mallory, executive director for the American Society for Bariatric Surgery (ASBS), expects that number to increase to about 140,000 to 145,000 in 2004.

Variations of this type of operation have been around for several decades, but the procedure most commonly used today is called gastric bypass.

In this method a small pouch, or stoma, is created by the use of a line of staples forming a new wall. Unlike earlier versions where much of the stomach and intestines would be removed, bypass surgery drastically reduces stomach volume, restricting the patient's food intake. Instead of a large abdominal incision, many surgeons use laparoscopic technology, which employs the use of a small camera and several customized tools, resulting in less scarring and a faster recovery.

In 2001, the Food and Drug administration approved another procedure for bariatric surgery that is now in use in American hospitals. During this procedure, called gastric banding, a small silicon band is placed around the upper part of the stomach. This creates about the same size pouch as in bypass surgery, and constricts passage to the lower stomach. Though this procedure produces slower weight loss, it is more easily reversed than bypass surgery.

Though the surgery offers the possibility of life changing health benefits, it also carries with it some very real risks.

An estimated 0.1 to 2% of patients die as a result of complications of surgery, and about the same percentage suffer complications that leave them bedridden or unable to lead a normal life. The most common of these include respiratory failure, staple leakage, stomach obstruction, and bleeding.

Even after successful surgery, some patients suffer post-operative side effects such as abdominal hernia, vitamin deficiencies, osteoporosis, and vomiting. The possibility of these side effects can be lessened by careful attention to diet, chewing food thoroughly before swallowing, taking vitamin supplements, and any other precautions recommended by your doctor.

Reviewing the Risks and Choosing a Surgeon

Because this surgery involves dramatic changes in eating habits and lifestyle, many cities and hospitals have developed support groups for patients both before and after surgery and aftercare programs to help patients adapt to their new life. Similarly, organizations such as the ASBS have formed for purposes of education and regulation.

Candidates for surgery should have a Body Mass Index (BMI) of 40 or 35 with associated health risks, be dedicated to life changes, and be acceptable of surgical risks. There is no consensus registry of complications from surgery, and no specific criteria for a doctor to practice bariatric surgery, although regular membership in the ASBS requires at least 25 bariatric surgeries preformed along with a surgical recommendation. Because of this it is important to find out your doctor's surgical history, the reputation of his or her practice, and the availability of post-op support.

The choice of bariatric surgery is a life altering one and picking the right surgeon is not a small task, says Mallory. "Look for experience and dedication."