There are many different types of opertaions carried out worldwide for the management of morbid obesity. At our centre, I practice only those that have proven record of safety and effectiveness in achieving the desired weight loss.

The operations can be divided into two main categories depending on the mechanism of their action:

Gastric Restriction:

The operation is designed to limit how much one could eat at one time by reducing the size of the stomach. These operations are ususally performed laproscopically (by keyhole surgery), and the most favoured procedure is the LapBand operation. This procedure offers good weight loss that can be durable particularly in the relatively 'lighter' patients.

Gastric Bypass:

In addition to offering gastric restriction, this operation also reduces the amount of food that could be digested. This procedure offers an effective way of rapid weight loss, and is undoubtedly a durable operation that has stodd the test of time. It is particularly useful for the 'heavier' patients and for those who crave for sweets (sweet-eaters). Although most centres perform this procedure by open technique, we conduct this operation by keyhole surgery.





What is gastric (stomach) banding? and how does it work?

In this procedure the capacity of the stomach is made smaller by placing an adjustable band made of silicone around the upper part of the stomach. This system is called the LapBand. The band creates a new small stomach pouch, which can hold only a small amount of food. The larger part of the stomach is below the band. The stoma (stomach outlet) controlled by the band between the two parts slows down the passage of food from the upper to the lower part of the stomach. You achieve the feeling of satiety (fullness) when the small stomach pouch above the band is full. The result: Food intake is limited and you attain desirable weight-loss results by reducing the capacity of the stomach and lengthening the feeling of satiety.

The band is designed to be adjusted as your situation requires. To modify the size of the stoma, the inner surface of the band can be adjusted by adding or removing (inflating or deflating) saline, a salty solution similar to fluids found in the body. The band is connected by tubing to a reservoir, which is placed well beneath the skin during surgery. After the operation, the doctor can control the amount of saline in the band by piercing the reservoir with a fine needle through the skin. If the band is too loose and weight loss is insufficient, the stoma size can be made tighter by adding more saline. If the band is too tight, the doctor can remove some saline. This can be done in a clinic by the surgeon, but is often done by a radiologist (X-ray doctor) in a radiology department without further surgery.

The success of this type of surgery, however, also depends on your motivation and commitment to achieving long-lasting weight loss.

For more information on the LapBand system, click here.

What is gastric (stomach) bypass? and how does it work?

The gastric bypass is a surgical operation that results in marked reduction in the size of the stomach to a small stomach pouch, reducing the amount that you can eat at one mealtime before you feel full. None of the stomach is actually removed. The food then passes through the intestine, but not all the calories get absorbed as part of the intestine has been bypassed. A third effect of the gastric bypass operation is what is called ‘dumping’, which gives you a lightheaded feeling, nausea and occasionally diarrhoea. This happens in response to overeating sweet foods such as chocolate. Many patients never experience dumping, but in those who do, they lose the sweet taste and craving, particularly for chocolate, and this can be very valuable in helping to change old bad habits.

It is this triple effect of reducing the amount of food that you can eat, and then reducing the calories that you can absorb from it, combined with dumping as a protection against overindulgence with the wrong kind of foods that makes the operation so effective.





What are the risks of the operation?

The operation for morbid obesity is a major surgery, but has been shown to be safe and well tolerated. The national data indicate that surgery for the very obese patients carries a risk to life of 0.5% and a risk of wound infection or hernias of 5%. These are the two major complications of the surgery. Chest infections and deep vein thrombosis are of potential concern but we take various special precautions to prevent them, and these complications have not been a problem.

The greatest hazard to patients having the gastric bypass operation is of a leak from the new, stapled joint between the stomach and the intestine. We X-ray all of our patients after the procedure to make sure that there is no leak. The chance of a leak is less than 1%. We have had no leaks in all the procedures we have carried out to date. If it did occur, the patient may need an urgent second operation.


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Why consider an operation if there is some risk?

Patients who are morbidly obese have a greatly increased risk of death from all causes, especially diabetes, heart disease and lung problems. Many patients, as they reach their late 30's, begin to develop complications of obesity that are impossible to manage without significant long-term weight reduction. The operation is generally not recommended for patients over the age of 55 or 60 because the injury to the body from prolonged obesity can no longer be reversed by surgery. It is the long-term benefit in terms of quality of life that justifies surgical intervention.


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What are the long-term results from surgery?

Most patients will lose approximately 100-120 pounds in the first year depending on the initial starting weight. The higher the beginning weight, the greater the weight loss. By the end of the second year, all the weight loss that will result from the surgery has occurred. The weight loss levels off because the new stomach stretches slightly. Most importantly, the life-long eating habits determine the final weight.


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How long is the surgery? and how long will I stay in hospital?

The gastric banding procedure takes 1-2 hours while the bypass requires 2-4 hours to perofrm. Most patients begin liquids on the same day of the gastric banding operation, and are discharged the following day aftr surgery. If you had the gastric bypass operation, then you will start drinking after having an X-ray to check the new joint between the stomach and bowel (usually on the 2nd postoperative day), and are discharged from hospital with 2-4 days.

You may be ready to return to work within 2-4 weeks of having keyhole surgery. You will normally be given an appointment to be seen in clinic 4-6 weeks after the surgery to discuss your progress. If you have had a gastric banding, you will be called to have the band inflated in the X-ray department some 4 weeks after surgery.


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