Treatment Guide: Bariatric Surgery

Four procedures that make the weight disappear

Obesity used to be dismissed as a lack of self-control. It’s now seen as a life-threatening disease with links to diabetes, high blood pressure, high cholesterol and arthritis. In 2007 more than 140,000 obese men and women who’d failed at diet and exercise regimes turned in desperation to bariatric surgery. The goal: to alter the anatomy of the digestive system to absorb less food.

[sidebar]Currently there are four major options at Philadelphia hospitals:

Roux-en-Y gastric bypass: Named for the French surgeon who developed it, this is the standard by-pass surgery, and since the mid-1990s more than 60 percent are being done through a laparoscope. It cuts the surgery down to about an hour and leads to a quicker recovery. The doctor creates a small pouch about the size of a walnut at the top of your stomach using surgical staples to seal it off from the remainder. Then he makes a cut below the first section of the intestine and attaches that new end directly to the pouch so the food bypasses most of the stomach and the upper part of the intestine. “More important than reducing the size of the stomach,” says Dr. Ramsey Dallal, head of the Albert Einstein bariatric surgery center, “is that this surgery alters the hormone called gherelin, which controls hunger. People just don’t want to eat much.” Expect one to two days in the hospital and a loss of 50 to 60 percent of your body weight in two years.

Biliopancreatic diversion with duodenal switch: For diabetic patients who are more than 200 pounds overweight, Dr. Fernando Bonanni Jr., director of the Institute for Metabolic and Bariatric Surgery at Abington Hospital, may recommend this relatively new, more complicated surgery, which removes 80 percent of the stomach and reshapes it into a pipe about the size of a banana. What’s left is then reconnected to a much lower section of the intestine. “The first three months of adaptation are rough,” he says, “with loose bowels several times a day. But past that, it’s fantastic surgery.” This variation carries a higher risk of malnutrition and requires close lifelong monitoring. Dr. Bonanni is the only one in Pennsylvania doing the procedure with a laparoscope.

Lap-Band adjustable gastric banding (LAGB): Dr. John Meilahn, director of bariatric surgery at Temple Hospital, does this simpler procedure (which has been FDA approved since 2001) on about half of his patients. This is one of the two weight-loss surgeries geared to food restriction without a malabsorption component. He uses the new wider inflatable band that encircles the entire stomach to create a pouch that restricts how much you can eat at a given time. Adjustments to tighten the band like a belt are made periodically over the first four to six months and tweaked every six to 12 months thereafter. “This procedure is less invasive but it requires more patient compliance, “Dr. Meilahn points out. “Weight loss is also slower — 40 to 60 percent over two to three years — so it’s better suited to patients whose body mass index is under 50.”

Vertical sleeve gastrectomy: This procedure, which essentially resects the stomach into a long, sleeve-like pouch to restrict food intake, is still considered experimental since there is no data available beyond five years and the cost (around $10,000 ) is currently not covered by insurance. But Abington’s Dr. Bonanni, who is one of the few doing this variation locally, thinks it’s more promising than the band because it doesn’t need adjustments, there’s nothing foreign in the body, and it’s simpler to do than the other options.