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Surgery: not an easy a fix as you'd think

EDITOR'S NOTE: This weekly column by reporter Bill Kettler answers readers' questions about topics of general medical interest with information provided by doctors from PrimeCare, Jackson County's independent practice association.

How safe and successful is gastric bypass surgery? What about lap band surgery?

- Susan D., Medford

Obesity is one of the fastest-growing health problems in the United States, so it's no surprise that there's increasing interest in surgical procedures that offer hope for people who are extremely overweight.

Gastric bypass surgery is serious business, says Dr. Mark Eaton, who performs the procedure at Rogue Valley Medical Center.

That's why it's available only to people who are morbidly obese (100 pounds or more overweight) and have been unable to lose weight even through medically supervised diet and exercise programs.

Eaton recommends bypass surgery only for people "who are going to face serious health problems (because of their weight) who are not going to get better any other way."

He and his colleagues perform the "Roux-en-Y" procedure, which involves dividing the stomach into two parts to create a tiny new stomach pouch about the size of a golf ball.

An opening is made in the new pouch, and the small intestine is connected to it. (The stomach is left inside the body and stapled shut.)

It takes very little food to fill the tiny new stomach and create the sensation of fullness, which reduces the desire to eat. Unfortunately, bypassing the lower stomach eliminates many of the gastric juices that are necessary for proper digestion. This "malabsorption" means that people who have stomach surgery must take vitamins for life.

Unlike the gastric bypass, the lap band procedure is purely restrictive. The surgeon places a band around the upper part of the stomach. The band reduces food intake by making people feel full faster. Digestion proceeds normally as the food slowly makes its way past the band and into the stomach.

As with any surgery, there can be complications. In gastric bypass, there will be scar tissue, which could cause the small intestine to kink or twist, creating an obstruction that could lead to death if not treated. The new connection between the small intestine and the tiny new stomach could leak. Patients also could suffer a heart attack or pneumonia.

In terms of safety, Eaton says that on average, one patient in every 200 who has the Roux-en-Y procedure will die within the first 30 days after surgery. For lap band surgery, the mortality rate is one in 400 to 500.

Eaton says 80 to 90 percent of gastric bypass surgeries are successful, with success defined as significant long-term weight loss, or more specifically, that a patient loses at least three- quarters of his or her overweight pounds.

For example, consider a man whose ideal weight is 170 pounds. Before surgery he weighs 370 pounds, which makes him 200 pounds overweight. Three-quarters of 200 pounds is 150 pounds. The patient would be a success if his weight stayed below 220 pounds (370 pounds minus 150 pounds).

Lap band surgery has a success rate of about 60 percent. Eaton says the success rate is lower because it's easier for patients to eat too much.

People who are considering bypass surgery need to understand that the operation is only one part of the treatment plan.

"The surgery by itself will fail if the patient doesn't participate in the (new) diet and exercise," he says. "The surgery is a tool that enables patients to do something (lose weight) that they haven't been able to do before."

Send questions to reporter Bill Kettler by e-mail at bkettler@mailtribune.com or mail them to "Ask your Doctors," Mail Tribune, P.O. Box 1108, Medford OR 97501.