M21 — June 2012 — Weight Loss Surgery Options

Intro: Weight Loss Surgery — America's curiosity about it has expanded with our waistlines. However, even with obesity at epidemic proportions, it's a drastic decision that patients and their doctors have to weigh very carefully. Here's Dennis Douda for Mayo Clinic's Medical Edge.

Mayo Clinic Gastro-intestinal surgeon Michael Sarr calls weight loss surgery an attempt to change the anatomy of the digestive system, to prevent people from absorbing too many calories for their metabolism. Dr. Sarr says in no way is it a short cut, but rather a medical solution for heading off the unhealthy ravages of obesity.

"High blood pressure, degenerative joint disease, diabetes, heart disease, sleep apnea and a bunch of other things."

Among the innovative surgical approaches is the gastric band.

"Imagine it as a donut that's placed around the top of the stomach."

"So it decreases the size of the connection between the swallowing tube and the stomach, and it limits the rate at which stuff passes through."

Dr. Sarr says one problem with the band is that it's too easy to cheat on a diet, perhaps loading up on high calorie ice cream or sweets which will slip through the band. Other choices?

"The second, which is probably the most common, is called Roux-en-Y gastric bypass."

"So it works in two ways. It works by decreasing the amount that you can eat and it works such that you decrease the part of the small intestine where most of the absorption occurs."

The third operation is called the sleeve gastrectomy. It reduces the stomach to about the size of a man's thumb.

"That's kind of the hot operation now because there's no bypass. Everything that gets, that you eat goes through the normal channel. It's just that you can't eat very much."

Dr. Sarr says short-term data suggests it's almost as good as a gastric bypass. The next option is as complicated its name.

"Duodenal switch biliopancreatic diversion."

It reduces stomach size, bypasses 85% of the small intestine AND reroutes the flow of bile and pancreatic juices.

"So functionally the food goes one way. The digestive enzymes go the other way. They meet and then there is three feet of intestine for the food to be broken down chemically and absorbed."

Ultimately, Dr. Sarr says, success for any of the procedures depends on a patient's lifelong commitment to healthy eating and exercise.

For Mayo Clinic, I'm Dennis Douda.

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Dr. Sarr says the national success rate for losing half of one's excess weight through diet and exercise is only about 5 percent, compared to 60% success for gastric bypass patients.

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