Bariatric Surgery -- Is It Right for You?

WebMD Live Events Transcript

Bariatric surgery is not just a fad. It's a serious, life changing procedure that is helping thousands of obese patients lose the weight necessary to improve health and lengthen their lives. What does it take to qualify for this surgery? Who should consider it? Who should not? Philip Schauer, MD, of The Cleveland Clinic answered these questions and more on July 27, 2005.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live. Our guest today is Philip Schauer, MD, from The Cleveland Clinic. He is here to discuss bariatric surgery (weight loss surgery).

Welcome Dr. Schauer. Could you tell us a little about your background and what you do?

SCHAUER:
Sure, Kate. I am currently the director of bariatric surgery at the Cleveland Clinic. I just arrived about six months ago from the University of Pittsburgh where I was for approximately ten years. I developed the bariatric surgery program there as well.

I have been involved with bariatric surgery for approximately ten years. In fact I'm currently the president elect of the American Society for Bariatric Surgery.

I also specialize in laparoscopic or minimally invasive surgery of the gastrointestinal tract. But bariatric surgery has been my primary interest for nearly a decade.

MODERATOR:
What is bariatric surgery?

SCHAUER:
Simply put, it's surgery that involves the gastrointestinal tract, the stomach, the intestines, and it's meant to enable people to lose weight long term.

MODERATOR:
What are the primary procedures involved?

SCHAUER:
Kate, there are probably 20 or 30 operations that have developed over the last 50 years to enable people to lose weight long-term. Over the past say 10-15 years, three major operations have emerged that have been shown to be both safe and effective. These operations include the gastric bypass, which is also called Roux-en-y gastric bypass.

This operation is currently the most commonly performed procedure in the United States; approximately 75% to 80% of all bariatric operations in the U.S. involve gastric bypass. It involves two things that we do to the intestinal track:

  • We staple across the stomach to make a very small stomach pouch, reducing stomach volume by about 95%.
  • We bypass a small portion of the upper intestinal tract. The small stomach pouch allows an individual to feel full with a small amount of food and reduces appetite. The bypass also aids weight loss by decreasing the absorption of some of the calories that are eaten.

That's the gastric bypass procedure. The average patient tends to lose about 65% to 75% of the excess weight they're carrying. So the patient that is 100 pounds overweight will typically lose 65 to 70 pounds and keep that weight off long term -- five, ten, fifteen years and beyond.

Patients who have this operation do need vitamin supplements such as iron, B12 and calcium in order to offset deficiencies that could occur after the surgery.

The second most common operation in the United States for weight loss is called gastric banding. Another term would be adjustable gastric banding. And another term commonly used would be the lap band, which is actually a specific device made by Inamed.

A lap band is an adjustable band made of silicone that is placed around the upper stomach. And it, like gastric bypass, creates a small pouch about the size of a walnut. This band is adjustable. It can be adjusted after surgery; it can be made tighter or looser by filling the band with fluid. The band is attached to its tubing -- attached to a reservoir that's placed under the skin of the abdomen. After surgery the doctor can add fluid through the skin and a port to adjust the diameter of the band that will increase weight loss.

This operation involves probably 15%-20% of the operations in the United States, and the average patient tends to lose about 50% of his or her excess weight. Basically these two are the predominant operations used today.

"We're just beginning to understand the regulation of appetite."