Hotline topic: gastric bypass, bands

Nearly a quarter-million of the 15 million morbidly obese Americans had some type of bariatric surgery last year. But though the surgeries have a great success rate, they have to be accompanied by a patient's willingness to eat better and exercise more. And they are not without some risk.

That's all according to the American Society for Bariatric Surgery, which touts the weight-loss procedures for their positive impact on health and self-image as well as reduction of serious related illnesses including heart disease and diabetes.

Bariatric surgery is the topic of the Deseret News/Intermountain Healthcare Hotline on Saturday. From 10 a.m. to noon, Dr. Rodrick McKinlay, a general and bariatric surgeon, and Dr. Sherman Smith, director of bariatric surgery at LDS Hospital, will take phoned-in questions. All calls are confidential. They'll also answer a sampling of e-mail questions online. Call 800-925-8177 or e-mail Hotline@desnews.com by 5 p.m. Saturday.

The two most common procedures are gastric bypass and gastric banding (lapband).

In gastric bypass, which is now usually done laparoscopically, the doctors say the stomach size is reduced from football to golf ball size, with the smaller stomach attached to the middle of the small intestine. That bypasses the duodenum, which absorbs the most calories. Patients eat less, said Sherman, not only because the stomach is smaller, but also because the surgery reduces a hormone called grehlin that screams "I'm hungry." So appetite is also reduced.

Barring complications, someone with a minimally invasive gastric bypass can expect to stay in the hospital overnight typically.

The other common procedure is laparoscopic adjustable gastric banding (lapband, for short) in which a band filled with silicone is wrapped around the upper part of the stomach to create a small pouch and restriction. Patients feel fuller after eating a small amount and the size can be adjusted by adding more saline or removing it.

Patients undergoing gastric banding may be out of the hospital the same day and they rarely stay longer than the day after, McKinlay said.

Both procedures, though, can have complications. The rates are similar, although the bypass, which provides more powerful weight loss, may have more serious complications, he said. And in both cases, patients who get sloppy about the post-procedure lifestyle changes can begin to gain weight again. Patients with lapband lose weight more slowly, but they tend to regain a little less than those with gastric bypass, the doctors said.

Which procedure a patient should have is something that surgeons discuss but that patients must finally decide. Smith said that seriously overweight people tend to choose the gastric bypass, while the lapband appeals to those who are not quite as heavy.

There are two other bariatric surgery options to address weight loss, and others are constantly being investigated. In a bilio-pancreatic division with duodenal switch, the surgeon makes a sleeve-shaped stomach that attaches to the final section of the small intestine. A vertical sleeve gastrectomy, which is just "emerging," involves removal of most of the stomach. But there are no long-term study results for that.

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E-mail: lois@desnews.com