Laparoscopic Surgery for Severe (Morbid) Obesity Patient Information from SAGES

Laparoscopic surgery for obesity is for people who are severely overweight. Laparoscopy involves using a specialized telescope (laparoscope) to view the stomach, which typically allows smaller abdominal incisions. This brochure will explain:

  • What is severe obesity?
  • Medical and surgical treatment options for severe obesity
  • How laparoscopic obesity surgery is performed
  • Expected outcomes of the procedure
  • What can be expected after laparoscopic obesity surgery

What is Severe Obesity?

Severe obesity, sometimes known as “morbid obesity”, is defined using various methods. One of these methods uses Ideal Body Weight and is defined as being approximately 100 pounds (45.5 kg) or 100% above ideal body weight. This is determined according to the Metropolitan Life Insurance Company height and weight tables. Body Mass Index or BMI is another method used to determine severe or morbid obesity. BMI is calculated based upon a person’s height and weight, and is generally more accurate than ideal body weight calculations. According to the Center for Disease Control (CDC), the rates of obesity have been increasing steadily with a prevalence of approximately 25% in most US states. This condition is associated with the development of life-threatening complications such as hypertension, diabetes, sleep apnea, and coronary artery disease, to name a few.

Numerous therapeutic approaches to this problem have been advocated, including low calorie diets, medication, behavioral modification and exercise therapy. However, the only treatment proven to be effective in long-term management of morbid obesity is surgical intervention.

What Causes Severe Obesity?

The cause of severe obesity is poorly understood. There are probably many factors involved. In obese persons, the set point of stored energy is too high. This altered set point may result from a low metabolism with low energy expenditure, excessive caloric intake, or a combination of the above. There is scientific data that suggests obesity may be an inherited characteristic.

Severe obesity is most likely a result of a combination of genetic, psychosocial, environmental, social and cultural influences that interact resulting in the complex disorder of both appetite regulation and energy metabolism. Severe obesity does not appear to be a simple lack of self-control by the patient.

What are the Treatment Options?

Medical Treatment

In 1991, the National Institutes of Health Conference concluded that non-surgical methods of weight loss for patients with severe obesity, except in rare instances, are not effective over long periods of time. It was shown that nearly all participants in any non-surgical weight-loss program for severe obesity regained their lost weight within 5 years. Although prescriptions and nonprescription medications are available to induce weight loss, there does not appear to be a role for long-term medical therapy in the management of morbid obesity. Weight gain is rapid once medication is withdrawn. Various professional weight loss programs use behavior modification techniques in conjunction with low calorie diets and increased physical activity. Weight loss of one to two pounds per week has been reported, but nearly all the weight loss is regained after 5 years.

Surgical Treatment

A number of weight loss operations have been devised over the last 40-50 years. The operations recognized by most surgeons include: Roux-en-Y gastric bypass, gastric banding (adjustable or non-adjustable), sleeve gastrectomy, malabsorption procedures (biliopancreatic diversion, duodenal switch) and vertical banded gastroplasty. The gastric bypass procedure involves dividing the stomach and forming a small gastric pouch. The new gastric pouch is connected to varying lengths of your own small intestine constructed into a Y-shaped limb (Roux-en-Y gastric bypass) (Fig. 1).

The laparoscopic gastric band involves placing a 1/2 inch belt or collar around the top portion of the stomach. This creates a small pouch and a fixed outlet into the lower stomach. The adjustable band can be filled with sterile saline. When saline is added, the outlet into the stomach is made smaller which further restricts food from leaving the pouch (Fig 2).

The sleeve gastrectomy involves removal of at least 75% of the stomach. This reduces the volume capacity of the stomach (Fig 3).

The malabsorption operations cause weight loss by decreasing absorption of calories from the intestines. These operations involve reducing the stomach size and bypassing most of the intestines (Fig 4).

The vertical banded gastroplasty involves the construction of a small pouch that restricts the outlet to the lower stomach. The outlet is reinforced with a piece of mesh (screen) to prevent disruption and dilation.

Choosing between the different operative procedures involves the surgeon’s preference and consideration of the patient’s eating habits.

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This brochure is intended to provide a general overview of a surgery. It is not intended to serve as a substitute for professional medical care or a discussion between you and your surgeon about the need for a surgery. Specific recommendations may vary among health care professionals. If you have a question about your need for a surgery, your alternatives, billing or insurance coverage, or your surgeons training and experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the operation or subsequent follow up, discuss them with your surgeon before or after the operation.