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

About the surgery

How is Laparoscopic Obesity Surgery Performed?

In a laparoscopic procedure, surgeons use small incisions (1/4 to 1/2 inch) to enter the abdomen through trocars (narrow tube-like instruments). The laparoscope, which is connected to a tiny video camera, is inserted through the small trocar. A picture is projected onto a TV giving the surgeon a magnified view of the stomach and other internal organs. Four to six small incisions and trocars are placed for use of specialized instruments to perform the operation.

The entire operation is performed inside the abdomen after expanding the abdomen with Carbon dioxide (CO2) gas. The gas is removed at the completion of the operation.

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What Happens If the Operation Cannot Be Performed by the Laparoscopic Method?

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

What Should I Expect the Day of Surgery?

• You will arrive at the hospital the morning of the operation.
• Preparation before surgery often includes changing into a hospital gown.
• A qualified medical staff member will place a small needle/catheter (IV) in your vein to dispense medication during your surgery.
• Often pre-operative medications are necessary.
• You will meet the anesthesiologist and discuss the anesthesia.
• You will be under general anesthesia (asleep) during the operation, which may last for several hours.
• Following the operation you will be sent to the recovery room until you are fully awake. Then you will be sent to your hospital room.
• Most patients stay in the hospital the night of surgery and may require additional hospital days to recover from the surgery.

What are the Expected Results after Laparoscopic Obesity Surgery?

**Weight loss
The success rate for weight loss is reported as being slightly higher with the gastric bypass operation than the gastroplasty or gastric banding, but all techniques show good to excellent results. Most reports show a 50% or greater excess weight loss after one year. Weight loss generally continues for all the procedures for 18-24 months after surgery. Some weight gain is common about two to five years after surgery.

**Effect of surgery on associated medical conditions
Weight reduction surgery has been reported to improve conditions such as sleep apnea, diabetes, high blood pressure and high cholesterol. Many patients report an improvement in mood and other aspects of psychosocial functioning after surgery

What Complications Can Occur?

Although the operation is considered safe, complications may occur as they may occur with any major operation.

The immediate operative death rate for any of the laparoscopic obesity procedures is relatively low in reported case series (less than 2%). Other complications such as wound infections, wound breakdown, abscess, leaks from staple-line breakdown, perforation of the bowel, bowel obstruction, marginal ulcers, pulmonary problems, and blood clots in the legs are slightly higher. In the post-operative period other problems may arise that may require more surgery.

These problems include pouch dilatation, persistent vomiting, heartburn or failure to lose weight. In some individuals, revision or reversal of the operation is necessary and complication rates with secondary surgery are higher.

Gallstones are a common finding in the obese patient. Symptoms from these gallstones are a common occurrence with weight loss. Many physicians either treat patients with bile lowering medication (Actigall or URSO) or recommend gallbladder removal at the time of the operation. This should be discussed with your surgeon and physician.
After gastric bypass, nutritional deficiencies such as Vitamin B-12, folate, and iron may occur. Taking necessary vitamin and nutrient supplements can generally prevent them. Another potential result of gastric bypass is “Dumping Syndrome”. Abdominal pain, cramping, sweating, and diarrhea characterize Dumping Syndrome after eating drinks and foods that are high in sugar.

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Brought to you by:

SOCIETY OF AMERICAN GASTROINTESTINAL AND ENDOSCOPIC SURGEONS (SAGES)
11300 West Olympic Blvd., Suite 600
Los Angeles, CA 90064
Tel:
(310) 437-0544
Fax:
(310) 437-0585
E-Mail:
publications@sages.org
Revised:
March 1, 2015
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.