Laparoscopic surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions – usually about 0.5 – 1.5 cm. This type of keyhole surgery uses images displayed on TV monitors to guide the surgeon through the procedure.
This type of surgery is regarded as minimally invasive and it has a number of advantages compared with open procedures, including reduced pain due to smaller incisions, less haemorrhaging and shorter recovery time. However, it is still a major surgical procedure and its increasing use as a surgical procedure for weight loss means that many more higher risk patients are undergoing what is often an unnecessary operation.
What is laparoscopic surgery?
The key element in laparoscopic surgery is the use of a laparoscope, of which there are 2 types – a telescopic rod lens system, that is usually connected to a video camera, a digital laparoscope. During the procedure, the abdomen is usually insufflated – basically blown up like a balloon, with carbon dioxide gas. This gives the surgeon a much larger cavity and plenty of room to work within.
The procedures that are actually performed with a laparoscope during weight loss surgery can be one of several, including:
· A Roux-en-Y gastric bypass, in which greater than 95% of the stomach is “bypassed” and a small portion (the size of an egg) remains functional.
· An adjustable gastric band procedure, in which the stomach is restricted or “cinched” by the placement of the band, which can be adjusted after surgery as needed for further weight loss.
· A sleeve gastrectomy, which is the removal of two-thirds of the stomach with a “bypass” of the intestines.
After the surgery is completed the patient usually stays in hospital for up to 3 days and may be off work for up to 4 weeks. Post-surgery support should involve working with a dietician to follow specific eating guidelines and regular follow-up visits should be scheduled during the first year after surgery to check the patient’s overall physical and mental health, metabolism and nutritional status. Many patients will also require plastic surgery (abdominoplasty) 1 to 2 years after weight loss to remove skin folds around the abdomen.
So what are the benefits of laparoscopic weight loss surgery?
OK let’s be honest – if you have this surgery, you will experience serious weight loss, which usually occurs in the first 12 months following the procedure. The loss of weight may also remove or reduce the effects of other medical problems such as diabetes, hypertension and coronary artery disease. That’s the good news.
The bad news is that this type of surgery, like all major surgeries, carries a number of dangers. The death rate from these types of surgeries varies between 1 and 2%, about 1 in 5 patients need re-hospitalisation for corrective treatment and, in general, mortality and morbidity rates of follow-up operations are higher than those of initial surgeries.
Other dangers are too numerous to list, but they include a 10% chance of infection or disease, potential gaseous distention of the stomach, post-operative leaks with peritonitis and subsequent abdominal trauma. Other potentially serious health complications include internal hernias caused by the Roux limb, stomal stenosis and marginal ulcers, which are treatable with acid suppression therapy.
The reduction in nutrient uptake, caused by the bypass of the small intestine where most vitamins and minerals are absorbed, means that nutritional deficiencies will occur and will lead to long-term complications if patients do not continue with vitamin and mineral supplementation. After the majority of stomach bypass operations, lifelong vitamin B12 injection therapy and a daily multivitamin intake are mandatory. In addition, calcium and iron supplementation is often needed.
The bottom line is that weight loss surgery should only be a “last chance” solution for people with an urgent medical need. Disturbingly, many people are now voluntarily opting for these types of procedures, thereby placing themselves in danger, whilst failing to properly address the reasons for their weight gain and making a proper lifestyle change.