Weight Loss Surgery for Morbid Obesity

Obesity has become an epidemic problem worldwide. It is a serious medical problem as it directly links to many common diseases (Table 1). Obesity is defined according to Body Mass Index (BMI, i.e. body weight/height2). There is no single effective treatment and combination of different therapies is the key (Table 2).

Surgery for weight loss has been devised over the last 40-50 years. The type of surgery fall into two broad categories:

1. Restrictive (reduces the size of the gastrointestinal tract) e.g laparoscopic gastric banding
2. Malabsorptive (alters metabolism and reduces absorption) e.g. gastric bypass

The indications of surgery are shown in Table 3. Surgery has become increasingly popular as they are usually performed with laparoscopic approach (key-hole surgery). Gastric Banding and Gastric Bypass have been proven to be very effective. In average, patients can lose about 50-60% of their excess weight loss. More importantly, surgery can result in improvement or complete resolution of the various obesity complications.

In laparoscopic gastric banding (Figure 1), a silicone band is inserted into the abdomen and it encircles the upper part of stomach to create an upper gastric pouch. Food intake of patient is reduced by its restrictive and satiety effects. It is minimally invasive and the diameter of the band is adjustable through an access port which is implanted under the skin. Adjustments of the band are usually carried out at out-patient clinic during the follow-up visits and are critical for successful outcomes.

Mechanism of laparoscopic Gastric Banding

• Early and prolonged satiety
• Reduced apetite

Advantages of LAGB:

• Least invasive of all surgeries described for obesity
• Performed laparoscopically (key-hole surgery)
• Adjustable - balloon can inflated or deflated to control food intake
• Avoids irreversible damage Ð no cutting or stapling of stomach
• Reduced post-operative pain
• Shorter hospital stay
• Faster return to work
• Improved cosmesis

In laparoscopic gastric bypass (Figure 2), a small upper gastric pouch is created by dividing the stomach at its upper pole and a gastrointestinal bypass is performed to achieve certain extent of malabsorption. This procedure is very effective but the risk of complication is higher.

“Almost all patients recovered within a few days because it is a key-hole surgery. More importantly, it is very rewarding to see their medical illnesses such as diabetes and hypertension improved or even resolved with weight loss after surgery”, says Dr Jimmy So, Consultant, Department of Surgery, NUH.

The best treatment for obesity is a multidisciplinary approach. Hence, in National University Hospital (NUH), we have set-up a weight management program which involves a team of expertise. Patients will undergo consultations with endoscrinologists to assess possible etiology and complications of obesity. Our dietitians will assess the patient individually and design a special diet program for weight reduction according to the patient’s need. Patient will also undergo exercise therapy with our physiotherapists.

For more information or Appointment, please contact:

Surgery Clinic at Tel: 7725730 or
Wellness Centre:
Tel: 6772 4461/4462
Fax: 6778 3227
Email: WellnessCtr@nuh.com.sg

Table 1. Diseases related to Obesity

• Type II Diabetes Mellitis
• Hypertension
• Coronary Heart Disease
• Hyperlipidemia
• Asthma
• Sleep apnoea
• Reflux esophagitis
• Gallstones
• Osteoarthritis and spine problems
• 10. Certain cancers e.g breast cancer

Table 2. Multidisciplinary Treatment of Obesity

• Dietary modification
• Physiotherapy
• Drugs
• Obesity Surgery(if indicated)

Table 3. Criteria for Obesity Surgery

1. patients are morbidly obese (BMI > 40 kg/m2) or
2. severely obese (BMI > 35kg/m2) with the obesity related complications.

Fig 1. Laparoscopic gastric banding with its access port

Fig 2. Gastric Bypass

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Information in this webpage is given as a guide only and does not replace medical advice from your doctor. Please seek the advice of your doctor if you have any questions related to the surgery, your health or medical condition.

Information is correct at time of publishing (December 2005).