Surgery can control weight by changing the energy balance in two ways:
1. Decrease the amount of food you eat (restriction);
2. Make sure that part of the food is not digested nor completely absorbed (malabsorption), being eliminated by the feces;
3. Decrease the amount of food eaten and make part of it poorly digested or absorbed (mixed – restriction / malabsorption).
The appearance of these processes to try to control weight was not a matter of chance, but of observations made by surgeons of operations performed to treat other types of diseases, such as cancer and others, in which it was necessary to remove part of the stomach or small intestine. The near impossibility of maintaining weight and / or even increasing it with this type of surgical procedures led us to think that with some modifications these surgeries could be applied to weight loss in morbid obesity.
It is very important to have an idea of how these surgeries work, because a lot has changed in recent years. During the last few years we have learned that to control weight with surgery that only restricts food intake, there is a need to create a reservoir in the upper part of the stomach, with a small initial capacity, which varies between 15 and 25 mls, and that binds to the rest of the stomach through a stoma, thus promoting less food intake.
This stoma, which is normally narrow, may be of variable size in the adjustable gastric bands or even be reinforced with prosthetic material to prevent its expansion in other surgeries. Therefore, the small reservoir and the narrow outlet produce a quick feeling of satiety which, in the cooperating and compliant patients, induces a behavioral modification, thus reducing caloric intake and inducing weight loss.
In this type of surgery there is a very high commitment of the patient to the physician and surgery, and there are two rules that are essential to comply with:
✔️ Chew everything very well;
✔️ Swallow food very slowly.
Because if this is not the case, the patient may experience pain, reflux or vomiting and may increase the size of the reservoir (dilation), the outlet or both, losing the purpose of the surgery. The consumption of liquids with a high calorie content and the intake of food after hours (snacks) should always be avoided.
Failure to comply with these precepts is one of the most frequently verified reasons for failure. This type of surgery, simple and less risky, does not always produce the weight loss expected by surgeons and patients. For this reason, malabsorption techniques began to be used, some of which include the bypass of large segments of the small intestine.
The major disadvantage is that the risks, complications and side effects increase with the widening of the intestinal bypass. Together with your surgeon, you should thoroughly assess the risks and benefits of each operation. However, always keep in mind that the more complex the surgical intervention is to help you lose weight, the more serious the risks and side effects will also be.
Ask your doctor, be fully aware of what may happen to you with any of the surgical procedures, contact other patients and only after you are certain of the surgery you are going to perform should you proceed to the surgery. Always bear in mind that surgery does not cure obesity and that only patients who are well informed and willing to change their lives make these operations a success.
There are many sources available on the market to help you choose a surgical technique, including the Internet, but never forget to clarify yourself properly with your physician, as only he or she will be able to inform you of all the changes that you will suffer and only he or she can choose the best surgical method to help you lose weight.