• Bariatric Surgery

    Introduction

    Bariatric surgery (weight-loss surgery) includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery).

    Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality. However, a study in Veterans Affairs (VA) patients has found no survival benefit associated with bariatric surgery among older, severely obese people when compared with usual care.

    What causes the airway to collapse during sleep?

    • Extra tissue in the back of the airway such as large tonsils.
    • Decrease in the tone of the muscles holding the airway open.
    • The tongue falling back and closing off the airway

    Indications

    The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI 35 plus serious coexisting medical conditions such as diabetes, hypertension, impaired glucose tolerance, hyperlipidemia, and obstructive sleep apnea.

    Eating and Drinking After Bariatric Surgery

    Eating Issues: Immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or sugar-free gelatin desserts.
    Fluid Issues: It is very common, within the first month post-surgery, for a patient to become dehydrated. Patients have difficulty drinking the appropriate amount of fluids as they adapt to their new gastric volume.

    Effectiveness of Surgery

    Reduced Mortality and Morbidity: Several recent studies report decreases in mortality and severity of medical conditions after bariatric surgery. In the Swedish prospective matched controlled trial, patients with a body mass index (BMI) of 34 or more for men and 38 or more for women underwent various types of bariatric surgery and were followed for an average of 11 years. Surgery patients had a 23.7% reduction in mortality (5.0% vs. 6.3% control, adjusted hazard ratio 0.71).

    A randomized, controlled trial in Australia compared laparoscopic adjustable gastric banding ("lap banding") with non-surgical therapy in 80 moderately obese adults (BMI 30–35). At 2 years, the surgically-treated group lost more weight (21.6% of initial weight vs. 5.5%) and had statistically significant improvement in blood pressure, measures of diabetic control, cholesterol.

    What should you do if you suspect you may have Obstructive Sleep Apnea?

    See your doctor; evaluation by a doctor specializing in sleep disorders is recommended. Have a sleep study done; a sleep study can provide the doctor with information about how you sleep and breathe. This information will help the doctor to determine your diagnosis and treatment options.

    Adverse Effects

    Complications from weight loss surgery are frequent. A study of insurance claims of 2500 who had undergone bariatric surgery showed 21.9% complications during the initial hospital stay and a total of 40% risk of complications in the subsequent six months. This was more common in those over 40 and led to an increased health care expenditure. Common problems were gastric dumping syndrome in about 20% (bloating and diarrhea after eating, necessitating small meals or medication), leaks at the surgical site (12%), incisional hernia (7%), infections (6%) and pneumonia (4%). Mortality was 0.2%.

    Increased risk of fracture has also been linked to bariatric surgery. Rapid weight loss after obesity surgery can contribute to the development of gallstones as well.

    Courtesy of the American Academy of Sleep Medicine (http://www.aasmnet.org)