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HEALTH&FITNESS
310
June14
To treat severe obesity, gastric banding
and similar procedures that restrict
the amount of food you’re able to
eat have been around for some time,
agrees DR LIM KHONG HEE, a general
surgeon with a longstanding interest in
upper gastrointestinal and advanced
laparoscopic procedures.
But there’s an exciting new approach
to this area, he says, which is now
being called metabolic surgery. Earlier
regarded by some as a purely cosmetic
procedure, and wrongly grouped
together with techniques such as
liposuction, the emphasis has changed:
“It is now increasingly recognised that
obesity is linked with life-threatening
conditions such as diabetes, high blood
pressure, heart disease, osteoarthritis,
sleep apnoea and more.”
Over the years, he says, surgery has
been very effective in helping severely
obese patients lose weight. Compared
with conservative treatment with diet and
exercise alone, which has a success
rate of around five percent, adding
surgical options increases the rate of
success in the long term to around 50
to 70 percent.
That’s not in itself surprising. What
is
surprising is that metabolic surgery
has been shown to send diabetes into
remission almost immediately, even
before patients lose weight. Very often –
and almost mysteriously – they become
asymptomatic and are able to either
dramatically reduce their medication or
even go off it altogether. This improves
their quality of life and even lengthens
life expectancy.
How does it work?
“There are a few theories,” says Dr Lim.
“One is that rerouting food along the
gastrointestinal (GI) tract, allowing it to
be directly delivered to the later part of
the small intestine, affects the release of
different hormones along the way. This
could enhance the effectiveness of the
patient’s insulin.”
Options
Gastric banding
surgery is very popular
in Australia and increasingly so in the
US, too, explains Dr Lim. He used to
do this regularly, but less so nowadays
because of band-related complications,
such as band erosion, that later require
surgical removal.
“Nowadays, I tend more often to
perform
sleeve gastrectomy
, the
removal of 75 to 85 percent of the
stomach. Not only does it restrict the
amount of food the patient can eat, but
the upper part of the stomach releases
an appetite-regulating hormone called
Photoeuphoria | Sebastian Kaulitzki | Dreamstime.com