Obesity Out With Minimally Invasive Surgery

Laparoscopic gastric banding, a minimally invasive procedure, allows people grappling with obesity to lose weight in a controlled and effective manner.

With a growing number of obese people unable to lose weight despite their best efforts, weight-loss operations are a viable option.

In Singapore, overweight patients are first put on a weight-loss programme of diet, exercise and lifestyle changes. Medication is included if necessary. It is only when the weight loss does not meet targets over time that surgery is considered.

Surgery is recommended only for people with a body mass index (BMI) beyond 35*. About 1.7 million Singaporeans with a BMI of 23 or more are vulnerable to developing obesity-related illnesses such as diabetes and heart disease. Studies reveal that obesity-related illnesses have the largest impact on health in terms of suffering and cost, and that a high BMI is the largest single contributor to diabetes.

Thankfully, with medical advancements, there are now minimally invasive weight-loss surgeries to help.

Laparoscopic gastric banding (Lap-band surgery)

Performed under general anaesthesia, this procedure takes between 30 and 60 minutes. The surgeon makes several tiny abdominal incisions of about 1cm each and uses them as entryways into the abdomen. Using an instrument called a laparoscope, which carries a tiny working camera and other tools, he places a band around the uppermost part of the stomach, leaving a very small, 15cc pouch for food. The size of the pouch means that you feel full after eating a small amount of food, and lose weight. The band can be tightened, loosened or even removed any time after the operation. Lap-band procedures typically result in a loss of 35- 45% of excess weight.

Lap-band advantages

Of all the surgeries used to treat obesity, Lap-band causes the least trauma. With no cutting or stapling of the stomach, and no large incisions or scars, you can regulate the amount of food you can eat simply by inflating or deflating the band.

Patients normally leave the hospital within one to three days after surgery, and it is possible to return to your normal activities within a week or two, unless the procedure is not done laparoscopically or complications develop. The Lap-band system can be easily removed, and the stomach gradually returns to its original form.

Laparoscopic sleeve gastrectomy

This procedure involves removing more than half of the stomach. The surgeon divides the stomach vertically and removes most of it, leaving a long, slender pouch that looks like a shirt sleeve.

This reduced size means that only a small amount of food can pass through, limiting the amount of food you can eat. The resizing also causes changes in the gut hormones, to suppress appetite, regulate blood sugar and keep you feeling full for a longer time.

Patients who undergo this procedure typically lose more than 50% of excess body weight. Stomach function is not affected because the nerves and outlet valve remain unchanged, and there is less risk of vitamin and mineral deficiencies because the food follows the normal digestive path.

Complications

As with any surgery, laparoscopic surgery comes with risks such as blood clots, bleeding and infection. There is also some risk of breathing problems and allergic reactions to medication.

It is therefore important that you seek advice from a skilled specialist to ensure your chances of success. Your recovery time can also be greatly improved under the care of an experienced medical team.

*BMI is calculated using the formula: weight (kg)/height (m)2.