Slide 8-27. The NIH Consensus Conference reported in 1991 established gastric bypass operations as the only recommended surgical approaches to obesity, since there was extensive data supporting the utility of these approaches. Ileo-jejunal bypass was recommended only under strict control with research protocols. The two most common operations are vertical banded gastroplasty and Roux-en-Y Gastric Bypass.

Slide 8-28. A vertical banded gastroplasty creates a narrow channel for food to pass through in the stomach. The major complications include nausea and vomiting, stretching of the channel with weight regain, and stricture and obstruction. The results of the operation are comparable to what is achieved with very low calorie diet, and the patients require significant diet and lifestyle change to maintain their weight loss.

Slide 8-29. A Roux-en-Y Gastric Bypass creates a small gastric pouch the size of a hard boiled egg, where food that is well-chewed can enter the intestine resulting in a rapid onset satiety response. The side effects of the operation include dumping syndrome and hypoglycemia. As with the Vertical Banded Gastroplasty, there is a need for diet and lifestyle change. The side effects are more pronounced than the former operation, but the results are also more predictable. Vitamin B12 must be administered bimonthly by injection, since the area of the stomach which produces intrinsic factor is bypassed. This operation is preferred as the primary operation for obesity at many academic medical centers with comprehensive obesity programs.

Slide 8-30. Liposuction and other plastic procedures to remove fat cells are cosmetic procedures. Fat cells in the areas around the sites of fat removal can hypertrophy when there is weight regain. Shown here is the bad result of a patient who regained all of her weight following a liposuction procedure performed on her thighs. This photograph graphically illustrates the principles of vertically integrated management. There are no magical solutions to overeating, and diet and lifestyle must be used with all the approaches discussed in this chapter.

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