The surgical option
Surgical treatment is medically necessary because it is the only proven method of achieving long–term weight control for the morbidly obese patient. Surgical treatment is not a cosmetic procedure. It does not involve the removal of adipose tissue (fat) by suction or excision, like liposuction.

It involves reducing the size of the gastric reservoir, with or without a degree of associated malabsorption. This reduces solid food intake with in turn reduces total caloric consumption. It induces early satiety and provides satisfaction of hunger even after eating small amounts of food.

Who can go in for surgery?

Surgery for obesity is a very major step and should never be entered into lightly without considering carefully its advantages and disadvantages. Current surgical opinion is that patients should be at least 50% above their ideal weight and have had a severe weight problem for at least five years. It is important of course that patients should have tried less drastic methods of weight loss.

Patients with a Body Mass Index (BMI) of more than 40kg/m2 are potential candidates for surgery – provided they strongly desire a substantial weight loss – because obesity severely impairs the quality of their life. There are other related indications such as diabetes, hypertension, sleep apnea, asthma, angina, claudication, infertility, stress incontinence, intertrigo, depression, gastric reflux, arthritis and clumsiness.

What is the stomach exactly?

The stomach is a hollow bag which joins up to the mouth via the esophagus (throat) and empties into the small intestine where most of the digestion of food occurs. The main function of the stomach is to act as a temporary reservoir (it can hold 1 to 1.5 litres) for swallowed foods and fluids since the bowel cannot cope with digesting a large amount of food at once. A valve called the pylorus controls the rate at which the stomach contents drain into the small bowel.

When the stomach is full, the nerves in the wall of the stomach send messages to the brain to let you know you are “full”. When the stomach is empty the message is “hungry”. The trouble with obesity is that fat people keep getting more “hungry” messages than “full” messages – so they eat more than they need.

What happens in the stapling operation?

The actual surgery involves creating a small pouch in the upper part of the stomach that effectively becomes a new `baby stomach’. The staples join the walls of the stomach together to form this pouch but leave a narrow opening called the stoma between the pouch and the rest of the stomach. Three strong stitches are put around the stoma to make sure it stays 12 mm wide and doesn't stretch. The food still goes down the normal way and is digested in the bowel normally.

The big difference is that the pouch will only allow a very small amount of food to be fitted in at one time. When this happens, satisfaction is achieved and hunger will subside until the pouch eventually empties into the duodenum. So you feel full after eating a small amount of solid food and your intake of food can be kept to two or three tiny meals a day with no desire to eat between meals.

How does gastroplasty work?

Gastric stapling works by drastically restricting the amount of solid food you can fit into the stomach at each meal – but it has the advantage of giving satisfaction in the stomach as soon as this amount is eaten. After gastric stapling you eat just 50 to 90 ml of solid food and you actually