Treatment Options
For obese patients seeking treatment, there are multiple non-surgical and surgical treatment options. Non-surgical options include commercial weight loss programs (Weight Watchers, Jenny Craig), medically supervised weight loss programs, and drugs prescribed for weight loss. While these work for some patients, many patients have tried these options and failed. For these patients, surgery may be a consideration.
There are several surgical procedures that are commonly used to treat obesity. The two most common are gastric bypass and adjustable gastric banding. Both procedures are usually done through small incisions made in the abdominal wall (laparoscopically).
Gastric Bypass
In gastric bypass, the surgeon uses a cutting stapler to create a small stomach pouch that can hold less food than the full stomach. Next a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the remainder of the stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine).
In this operation, the amount of food the patient can eat at one time is reduced (restriction), and the amount of calories absorbed by the body is reduced due to bypassing of the section of intestine (malabsorption). Weight loss with gastric bypass is excellent. With this type of operation most patients lose about 60 to 70 percent of their excess weight for 10 years or more. Complications of this procedure may occur in 5-15% of patients and may include infection, intestinal leaks or hernias. This type of operation may cause vitamin or calcium deficiencies due to the bypassing of a segment of intestine, so often patients have to take nutritional supplements. In addition, it can cause “dumping syndrome,” where certain foods high in sugar cause the patient to have uncomfortable nausea, bloating and sometimes diarrhea.
Adjustable Gastric Bands
An adjustable gastric band is a silicone implant that the surgeon places around the stomach near its upper end. This creates a small pouch and a narrow passage into the rest of the stomach.
This small outlet delays the emptying of food from the pouch into the larger part of the stomach and causes a feeling of fullness after a small meal (restriction). The main advantages of this surgery are that there are fewer complications than with gastric bypass, and if necessary the band can be surgically removed. Complications of this procedure include surgical infection, obstruction of the band opening, implant related infection or foreign body reactions, and longer-term issues such as band erosion or migration. While complications are less with this operation, patients who undergo adjustable gastric banding generally lose less weight than patients who have gastric bypass.
The TOGA® Procedure
The TOGA® Procedure is being evaluated as a new incision-free option for treatment of obesity. In the TOGA® Procedure, the physician inserts the TOGA® System devices through the patient’s mouth and uses the devices to create a stapled sleeve at the entry to the stomach. This is intended to give patients a feeling of fullness after a small meal (restriction). The TOGA® Procedure is only available as part of clinical studies at this time. Learn more about clinical studies of the TOGA® Procedure.
** The TOGA® System has been granted CE Mark but is not yet available for sale.
The U.S. National Institutes of Health (NIH) provide information on surgical treatments for obesity: http://win.niddk.nih.gov/publications/gastric.htm.
