Non-surgical treatments work only in 1 out of 20 severely obese patients. The National Institutes of Health Technology Assessment Conference of 1992 ‘Voluntary Methods for Weight Loss and Control’ determined that even in the best available weight-loss programs using any combination of diet, behaviour modification, exercise, or medication, two-thirds of any weight lost is regained in the first year after the program, and almost all within 5 years.
Surgery is the only effective treatment.

Obesity is related to multi-faceted problems and complications, that require a multidisciplinary approach. Past results show that weight loss surgery has higher long-term success when integrated with psychological and dietary support; not only in the preoperative phase, but also for the postoperative follow up. Each physician within a multidisciplinary team plays a crucial role.

But most and above all, the patient's motivation is the key success factor: weight loss surgery only succeeds if patients are committed to work with it for the rest of their life and to change their behaviour. They should approach surgery as the beginning of a whole new phase in life. Most performed procedures worldwide are gastric banding and gastric bypass procedures.

Adjustable Gastric Banding

Adjustable Gastric Banding is the least invasive weight loss procedure, based on the principle of stomach restriction. A band is placed around the upper part of the stomach, dividing it into two portions, in a shape of an hourglass: one small pouch and one larger portion. The upper pouch can hold only a limited amount of food, and the band makes it empty slowly: therefore, the patient feels full faster because the receptors in the stomach send an early and long-lasting signal of satiety to the brain; as a result, the patient eats less, which results in weight loss.

Food digestion occurs through the normal digestive and absorption process. The volume of the band is adjustable, which means that  the pace at which the stomach pouch empties can be increased or decreased according to patients’ situation and needs. In Europeanstudies, patients lost 60% of their excessive weight after three, four and five years after the operation.

Gastric bypass procedures

Gastric Bypass Roux-en-Y combines principles of restriction and mal-absorption. A small stomach pouch is created, and the remaining part of the stomach is separated from it. Then, the small pouch is connected directly to the middle portion of the small intestine (jejunum): therefore, the food no longer passes through the rest of the stomach and the upper portion of the small intestine (duodenum).

Since the first part of the small intestine – the duodenum - transports the digestive juices, it is now attached to the lower end of the bypass. It is only at this stage that food mixes with the stomach juices, bile and pancreatic juices, a process, which is necessary for the delayed digestion. This means that the uptake of calories is restricted. One year after surgery, patients lose on average 77% of excess body weight. Studies show that after 10 to 14 years, patients have maintained 60% of excess body weight loss. In a recent study of morbidly obese patients, Roux-en-Y gastric bypass has shown 83% resolution of type 2 diabetes, 85% resolution of obstructive sleep apnea, 75% resolution of hypertension, and 93% improvement of hyperlipidemia and hypercholesterolemia. In most cases patients report an early sense of fullness, combined with a sense of satisfaction, that reduces the desire to eat.

Obesity Surgery Center – Krankenhaus Hallein in Austria is one of the leading Hospitals in Europe treating morbid obesity and situated 20 Km south of Salzburg. Karl Miller, MD, Assoc. Prof. of Surgery, general surgeon and bariatric surgeon is head of the surgical department and director of the obesity management team. Following procedures will be offered laparoscopically (minimal invasive surgical techniques) with expertise:
• Adjustable Gastric Banding
• Gastric Sleeve Resection
• Y-Roux Gastric Bypass
• Gastric Stimulation (Pacemaker)
• Intragastric Balloon (gastroscopic placement)

Obesity Surgery Center – Krankenhaus Hallein, Austria
Buergermeisterstr. 34, A-5400 Hallein, Austria
Tel.: +43-6245-799-360 or +43-6245-799-363
Mrs: Elfi Gimpl (Assistant to Prof. Miller)
Fax: +43-6245-799-361
chirurgie@kh-hallein.at
www.obesityteam.com