Stomach Surgery - Information, Treatment, Therapy & Surgery

Gastric bypass surgery to reduce the size of the stomach is recommended in cases of morbid obesity where multiple attempts to lose weight have failed.

Any surgical procedure constitutes an infringement of bodily integrity and, if performed under incorrect indications or if complications arise, may constitute bodily harm.

This is important for procedures involving the reduction in size or removal of healthy organs, including gastric bypass surgery to treat obesity. Only severe obesity and a risk to the body justify gastric surgery. The procedure should be performed by experienced specialists in visceral surgery.

Obesity is a disease that poses a significant health risk. The key indicator of obesity is the body mass index (BMI).

BMI is defined as follows:

• BMI = body weight in (kg)/[height in (m)]²
• A normal weight is a BMI of 18.5–24.9
• Underweight is defined as a BMI of < 18.5

The conditions of being overweight and obesity are classified as follows:

• Mild overweight: 25–29.9 kg/m²
• Class I obesity: 30–34.9 kg/m²
• Class II obesity: 35–39.9 kg/m²
• Class III obesity: ≥ 40 kg/m²

Various tests are required before surgery to comprehensively assess the patient’s health.

In cases of mild to moderate overweight, specialists do not yet perform surgery. Here, the focus is on lifestyle changes, dietary adjustments, and sufficient physical activity.

In cases of severe obesity (BMI > 40), doctors decide to operate on the patient. The costs are usually covered by health insurance.

For obesity grades in between, specialists make decisions on a case-by-case basis and first recommend exhausting all conservative measures (such as diet and exercise). 

Surgical stomach reduction is intended to reduce the stomach’s capacity (the amount of food and drink the patient can consume). The goal is to reduce food intake and calorie consumption.

This is achieved through the stomach’s reduced capacity. The earlier onset of satiety is also a key factor. For this reason, severely overweight and obese individuals in particular benefit from gastric surgery. These are typically people who consume large quantities of food without ever feeling full.

The following bariatric surgical procedures are used:

• Gastric bypass
• Sleeve gastrectomy
• Gastric band

Gastric banding is the most common procedure. It is often referred to colloquially as “gastric banding,” a term derived from the English phrase “gastric band.”

During gastric surgery, specialists place a silicone band around the lower part of the esophagus or the upper part of the stomach. This band narrows the opening to the stomach and reduces the size of the entrance.

Doctors refer to the upper part of the stomach as the gastric fundus (or, in Latin, fundus ventriculi). This significantly restricts the diameter of the stomach.

The gastric band consists of a silicone tube that can be filled with fluid. The amount of fluid can be adjusted as needed.

This allows the stomach’s capacity to be adjusted, even after surgery. This is done via a connection between the tube and a chamber (port) located under the skin in the chest area. This chamber is visible from the outside as a small bump. It is easy to feel and puncture.

“Gastric banding” is a relatively minor procedure and can be performed via laparoscopy without major skin incisions.

The major advantage of “gastric banding” is that specialists can easily fill and empty it from the outside. They can also simply remove it again.

Since the stomach retains its shape and size, the condition of the organ remains the same after the band is removed. This does have the disadvantage that weight gain may occur again once the band is removed.

Complications that arise when part of the stomach is removed (as with other techniques) are extremely rare with gastric banding. Scarring, ulcers, or leaking sutures occur extremely rarely—if at all—with gastric banding.

In this procedure, doctors suture a loop of the small intestine to the pre-stomach (where the band is located), thereby bypassing the remaining stomach. In this way, doctors achieve a “functional stomach reduction.” “Functional” means that only the stomach’s function is reduced, but the organ itself is not physically made smaller.

As a result, the stomach processes fewer nutrients from food. Doctors refer to this as malabsorption (impaired digestion).

As a result, the patient consumes less solid and liquid food because they feel full sooner. In addition, patients are unable to digest a more or less significant portion of their food, or digest it significantly less effectively than normal.

In this procedure, specialists reduce the stomach’s capacity by approximately 80–90 percent. The surgery is performed through the abdominal wall via laparoscopy.

Experts use a stapler to narrow the stomach—which has a somewhat hemispherical shape—lengthwise. As a result, it is no longer hemispherical but elongated.

This creates a tube approximately 20 cm long with a diameter of 4–5 cm and a capacity of about 100 ml.

Weight loss of up to 50 kg (and more) is possible. Strict and consistent restriction of food intake are essential prerequisites. 

Ultimately, the stapled sutures may rupture, particularly in the event of uncontrolled binge-eating episodes. A rupture of the stapled suture can lead to serious complications, such as inflammation of the abdominal cavity caused by leaked stomach contents. 

In extreme cases, this necessitates an emergency laparotomy (emergency surgery involving the opening of the entire abdominal cavity).

Patient counseling provided by the treating physicians includes detailed nutritional guidance before and after gastric surgery. The dietary transition following the procedure takes place under medical supervision. The patient must strictly follow the instructions during the first four to six weeks after gastric surgery. It is recommended to eat several small meals a day instead of a few large portions.

Medical supervision prevents the significantly reduced food intake from causing deficiency symptoms such as muscle wasting or iron deficiency. As part of follow-up care, a gastroscopy may also be performed to check the sutures.

Through medical counseling, patients learn that eating too much after gastric surgery can trigger heartburn and vomiting. In extreme cases, a leak may develop at the stomach sutures. 

Comprehensive follow-up care and close monitoring after gastric surgery are intended to prevent complications. Experience shows that the primary goal for the patient is reliable weight loss. In rare cases, structures such as the diaphragm may also be affected by the procedure.

But preventing complications is even more important. Bariatric surgery is not suitable for stomach cancer—other surgical procedures are used in such cases.

For severely overweight individuals, modern medicine offers effective options in the field of bariatric surgery. 

People with obesity (adiposity) in particular benefit from the options offered by gastric reduction surgery. Treatment methods include gastric bypass, sleeve gastrectomy, and gastric banding. Patients should be aware that a change in diet is necessary for the rest of their lives.