Dear Alice,

How can I get some information on stomach staples?

Dear Reader,

Stomach stapling is a major surgical procedure for severely and/or morbidly obese individuals who have made numerous, unsuccessful attempts with traditional methods of losing weight (such as changing eating patterns, working with nutritionists on eating plans, dieting, regular physical activity), all with the knowledge and supervision of their health care provider. To qualify for gastrointestinal surgery (stomach stapling is one kind), the person needs to have a body mass index (BMI) of over 40. For a man, this means being at least 100 pounds overweight for his height; a woman must be over 80 pounds the healthy weight range for her height. This surgery gained popularity when multiple celebrities had the procedure done as a last resort treatment for morbid obesity.

For the procedure itself, a trained and experienced surgeon creates a small pouch at the top of the stomach, where it meets the esophagus, using staples and most often a band that is filled with saline that can enlarge and contract. The pouch will generally be large enough to hold only 1 to 3 ounces of food at a time. At the lower end of the "new" stomach, an opening of about 3/4 inches is made. This slows the movement of food, allowing the person to feel full more quickly. As a result, the person will be able to eat only a small amount of food — generally about one cup or less — at one time.

Sometimes the procedure is coupled with another one, called a malabsorptive operation, which diverts food from the stomach past much of the small intestine. This severely limits the body's ability to absorb nutrients and calories from the food, thus resulting in rapid weight loss.

Following the operation, the patient will have to consciously learn to change her or his eating patterns — to eat smaller amounts of food and to chew slowly and thoroughly. S/he won't be able to eat foods high in sugar or fat content, because they empty from the stomach more quickly than foods high in protein or complex carbs such as fiber, and can cause uncomfortable side effects. The patient will begin a lifelong dependency on nutritional supplements, since s/he will not be able to get enough vitamins and minerals from the food s/he eats. The individual will need to engage in regular physical activity as well, even if it's never been part of her or his routine.

Usually, maximum weight loss takes anywhere from 10 to 24 months after the surgery. Some people will not be successful. More than just the physical differences in the stomach, success also depends on the person's motivation to change her or his eating and exercise routines, continuing to use the traditional means of weight loss and maintenance that are most often successful and had been tried before having the surgery. These factors remain key to successful weight loss and maintenance, whether or not one has the procedure done.

While stomach stapling is a fairly simple procedure, it is not without risk. Nausea and vomiting are more prevalent, since eating larger amounts of food or not properly chewing will result in throwing up. Sugar and fat can cause "dumping syndrome," in which food moves through the stomach opening too quickly, causing nausea, vomiting, weakness, and even fainting. About 10 to 20 percent of people who undergo the surgery will need to have at least one follow-up operation due to complications. The band can slip, or even break, releasing saline into the abdomen; the staples can deteriorate and will need to be replaced. In a small number of cases, juices from the stomach can leak out into the abdomen, necessitating immediate emergency surgery. And in less than 1 percent of cases, infection can lead to death.

In addition, about 1/3 of the people who undergo the procedure will have gallstone problems and another 1/3 will have nutritional deficiencies. Some may also experience pulmonary embolisms (blockages of an artery) or respiratory failure. A final caution: the operation is quite expensive, and coverage varies depending on a person’s health insurance plan.

If you think you are a candidate for this type of surgery, you can speak with your health care provider. You have hopefully been working with her or him to lose weight already. If not, you might together come up with some simple, workable strategies for losing weight before having this type of procedure, if at all. If you are indeed a candidate, your provider will refer you to a bariatric surgeon, a doctor who specializes in the field of obesity and gastrointestinal surgery.

For further information, visit the National Institutes of Health (NIH) web page on Gastrointestinal Surgery for Severe Obesity, or the American Society for Bariatric Surgery web site.


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