Types of Obesity Operations

A number of types of surgery have been performed for severe obesity since the late 1950s. Many problems have been seen as a result. Since around 1990 some very good operations have emerged. These may be categorised as follows:

Gastric bypass procedures

This is the operation favoured in North America and The Wakefield Clinic. It is not commonly performed in other Australasian Centres or in Europe. We believe it leads to the most reliable and predictable weight loss, with few ongoing problems. The particular form of gastric bypass undertaken in the Wakefield Clinic is the 'Fobi Pouch' procedure (shown to the left). The operation is a major one, and although it is being performed laparoscopically in some centres, we are concerned that doing it this way is not as safe or as reliable as by open surgery.

Laparoscopic banding procedures

The laparoscopic (keyhole surgery) application of an adjustable band (the Lap-Band) became very popular in Australia and Europe following its introduction in the early 1990s. World experience is huge, and it is now apparent that although it is more easily accomplished than gastric bypass, it is not as effective, nor as reliable, and may be associated with many ongoing technical problems or eating problems which may lead to the need for revision surgery or even removal. For these reasons, this type of operation is not performed by the Wakefield Clinic.

Malabsorptive procedures

The original malabsorptive procedure was the small intestinal (or J-I) bypass. Although this was an effective operation it led to many serious and even life-threatening complications which dictated its reversal. Newer and safer forms of the operation include the so-called 'Scopinaro' operation or biliopancreatic diversion and the so-called duodenal-switch operation. Again these are very effective, but lead in a proportion of patients to serious metabolic problems and nutritional deficiencies. Long-term, close follow-up is mandatory, and in our view mean these procedures should not be regarded as operations of 'first-choice'.