Snoring and Sleep Apnea by Ralph A. Pascualy

Author:Ralph A. Pascualy
Language: eng
Format: epub
Publisher: Demos Medical Publishing
Published: 2010-07-16T16:00:00+00:00

Gastric bypass surgery: the stomach is stapled crossways, which greatly reduces the amount o f food i t can hold. A loop of small intestine is attached t o the upper stomach pouch t o receive its contents.

Complications after bypass surgery can be significant. They may include infections, bowel obstruction, collapse of lungs, blood clots, and other after effects seen following abdominal surgery. The most common complication after gastric bypass is excessive vomiting (44).

Gastric bypass by open abdominal surgery typically requires a hospital stay of a week or more, considerable postoperative pain and discomfort, and an extended recovery period lasting from 4 to 5 weeks to months.

HOW EFFECTIVE IS GASTRIC BYPASS IN TREATING SLEEP APNEA? The average weight loss after gastric bypass is 65 percent to 70 percent of excess body weight (not total body weight), leveling off in 1 to 2 years (46). One study reported that most of their surgical patients’ sleep apnea was significantly improved 6 months after surgery. Some patients had completely lost their symptoms. Many patients reported no daytime sleepiness or loud snoring. Changes in personality also were reported—greater responsiveness, fewer emotional problems, and less difficulty at work. A full year is needed for complete results, so during the 6 months following that report the patients in the study group might anticipate additional weight loss and further improvement in their apnea symptoms (45). In the long term, however, some people who have had gastric bypass surgery will return to their presurgery weight. The overall failure rate for gastric bypass surgery is reported to be from 30 percent to 50 percent (44).

Laparoscopic Adjustable Gastric Banding. “Lap-Band” surgery has been common in Europe and elsewhere but only was approved in the United States by the Food and Drug Administration in 1991. This surgery, as its name suggests, is usually performed laparoscopically, so the surgery itself is not especially risky if it is done by an experienced surgeon. It involves placement of an inflatable band around the upper part of the stomach. Inflating the band restricts the stomach to a small pouch with a small drainage opening. A tube running from the band to a port outside the abdominal wall is used to adjust the inflation of the band, which has to be done several times per year.

HOW EFFECTIVE IS LAP-BAND SURGERY IN TREATING SLEEP APNEAS? Statistics suggest that this surgery does not produce quite as great a weight loss as gastric bypass, achieving about a 50 percent loss of excess body weight (45). Among nine sleep apnea patients who had lap-band surgery, only three had their sleep apnea eliminated 18 months after surgery, but the remaining six did not improve at all (47).

Risks from lap-band surgery include those mentioned above for other bariatric surgeries plus potential damage to the esophagus or stomach, the possibility of infection from or malfunction of the inflatable band, and problems with the access port.

WHO CAN BE HELPED BY BARIATRIC SURGERY . Bariatric surgery may be an effective and permanent—if radical—solution for severely

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