Bariatric Surgery and Adjustable Gastric Thesis

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However, there are alternate therapies that may be considered first. Providing an anti-obesity drug to overweight patients with diabetes has been estimated to cost $8,327. Certain studies have indicated that there may be available a variety of cost-effective anti-obesity interventions (Cawley 2006: 74). Furthermore, extreme obesity usual requires a multi-dsici0plamnry approach and more than surgery is often required to complete the process (Folope, et.al. 2008).

For decades, the psychological literature has promoted a causal link between obesity and psychological problems. Obesity has been attributed to pathologic denial, lack of impulse control, depersonalization, existential vacuum, problems in personality development, and excessive orality. However, the mounting biological evidence brings into question the validity of these etiological theories. In addition, several research studies have found that obese people do not experience any more psychopathology than nonobese people. Melcher and Bostwick 1998)

There is an explosion of bariatric surgery clients. It may be necessary that psychologist or psychotherapists may need to evaluate more fully the eating patterns of these patients prior to surgery. A great deal of the current research suggests that if the psychological matrix of eating disorder can be recognized prior to bariatric surgery, the patient will have a greater chance of long-term success. (Toth and Schwartz 2006) However, some complications can occur with blockage of the band and unfortunately the reservoir implanted beneath the skin doesn't last forever. Consequently, weight regain with this method can also occur. In general gastric banding is no more successful than vertical-banded gastroplasty, and it too can result in iron and vitamin B12 deficiency. (Mcgowan and Chopra 2004)

Just as with vertical-banded gastroplasty, blockage of the band can be problematic, and unfortunately the reservoir implanted beneath the skin doesn't last forever. Consequently, weight regain with this method can also occur. In general gastric banding is no more successful than vertical-banded gastroplasty, and it too can result in iron and vitamin B12 deficiency. (Mcgowan and Chopra 2004:21)

This type of surgery does illicit extremely predictable and repeatable results. "The average weight loss in clinical practice after 2 years for adjustable gastric banding (GB) is 20%, Roux-en-Y gastric bypass (RYGB) is 30% and biliopancreatic diversion or duodenal switch (BPD) is 35%" (Vincent & le Roux 2008: 174). However, a Swedish study designed to compare surgically treated individuals with comparable individuals given conventional weight loss treatment has shown even greater long-term results. The Swedish Obese Subjects Intervention Study (SOS) provides results of large and relatively well-maintained weight losses over a follow-up period of up to eight years. This study was designed to compare surgically treated individuals with comparable individuals given conventional weight loss treatment (Sjostrom, Lissner, Wedel & Sjostrom 1999; Sjostrom, Peltonen & Sjostrom 2001).

At this current time Laparoscopic-adjustable silicone gastric banding (LASGB) is the most common bariatric procedure worldwide. "Along with a significant weight loss and changes in eating behaviour, LASGB has also been proven as an effective surgical procedure in improving obesity-related comorbidities" (Di Somma, et. Al. 2008: 395).

Bariatric surgery is able to improve glucose and lipid metabolism, and cardiovascular function in morbid obesity. (Biliary pancreatic diversion 2009). Par of the aim of this research was also to compare the long-term effects of restrictive (laparoscopic gastric banding, LAGB) procedures on metabolic and cardiovascular parameters, as well as on metabolic syndrome in morbidly obese patients.

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Another comorbid condition can include pseudotumor cerebri, a condition in which increased intracranial pressure often results in headache and sometimes in vomiting or blurred vision. Pseudotumor cerebri may be difficult to treat and can call for aggressive weight-loss therapy, and actually require bariatric surgery. (Daniels 2006)

Methods & Materials

This study will attempt to create a rat model of adjustable gastric banding. As previously stated in the literature review, rats are an ideal candidate for this model in that their food cycle behavior is identical in many important ways to humans. Especially in regards to the neurotransmitter and hormonal chemical reaction regarding the intake and satiation point of feeding. In order to accomplish this an adjustable gastric banding device with be surgically implanted in the rats. It will contain an inflatable cuff that can be adjusted externally through a typical port. Unlike the permanent setup in humans the port will be used to adjust the band throughout the research to observe the different effects at different band diameters. This will assist the researcher in creating staged reductions of food intake and observe weight loss over a period of several weeks. A modified herpes simplex virus (HSV129) will be used to observe the effect on the neural pathways mediating the balance of food intake. HSV129 will be transported transynaptically into CNS circuitry following injection into the stomach wall underlying the band.

Results

HSV129 labelled neurons were discovered in both the lateral and dorsal hypothalamus, arcuate nucleus as well as in the cerebral cortex. These specific sites were also discovered with feeding related peptides including orexin a and melanin concentrating hormone.

Conclusion

The resultant data recovered from this study show a heightened possibility that adjustable gastric banding has an effect on the sensory nervous system that is directed to the hypothalamus and cortical centre that may indicate a correlative connection between the banding and neuronal behavioral modification. This rodent model will certainly have application with future research in humans. Other animal studies certainly support the existence of a similar thinness or leanness phenotype that is under some genetic and hormonal control. In fact animals can be selectively bred for these traits.

…a substrain of Sprague-Dawley rats has been bred for their resistance to the development of obesity even when maintained on a high-fat diet. In addition, knockout mice created for the RII beta subunit of protein kinase were healthy but had greatly diminished white adi- pose tissue despite normal food intake. These animals were protected against developing diet-induced obesity, thus becoming potential models for the humans in our society who stay thin despite an obesity-promoting environment. (Fairburn and Brownell 2002:23)

Furthermore, the comorbid related traits to obesity have also been observed in rats. For instance, other studies have found that intermittent hypoxia induces a persistent increase in diurnal blood pressure (Robinson and Grunstein 2001). Future research along the lines of obesity and comorbid related diseases will show great promise using rodent models to begin the extremely difficult task of coding the genetic and chemical component of obesity.

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