Surgery for Obstructive Sleep Apnea
Take into account the surgical risks
Surgery is the most conservative treatment for obstructive sleeping apnea. However, for most people, it is not as effective as CPAP. Before making a decision, it is wise to look at all the options. Before you decide on surgery, it is a good idea to get another opinion from a physician. Surgery is not required for the most conservative treatment of sleep apnea. While they may require some effort or perseverance, they are not as painful or dangerous as any surgical procedure. The following criteria are met if a conservative surgery procedure is performed:
- This is a common procedure that has been performed for years and is not a new or experimental type.
- It doesn’t involve cutting major blood vessels, nerves, or dealing with major organs. There are usually no complications after surgery.
- This procedure can be done by an experienced surgeon without any variation in the outcome.
- You can do it on your own or with minimal hospitalization.
There are many possible pitfalls in surgery: excessive bleeding, side effects from medications, pain, swelling, drug reactions, nerve or muscle damage, and infection. General anesthesia is one of the greatest risks in surgery. General anesthesia is a particularly dangerous option for people with sleep apnea. Anesthesia can depress the breathing reflexes and people with sleep apnea have already experienced some respiratory difficulties. Anybody with sleep apnea should inform the surgeon before he undergoes surgery. The surgeon could also consult with the patient if the individual has sleep apnea. Both the surgeon and anesthesiologist need to know that the patient’s breathing needs will be closely monitored during and immediately following surgery.
Even “simple” surgery must be carefully considered. For someone who has suffered from sleep apnea, surgery may be the best option. In some cases, it may even be necessary to save their lives. Some surgical procedures can pose a risk to people who aren’t in immediate danger of severe long-term effects or just want to stop snoring.
Can Surgery Cure Sleep Apnea
Help versus Cure? It is important to know the difference between treatment for sleep apnea or a cure. This means that you can eliminate all diseases including stroke, heart attack, and other complications caused by sleep apnea. Patients A and B may both experience significant sleep apnea reductions after surgery. Patient A may have mild apnea at the beginning and may not require further treatment. An example of this would be a patient who is now alert and has an AHI of 10, from being a sleepy patient before surgery. Patient B might have had more severe apnea at the beginning and may still require CPAP. An example of this would be Patient B, who has an AHI of 60 and has it improved to 30 after surgery, but still has low blood oxygen at night, is at high risk for cardiovascular disease, and is still drowsy.
The results of each individual vary. All people are different and the results of surgery for sleep apnea may not be equal. For example, an early surgical procedure that was used for sleep apnea and is still being used today is uvulopalatopharyngoplasty (UPPP) (described later). UPPP is a treatment for sleep apnea that has a 50% failure rate. After 5 years, it may have a 25% success rate. This means that 50% of those who have undergone UPPP surgery still suffer from sleep apnea. The percentage will rise over time. The rate of success for lower jaw surgery (mandibular advancement or its variations) is high, but it can help people with severe sleep apnea when combined with maxillary. The failure to perform surgery to correct sleep apnea can be due to many reasons. One reason is that the treatment chosen is not appropriate.
Some patients can be pre-empted that UPPP will not cure their apnea. Some patients opt to have surgery regardless. Many times, a person with sleep apnea isn’t ready to face the fact that she has a long-term condition. Or, a family doctor may refer the patient directly to a surgeon who is familiar with nonsurgical treatment options. Many people who are not qualified to be surgeons find their sleep apnea recurs after surgery, and they need ongoing treatment. The newness of surgery to treat sleep apnea is another reason for low success rates.
Unfortunately, there is not enough data available to accurately predict which patients will benefit from a particular reconstruction procedure. Ask your sleep specialist for advice before you make a decision about surgery to treat sleep apnea. Before you accept the risk of any type of surgery, make sure that you are a good candidate. It is strongly recommended that you get a second opinion from a qualified specialist in sleep medicine who will not be performing the operation. A final note on choosing conservative treatment. Medical schools might be more open to more radical, experimental, and conservative options. This is fine for the advancement of medical science. However, it should be questioned if you are willing to take on that risk.
There are five types of surgery for sleep apnea
There are five main types of surgery that can be used to treat sleep apnea.
- Nasal surgery
- Surgery of the tongue and palate
- UPPP (uvulopalatopharyngoplasty)
- LAUP (laser-assisted uvulopalatoplasty for sleep)
- Radiofrequency thermal ablation (somnoplasty)
- Jaw surgery and other maxillofacial procedures
- Weight loss surgery
Nasal Surgery Nasal surgery can refer to a variety of ear, nose, and throat (ENT), procedures. These include surgery to repair the nasal septum, which is the wall that divides your left and right nostril passages. Some people may need to have their nasal surgery done before they can use CPAP. People suffering from nasal obstructions might feel “claustrophobic” and suffocated when using CPAP. They may also unconsciously remove the CPAP mask while they sleep. These problems can make CPAP users uncomfortable. Ask your sleep specialist if nasal surgery may be an option.
A person may be able to wear an oral appliance (mandibular advance device) after nasal surgery. This is something that was impossible before surgery. An oral appliance can make a person feel constricted if they have poor nasal airflow. Nasal surgery is usually not an effective treatment for sleep-disordered breathing or snoring. Sometimes, people report a reduction in their snoring following surgery to the nose. However, symptoms can return after a few months. The improvement in airflow through your nose can have a significant impact on overall airflow. This should be considered part of a comprehensive surgical approach if you are going to have palate surgery (see next section).
Surgery of the Tongue and Palate. UPPP
This was the first and most popular type of surgery to treat sleep apnea. A scalpel is used under general anesthesia to remove the rear third of your soft palate. It is important to keep the back of your soft palate in a straight line so that it will not collapse while you sleep.
Who can benefit from UPPP?
Whether a person is eligible for UPPP will depend on the purpose of the surgery and how the individual defines “helped”. If a sleep study shows that the patient has only snoring, UPPP has a 90% chance of success.
The fact that a bedmate reports that snoring has stopped after UPPP doesn’t necessarily mean that sleep apnea is gone. The chance of success for surgery to remove sleep apnea entirely is lower. It is also more difficult and harder to predict. However, it is likely to be less than 20%. These are the criteria that make this type of surgery most successful:
- They do not weigh more than 25 to 30 percent above their ideal weight and they don’t gain weight after surgery.
- They only have mild to moderate apnea and none of it is obstructive.
- A majority of their apnea is caused by an obvious anatomical obstruction in the upper part (throat) of the pharynx (throat). This includes the soft palate and upper throat area.
People with enlarged tonsils, adenoids (tonsils are often removed during UPPP); those with a long soft palate or large fleshy uvula; as well as people who have excess fleshy tissue in their throat. Combining UPPP with tonsillectomy may result in the best results. UPPP is not recommended for people suffering from severe apnea, or those whose apnea originates in other areas than the soft palate.
Those who have a very small or curved lower jaw, or a large tongue, or are positioned low in the neck or at the back of the neck, are less likely to succeed with UPPP. UPPP’s success is dependent on your weight. UPPP can be hindered by extra loading on the abdomen. People who undergo UPPP and gain weight will likely experience a return of obstructive apnea.
Until recently, little was known about the best people who could be assisted by UPPP. Cephalometry, which measures the size and position of structures in the head using radiographs (CT), magnetic resonance imaging (MRI) or computed tomography(CT), and fiberoptic examinations of the inside and airway, allows doctors to gain more information about how to select the best candidates for UPPP success (26-30). However, it is impossible to predict whether UPPP will succeed. You must consult your sleep specialist and an ENT specialist who is familiar with both sleep apnea and eliminating snoring. Your throat should be examined by an otolaryngologist.
For example, he may request a CT scan, MRI, or radiograph of your head to determine the relationships and sizes between different anatomical features that can cause your obstructive apnea. This will allow you to assess your chances of receiving UPPP treatment. What Are the Drawbacks to Uvulopalatopharyngoplasty? Compared with many surgical procedures, uvulopalatopharyngoplasty is not particularly risky. It doesn’t involve any major arteries or nerves. In healthy cases, it can be done as an outpatient procedure.
Some patients may require a hospital stay lasting 1 to 2 days. The anesthesia is the most dangerous. Preoperative medication, anesthetics, and painkillers, as well as sedatives and painkillers, can increase the risk of narrowing the airway. Anesthetics, along with other drugs, can cause breathing reflexes to be impaired. Sleep apnea means that your breathing reflexes may not function as normal if you have it. This is a higher risk than normal for anesthesia. This combined with existing apnea and possible obstruction of the throat from postoperative swelling, as well as pain medication, could lead to serious complications. UPPP can also cause pain. People who have undergone UPPP say that they feel more pain than they expected after the procedure (e.g., it is more painful than a tonsillectomy).
Severe pain may last up to a week. Patients report difficulty swallowing after surgery. It is easier to swallow food and liquid from the mouth by removing the uvula. It is common for 2 weeks following surgery. However, it will resolve with time if the surgeon has experience and skill with the procedure. Some people have swallowing difficulties. Most people who have difficulty swallowing will find they can overcome their problem by practicing and eating properly (20,23). There have been cases where airway obstruction has become more severe or more difficult after UPPP.
Why Have Uvulopalatopharyngoplasty If the Odds Are Poor? You may choose to have uvulopalatopharyngoplasty even if your chances of success are slim. This is because you can avoid other treatment options such as CPAP or oral appliances. UPPP is very safe when it’s performed on patients who have been thoroughly tested in a good sleep center and when the surgery has been performed by an experienced ENT doctor. We are unaware of any surgical complications or fatalities at the Swedish Medical Center.
How Can You Arrange for Uvulopalatopharyngoplasty? Until you have had a thorough examination by a doctor who is familiar with the causes of sleep apnea, and can weigh the benefits and risks for your case, it’s not a good idea to use UPPP to treat the condition. If you are a candidate for successful treatment with UPPP, the sleep specialist can refer you to a skilled surgeon.
LAUP is a soft palate surgery that can be used to alleviate snoring. Snoring is a sign of sleep apnea. However, LAUP has not been proven to be an effective treatment. It is difficult to distinguish between simple snoring from sleep apnea. Many people who seem to have “simple” snoring often have severe sleep apnea. LAUP surgeons will often screen those patients by using a questionnaire about snoring.
Questionnaires can’t diagnose sleep apnea accurately and are often underestimated. Many patients who have undiagnosed sleep disorders have undergone LAUP surgery, and are now left with serious complications. People who snore need to be examined by a sleep specialist in order to rule out sleep disorders. After sleep apnea is ruled out, LAUP should only be considered. LAUP is promoted as a replacement for conventional palate surgery (that’s, UPPP), as previously described. Patients who are considered good candidates by their ENT and sleep specialists for UPPP to treat snoring might consider LAUP. However, LAUP is not recommended to treat sleep apnea.
What is LAUP? LAUP is a series of laser cuts that are measured in length. These “cuts” create a V-shaped pattern on your soft palate. It is common to require several sessions. The laser cauterizes the tissue and leaves narrow scars. These scars can stiffen the soft palate, which may reduce snoring.
Does LAUP Eliminate Snoring? Although it is claimed that it eliminates snoring in 80 to 90% of cases, there have been reports that snoring can return up to 2 years after the surgery. What is LAUP’s Comparative Advantage to Conventional UPPP. LAUP is safer because it requires less time, less bleeding, and does not require hospitalization. It is slightly less expensive. Expect to pay approximately $1,600 for the surgeon and an additional fee for the facility. Conventional UPPP requires a general anesthetic, possibly a hospital stay, significant pain, risks from bleeding and infection, as well as general anesthesia. UPPP can cost as high as $3,000.
Is LAUP able to cure sleep apnea? According to published studies, no. LAUP can be used as an adjunct therapy for mild to moderate sleep apnea. About 50 percent of patients experience a 50 percent improvement. People with poor outcomes may be identified by careful examination of their airways. Patients with large palates and large tongues are at risk. LAUP can lead to fatal sleep apnea. People who believe that surgery will fix it are at risk. Sleep apnea goes beyond snoring. According to the American Academy of Sleep Medicine’s guidelines of practice for LAUP, patients should be evaluated by a specialist before they have LAUP. To determine if sleep apnea is gone, patients with sleep disorders should undergo a second sleep study.
Another new technique is somnoplasty. Radio-frequency energy is used to shrink the soft tissue. The U.S. Food and Drug Administration approved Somnoplasty for the treatment of sleep apnea in 1998. It can be used on the upper airway (soft palate and base of the tongue). Somnoplasty, like LAUP, is being promoted to the public as a simple treatment for the annoying, but the common problem of snoring. Patients run the risk of not being diagnosed with sleep apnea, just like LAUP.
Somnoplasty is not an effective treatment for severe to moderate sleep apnea, as LAUP has shown. In milder cases, it may be beneficial, possibly in combination with weight loss or CPAP. There haven’t been any definitive controlled studies done on Somnoplasty. How does Somnoplasty work? Somnoplasty uses radio waves at high frequencies to heat cells and cause scarring. The scar shrinks the tissue and reduces its bulk. This technology is used in surgery for many years to treat small tumors and cut out bleeding capillaries. Somnoplasty uses a lower level of energy. The procedure takes place in the doctor’s chair.
After anesthesia, the operator inserts a thin electrode in the tissue. The radio-frequency energy created by the electrode causes a lesion. It basically “cooks” small areas of tissue. It takes between 3 and 6 minutes to create a lesson. Usually, several lesions are created in one session.
After the surgery, swelling occurs within days. Scar tissue replaces lesions in a matter of weeks. Scarring reduces the size of the affected area and decreases its bulk. The extent of scarring is a factor in how much tissue shrinkage occurs. For best results, it is recommended that you have at least four sessions. Between sessions, there will be an 8-week healing period. What are the risks of somnoplasty surgery? Somnoplasty is less risky than scalpel surgery because it uses a local anesthetic. After 1 year of Somnoplasty experience, there have been no reports of any significant side effects. The long-term effects of Somnoplasty are still unknown.
After surgery, swelling can occur. This can pose a risk to patients with sleep apnea who have trouble keeping their airways open. After surgery, patients should be able to sleep at 45 degrees. Somnoplasty has a risk in common with LAUP. It can silence the main warning sign of sleep disorder by eliminating snoring. Patients could be unaware of the long-term effects of a potentially dangerous, undiagnosed condition. The experience and training of the surgeon performing Somnoplasty is another potential risk. It is a good idea to inquire about the qualifications of the person performing Somnoplasty. Can Palate Somnoplasty be used to treat sleep apnea? A series of lesions are created in the soft palate during Somnoplasty palate surgery. The goal is to shrink and tighten the palate.
Somnoplasty is approved by the FDA for use in the treatment of sleep apnea. Because it affects the same tissues, however, it is unlikely that it will be more effective than UPPP or LAUP for apnea. Unfortunately, long-term results have not been established. Reputable Somnoplasty practitioners will assess you and advise you on the possible dangers of sleep apnea. If you do not have these symptoms, or if you suspect that you may have sleep apnea underlying, don’t expect Somnoplasty to cure your problem. To determine if your sleep apnea is gone, it is important that you return to your specialist for a sleep study after Somnoplasty. Can Palate Somnoplasty eliminate Snoring?
According to reports, it may be able to reduce or eliminate snoring as well as LAUP. Unfortunately, long-term results are still not available. Tongue Reduction using Somnoplasty. Tongue reduction with Somnoplasty is a procedure that reduces the volume of the tongue to not block the throat. A scalpel or laser was used in the past to remove the notch at the back of your tongue. Sometimes, this was combined with tonsillar tissue located at the base. Since somnoplasty is a relatively new procedure, it is difficult to predict whether it will be more effective than the laser method. It is also difficult to predict the success rate of tongue reduction surgery for treating apnea.
Two surgeons presented the results of laser surgery on 24 patients who had previously had unsuccessful UPPP surgery. Laser tongue surgery was not considered successful in less than half of patients. Patients with an RDI of 10 or more and blood oxygen levels of below 90 still showed signs of success. Many of these patients would need CPAP. Although still experimental, Tongue Somnoplasty has some promise for treating obstructive sleep apnea.
What is the difference between somnoplasty and conventional UPPP? Somnoplasty is safer than UPPP because it involves less bleeding, requires less hospitalization, and does not require general anesthesia. One published study shows that Somnoplasty recovery is less painful than LAUP. Somnoplasty costs between $1,600 and $2,000 currently. Insurance usually does not cover it if it is done for primary snoring.
The Pillar procedure
Pillar is a new surgery that uses plastic implants to strengthen the soft palate. It seems to be moderately effective in decreasing snoring. This surgery is currently only available to a small number of sleep apnea sufferers. Early results indicate a slight improvement of the Apnea-Hypopnea Index. Long-term results are not available. We will wait to see if more patients have the Pillar procedure. Then, we can make a decision on whether it is effective in treating sleep apnea.
Jaw Surgery and Other Maxillofacial Surgery
Maxillofacial Surgery is the surgery of the mandible (lower) and maxilla (upper) as well as the bone and tissue of the faces. Head and neck surgery is performed by otolaryngologists or ENTs. It involves other parts of the head and face as well as the airway. Although surgery has been used for the treatment of sleep apnea for over 20 years, it is difficult to predict which patients will benefit from this type of surgery. These surgeries can be performed individually or together.
- Mandibular advancement – Moves the lower jaw forward
- Midface advancement – Moves the maxilla (upper) forward
- Hyoid surgery – Repositions the base of the tongue
There are many options for jaw surgery and maxillofacial surgery to treat sleep apnea. All of them are designed to eliminate obstructions in the lower jaw’s airway. To move the tongue forward, there are several surgical options available for the lower jaw. These procedures can be as simple as moving a small portion of bone forward at one end of the jaw or moving the entire jaw forward by cutting through both sides of it and sliding it forward. Another surgical procedure is to reposition the hypoid bone at the base of the tongue. This surgery was pioneered by the Stanford University Medical Center surgical team. It involves two stages: tongue advancement, tongue suspension, and hyoid suspension. Then, there is upper/lower jaw advancement.
Jaw surgery can help anyone.
These surgeries are not yet able to be predicted. The outcome of these surgeries can be affected by many factors, including the skull structure and soft tissue, as well as obesity and neuromuscular control of the airway.
The simplest and most effective procedure, mandibular advancement, is becoming more popular in the United States. However, its utility is still not fully understood. This procedure has only been used in a small number of patients suffering from complicated apnea. One patient with a small jaw and small airway opening was an example. Neither UPPP nor medication had been able to help him. Although surgery didn’t completely remove his apnea, it did reduce it by about half. Like many other cases of sleep apnea surgeries, success depends on whether you consider the total elimination of the apnea a success or if you accept the elimination of half the apnea while still using CPAP to treat any remaining apnea.
One sleep center found that 6 percent of people with obstructive breathing had a malformed lower jaw. Another 32 percent had a slightly shorter lower jaw. These people are the most likely candidates for mandibular enhancement surgery. Their apnea may be due to structural problems in their lower pharynx. This means that their jaw and tongue are positioned farther back than normal, and have a smaller lower airway opening. This complicated surgery for sleep apnea must be done as a team effort. The team should include the ENT specialist, the sleep specialist, and the maxillofacial doctor who will perform the actual mandibular operation. If teeth need to be repositioned, an orthodontist is needed. If the surgeon is experienced, the surgery is relatively safe. However, it is performed under general anesthesia which is particularly dangerous for those with breathing problems.
What are the disadvantages?
The lack of blood supply to the jawbone can cause problems in the healing process. The jaw can be closed for up to 6 weeks if the jaw is cut on both ends and moved forward (sliding Osteotomy). This causes significant discomfort for the patient. Orthodontics may be necessary to realign the bite and reposition teeth. This entire process is costly and takes a lot of time. This surgery has one major drawback. The jawbone can reposition itself to its original position after mandibular surgeries. This is due to the strong pull of the tongue muscles on the jawbone over many years. While some surgeons may disagree with this statement, other physicians are skeptical about the longevity of this type of surgery.
Tracheostomy was once a common treatment for sleep apnea. However, it is now much less common due to CPAP. It is now performed on two types: patients who are extremely sick due to sleep apnea, who require immediate (sometimes emergency), treatment to save their life, and those who have failed other treatments. The treatment of last resort is tracheostomy. If all else fails, it can be used to end sleep apnea. It is an optimistic form of surgery in that sense. Although it is very simple, there are some serious drawbacks. A tracheostomy is a small incision made into the trachea, or windpipe, at the front of your neck just below the voice box (larynx).
If a tracheostomy is the only permanent treatment for the patient’s sleep apnea, this opening can be made permanent. If the patient chooses to switch to CPAP or another therapy, the opening can be closed surgically. A tracheostomy allows air to flow through the opening to the upper airway. During the day, the tracheostomy is closed with a plug and the person can breathe normally through his nose or mouth. The tracheostomy opening is kept open at night and the person breathes through his neck. The tracheostomy is usually accessed through the tracheostomy. It is a small, curving tube with a flange on the top. It is inserted through a tracheotomy hole and extends several inches into the windpipe. The tracheostomy tube is usually worn continuously. The tube is held in place by the flange at its top. It also protects the throat opening.
Although tracheostomy surgery isn’t particularly dangerous, it is usually performed under general anesthesia. This can be potentially risky. There are two types of complications that can arise from tracheostomy. The first is the opening of the tracheostomy. Sometimes, the opening will attempt to close itself again. If the tissue surrounding the opening is not properly healed or becomes damaged, infected, or eroded, it can lead to other problems. To avoid these problems, there are many surgical options. A respiratory infection such as pneumonia is another problem with a tracheostomy. A tracheostomy allows a person to inhale air directly into their lungs. This bypasses all-natural germ-filtering systems found in the nose or upper airway.
Therefore, bacteria, viruses, or other foreign objects can easily get into the lungs. This must be prevented. After tracheostomy surgery, there may be some discomfort, swelling, and difficulty swallowing. The tube is worn until the incision heals. It is custom-made to fit each individual and is comfortable to wear. The patient must follow a strict, 24-hour program to care for the tracheostomy after a tracheotomy.
This includes cleaning, suctioning, and misting as well as applying salt solution or antibiotics. A suction machine should be used immediately after surgery to remove any mucous secretions from the tracheostomy tube. This will prevent obstruction of the airway and hinder breathing. Although mucus production is decreasing over time, a suction device will still be required indefinitely to clean the tube and prevent any further buildup. To avoid bacteria entering the tracheostomy, it is essential to maintain cleanliness. Both patients and their families should be taught these procedures by nurses and respiratory therapists.
A tracheostomy can help anyone.
A tracheostomy can help anyone suffering from obstructive or mixed sleep apnea. People who are selected for tracheostomy are often suffering from severe sleep apnea, which can lead to severe complications. You may have tried different treatments but failed. They could have severe sleep apnea-related heart problems or serious cardiac arrhythmias. They might have very low blood oxygen levels.
Tracheostomy reduces snoring and improves sleep quality. It is almost impossible to cure daytime drowsiness or apnea for anyone who has had the operation. It can reduce fatigue and prevent headaches in the morning.
What are the disadvantages of tracheostomy surgery?
The impact it has on a person’s day is one of the major drawbacks to tracheostomy.
Many people take several weeks or months to learn how to manage the frustrations associated with tracheostomy hygiene. They also need to adapt to the new appearance of their tracheostomy opening. This adjustment period is often accompanied by a bout of depression. Individuals are responsible for their own depression. They also need to be prepared for the procedure and have support from family members. Counseling should be given to the patient, their spouse, and any other family members about the procedure and the possible effects of temporary depression. People can adjust easier by talking with others who have had tracheostomies or are attending sleep apnea support group meetings.
Many people who have had tracheostomies report they are able to return to their normal lives after the adjustment period. They live a normal, active life and don’t seem to be bothered at all by their tracheostomies. They will need to be very careful around the tracheostomy entrance. They must also ensure that no air enters the windpipe through their tracheostomy. People with tracheostomies, for example, may not be able to swim. People with tracheostomies, which have an opening in their throat that leads directly to the lungs, are at great risk of drowning. They should avoid swimming and all water-related activities, such as water skiing, sailing, rafting, or fishing from a boat.
Another drawback is the cosmetics involved in covering the tracheostomy open. The opening is covered with a small shield or plate that is secured by a cord around its neck. Although it is not inherently objectionable, many choose to cover their tracheostomy plates with a turtleneck or scarf. The daytime sealing of the opening can also be a problem. If there is air leakage, it can make it difficult to talk. Sometimes, air leakage can be caused by coughing or sneezing. This can cause temporary embarrassment.
Poor healing and erosion can also cause problems. It is important to choose the best surgeon possible (a plastic surgeon) and to carefully follow the post-operative instructions. Ask your doctor any questions and continue to ask for assistance in dealing with any follow-up issues. Bariatric (Weight Loss Surgery). Because it surgically forces a change in eating habits that the individual is unable to achieve by any other means, weight loss surgery is also known as “behavioral” surgery. A person’s eating habits should be changed to lessen the amount they eat at a time. This can be done surgically by making your stomach smaller.
SURGICAL RISKS. Over the past two decades, there have been many types of bariatric surgeries. Because bariatric surgery is performed on obese patients, it carries particular risks. Obese people are at risk of dying from the procedure two to three times more than those of normal weight. It is therefore important to consider the potential risks and the benefits that can be reasonably expected after surgery. Gastric bypass patients are often considered obese. In one group, 17 patients weighed twice the recommended body weight. These patients were not having “cosmetic surgery” in order to lose weight. They were people whose lives were at risk due to their excessive weight and other complications.
Patients who are selected for gastric bypass are usually screened to ensure that they only include those who have successfully lost weight using carefully monitored weight-loss programs. Often, the screening includes a psychological assessment of the patient. For bypass surgery to be successful, patients need to understand the risks and behavioral changes required. Over the past 40-years, many types of weight loss surgery have been created. Gastric bypass and laparoscopic adjusted gastric banding are the most popular surgical weight-loss methods.
This is the most commonly performed bariatric procedure. Gastric bypass reduces the size of the stomach by placing staples across it. This divides the stomach into two pouches, one larger and one smaller. The “new” stomach is the upper pouch. It takes food from the stomach and then empties into the branch of the intestines attached to it. Food intake will be limited to twice the volume of the new stomach after surgery. This is usually around 30 mL. This means that you can only eat about one-quarter cup of food at a given time.
Major surgery is gastric bypass. It affects major organs, including the stomach and intestines. There are also large arteries involved. You can either open the abdominal cavity or perform laparoscopy (operating through small holes). Both methods have similar risks. Anesthesia, other medications, and surgical errors all pose risks. The placement of several tubes during and after surgery will increase the degree of the incision. These include a nasogastric tube for fluid removal, intravenous hookups, and possibly an endotracheal tube to support a ventilator. There are many complications that can occur after bypass surgery.
These complications can include infection, bowel obstruction, the collapse of the lungs, blood clots, and other side effects following abdominal surgery. Excessive vomiting is the most common side effect of gastric bypass. A gastric bypass performed by open abdominal surgery usually requires a one-week stay in the hospital, significant postoperative pain, and discomfort, as well as a prolonged recovery period of 4 to 5 weeks.
What is the effectiveness of gastric bypass?
Average weight loss following gastric bypass is between 65 and 70 percent of excess weight (not total weight), which can be achieved in a period of 1 to 2 years. According to one study, most patients who had undergone surgery for sleep apnea experienced significant improvement within 6 months. Some patients experienced complete relief. Patients reported no sleepiness during the day or loud snoring. There were also changes in personality: greater responsiveness, less emotional problems, and more difficulty at work.
For complete results, a full year is required. Patients in the study group may expect additional weight loss or improvement in their apnea symptoms over the six months that follow. Some people who have had gastric bypass surgery may return to their presurgery weight in the long term. Gastric bypass surgery has a failure rate of between 30 and 50 percent. Laparoscopic Adjustable Gastric banding. Although “Lap-Band surgery” has been used in Europe and other countries, it was only approved by the Food and Drug Administration (USA) in 1991. As the name implies, this surgery is typically performed laparoscopically. If done by an experienced surgeon, it isn’t particularly risky. The procedure involves placing an inflatable band around your stomach’s upper portion. The stomach is confined to a small pouch and drainage opening by inflating the band. To adjust the inflation of your band, a tube is connected to the band via a port located outside of your abdominal wall. This must be done multiple times per year.
What is the effectiveness of lap-band surgery for treating apnea?
This surgery is not as effective as a gastric bypass in terms of weight loss. It only achieves about 50 percent weight loss. Only three of nine patients with sleep apnea who underwent lap-band surgery had their condition completely eliminated within 18 months. Six others did not experience any improvement. Lap-band surgery has potential risks, including those for other bariatric procedures, stomach damage, infection or malfunction, as well as problems with the access port.
Who can benefit from bariatric surgery
For severely obese patients suffering from apnea, bariatric surgery can be a permanent and effective solution. This is if they are motivated to change their eating habits and if their doctors consider them suitable candidates for this type of surgery. It is important to weigh the potential benefits against the risks.