Bariatric Surgery- An overview

 

What is Bariatric Surgery?

If you’ve tried every diet and exercised yourself into submission — but you’re still not losing any weight. bariatric surgery just maybe what the doctor recommend.

Bariatric/weight loss surgery is an effective treatment option for patients suffering with morbid obesity. It also causes significant improvement in the obesity-related co-morbid conditions like Type 2 diabetes, high blood pressure, and joint pains, sleeping disorders like sleep apnea, heart diseases, infertility issues and several others.

 

Who is eligible for the surgery and how to go forward

You are eligible for bariatric surgery if:

• Your BMI is 40 or higher.


•  BMI is between 35 and 40, and you have diabetes, high blood pressure, high cholesterol, fatty liver disease or sleep apnea.


• You did not benefit from the weight loss management techniques


• You are uncomfortable in performing routine activities due to excess weight

But finding the right procedure requires a discussion between you and your bariatric surgeon. “We consider the patient’s history, conditions and expectations. Today, doctors perform almost all bariatric surgical procedures using minimally invasive techniques. That means smaller incisions (usually five or six in the abdomen) and faster recoveries. Most patients go home the day after surgery and recover in two to three weeks.

 

 

Types of Bariatric surgery

The most common bariatric surgery procedures are:

 

                               Gastric bypass                                                      

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.

                                               

Sleeve gastrectomy 

                                                                                                    

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

 

Biliopancreatic diversion with duodenal switch

The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food.

 

Adjustable Gastric Band

 

The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.

Reducing the size of the opening is done gradually over time with repeated adjustments or “fills.” The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged by studies that show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. What is known is that there is no malabsorption; the food is digested and absorbed as it would be normally.

The clinical impact of the band seems to be that it reduces hunger, which helps the patients to decrease the amount of calories that are consumed.

 

 

Risks

Short term risks associated with the surgery includes:

• Excessive bleeding/ Infection/ Blood clots


• Adverse reactions to anesthesia


• Lung or breathing problems


• Leaks in your gastrointestinal system

Longer term risks include:

• Bowel obstruction


• Gallstones


• Hernias


• Low blood sugar (hypoglycemia)


• Malnutrition


• Ulcers


• Vomiting


• Acid reflux


• Death (rare)

 

 

Does bariatric surgery always work?

Studies show that many people who have bariatric surgery lose about 15 to 30 percent of their starting weight on average, depending on the type of surgery they have. However, no method, including surgery, is sure to produce and maintain weight loss. Some people who have bariatric surgery may not lose as much as they hoped. Over time, some people regain a portion of the weight they lost. The amount of weight people regain may vary. Factors that affect weight regain may include a person’s level of obesity and the type of surgery he or she had.

Bariatric surgery does not replace healthy habits, but may make it easier for you to consume fewer calories and be more physically active. Choosing healthy foods and beverages before and after the surgery may help you lose more weight and keep it off long term. Regular physical activity after surgery also helps keep the weight off. To improve your health, you must commit to a lifetime of healthy lifestyle habits and following the advice of your health care providers.