Introduction to Bariatric Surgery
What Is Bariatric Surgery?
Bariatric surgery is a procedure targeted at helping a patient achieve weight loss. This option is usually recommended for patients who may be required to achieve substantial weight loss due to health reasons but have not been able to, despite making changes to their dietary and lifestyle habits such as exercising. Dr Ganesh: “Weight loss surgeries are performed when diet and exercise haven’t worked or when you suffer from serious health problems due to your excess weight.”
How Can I Qualify for Bariatric Surgery?
While bariatric surgery may seem like an excellent weight-loss surgery option, it is not for everyone who is severely overweight. Additionally, patients must also be willing to make permanent changes to lead a healthier lifestyle. In weight loss surgeries, patients may be required to stick to long-term follow-up plans that include monitoring their nutrition, lifestyle, and behaviour and the progress of their medical conditions to achieve sustainable results. For patients to qualify for bariatric surgery as a weight management option, they must:
- Have a body mass index (BMI) of 40 or higher (extreme obesity).
- Have severe weight-related health issues, such as type 2 diabetes, high blood pressure or severe sleep apnea.
In some cases, patients may qualify for certain types of weight-loss surgery even if their BMI ranges between 30 and 39 due to severe weight-related health problems. To determine if you qualify for such surgeries, you must seek professional advice from a doctor to better assess your condition.
What Are the Types of Bariatric Surgery?
There are several types of Bariatric Surgeries; they are:
- Gastric Balloon
- Gastric Banding
- Gastric Bypass
- Sleeve Gastrectomy
- Biliopancreatic Diversion (either with or without a duodenal switch)
While each type of bariatric surgery may have its pros and cons, it is recommended for you to speak to a doctor to discuss the most suitable treatment for your condition.
A gastric balloon, also known as stomach balloon, is an inflatable medical device temporarily placed into the stomach to reduce weight.
Inserting a gastric balloon is a short term, non-surgical weight loss alternative. Gastric balloon insertion is usually performed as a day surgery procedure and under sedation. During which, a balloon is placed inside the stomach via a gastroscope.
Once inserted, the procedure results in a sensation of fullness. This generally helps reduce portion size and helps aid in a gradual weight reduction. It is recommended that the balloon be removed after six months.
Gastric banding or a gastric bypass involves placing a band around the upper portion of the stomach. The band reduces your stomach’s size, which in turn restricts the amount of food you can eat.
Tightening of the band will be done progressively over many months. Gastric banding works well in motivated patients who can comply with dietary plans and regular exercise.
Although this procedure is reversible, the band is meant to be implanted permanently. Most patients who have the band removed, find that they regain their weight.
Roux-en-Y Gastric Bypass
This procedure is the most common gastric bypass method. The surgery is non-reversible and works by decreasing the amount of food that a patient can consume in each meal and reducing the absorption of nutrients.
During this procedure, a large portion of one’s stomach is removed from its connection to the small intestine, sealing it off from the rest of the stomach. The first section of the small intestine is also removed. The remaining “pouch” and small intestine are then sewn together.
Any food consumed then goes into this small stomach pouch and then directly into the small intestine. As food bypasses most of your stomach and enters through the middle part of the small intestine, the amount of food that a patient can consume is significantly reduced.
Simultaneously, nutrients that usually pass through the small intestine go through a smaller tract, resulting in decreased absorption of nutrients.
Sleeve gastrectomy involves removing about 80% of the stomach, leaving a pouch that looks like a sleeve. Since the stomach’s size has been reduced, the stomach cannot hold as much food. The production of ghrelin, the hormone that regulates hunger, is also lowered following the reduction in the stomach’s size, which may lessen your desire to eat.
Some advantages of a sleeve gastrectomy include significant weight loss and no removal or bypass of the intestines. A sleeve gastrectomy also requires a shorter hospital stay than most other procedures.
Biliopancreatic Diversion With Duodenal Switch
Biliopancreatic Diversion involves a two-part surgery to be performed. The first part of the procedure requires surgery similar to a sleeve gastrectomy. The second part of the surgery consists of connecting the end portion of the small intestine to the duodenum, the first part of the small intestine, bypassing most of the intestine.
This procedure limits the quantity of food consumed and reduces the absorption of nutrients. While it can be advantageous, the procedure carries more significant risk, including malnutrition and vitamin deficiencies.
When deciding on the type of weight-loss surgery most suitable for you, speaking to a doctor to understand your situation and the recommended course of surgery is advised. Your doctor will take several factors into account, and this includes:
- Body mass index (BMI)
- Eating habits
- Other health issues
- Surgical history
- Risks involved
What Is the Difference Between Gastric Sleeve vs Gastric Bypass?
Gastric sleeve surgery and gastric bypass surgery reduce the stomach’s size from its regular size to a small pouch. The reduction of the stomach’s size will cause the pouch to fill up quickly, in turn restricting the amount of food consumed before you feel full.
At the same time, ghrelin, the hormone in charge of inducing hunger is reduced as the stomach’s size is reduced. Both factors combine to cause an individual to lose weight. While both procedures aim to achieve the same effect, how the new stomach pouch is created differs.
In gastric sleeve surgery, the surgeon permanently removes about 80 percent of the stomach. The remainder is sewn into a small banana-shaped stomach pouch, and no additional changes are made.
In gastric bypass surgery or Roux-en-Y gastric bypass, a small stomach pouch is created by removing most of the stomach and the duodenum. This new stomach pouch is then reconnected to the remaining small intestine creating a bypass.
The small intestine portion removed with the stomach absorbs some nutrients and calories. Since this section is bypassed, calories’ absorption would be reduced, contributing to weight loss. Gastric band surgery, the third type of bariatric surgery may also be a viable option.
In a gastric band surgery, a reduced stomach pouch is created by placing an inflatable band around part of the stomach. The band acts as a regulator to the opening’s size between the pouch and the rest of the stomach. The size of this opening between the pouch and the rest of your stomach will affect the amount of weight you lose.
Its size can be adjusted by inflating or deflating the band through a port placed under your abdomen’s skin. One essential thing to note is that unlike gastric sleeve and gastric bypass, gastric band surgery is entirely reversible.
When Should Bariatric Surgery Be Considered?
Bariatric surgery may be considered an option to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems. This may include:
- Heart disease and stroke
- High blood pressure
- Nonalcoholic fatty liver disease (steatohepatitis) (NAFLD) (excess storage of fat in the liver)
- Sleep apnea (a sleep disorder which causes breathing to be disrupted repeatedly while asleep)
- Type 2 diabetes
Bariatric surgery is recommended after attempts to lose weight by improving diet, and regular exercising have failed to achieve results.
What Are the Risks of Bariatric Surgery?
Bariatric surgery is a relatively safe procedure. While it may be rare, there are still risks of possible complications after bariatric surgery, and this includes:
- Development of gallstones
- Vitamin and nutritional deficiencies
- Development of dumping syndrome (a condition which causes nausea, sweating, and severe diarrhoea from eating too quickly or eating sugary, fried, or fatty foods, or dairy)
- Saggy or loose skin from extreme weight loss
Other Potential Complications of Bariatric Surgery
Following the proper pre and post-surgery diets may help you avoid complications, such as dehydration, nausea, and constipation. However, two complications may require more attention. They are Obstruction and Dumping Syndrome.
Obstruction occurs when the connection between your stomach and intestines become narrowed. This can happen even if you are careful about what you eat. If you experience nausea, vomiting, or stomach pain for more than two days, this may be a sign of possible obstruction. If this occurs, you are advised to seek medical attention.
Dumping syndrome occurs when food or beverages enter your small intestines too quickly or in large amounts. It can also happen when you are eating and drinking simultaneously, increasing intake volume. It can happen at any stage of the post-op diet. Symptoms of the dumping syndrome include:
To avoid developing dumping syndrome, patients are advised to take at least half an hour to consume each meal. You are also advised to choose low-fat and low-sugar foods to reduce the stress on the stomach. Drinking of any fluid should only be done 30-45 minutes after each meal, and they should be sipped very slowly.
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