Bariatric Surgery -

Home » Bariatric Surgery

Bariatric Surgery

February 11, 2021

Obesity is a lifestyle disorder, characterised by an excess amount of body fat. A person with a body mass index (BMI)- the index of weight-for-height >=30 is considered to be obese and a BMI >= 35 is severely obese. Obesity in most people, can be managed by dietary modifications and regular exercise. However, there are some obese people who fail to lose weight with these conservative measures; for them bariatric surgery can be a good option to lose weight and prevent obesity related health complications.

What is Bariatric Surgery?

All types of weight-loss surgeries are collectively known as bariatric surgery. These surgeries involve making certain changes in the anatomy of the digestive system, to help in weight loss. Bariatric surgeries are usually performed in case of severe obesity or obesity associated with serious health problems.

The surgeries can be based on either malabsorption or gastric restriction method or both. In the gastric restriction method, the amount of food that the stomach can hold is reduced, which aids in weight loss. In the malabsorption method, the digestive system is subjected to certain changes that lead to malabsorption of nutrients in the body, resulting in weight loss. Bariatric surgeries may also lead to hormonal changes in the body. Mostly, all weight loss surgeries are performed through minimally invasive approaches.

Types of Bariatric surgery

Gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with a duodenal switch are some common bariatric surgeries. Every type has its pros and cons.

Gastric bypass surgery:

Gastric bypass surgery is the most common type of weight-loss procedure performed. This surgery is also known as Roux-en-Y gastric bypass. In this method, the top of the stomach is divided to create a small, walnut-size (about 30 millimetres in volume) pouch in the stomach. The first portion of the small intestine is then divided, and the bottom end of the intestine is brought up and attached to the new stomach pouch. The swallowed food is passed from the pouch directly to the small intestine bypassing most of the stomach. The small size of the stomach pouch decreases the amount of food ingested and reduces the number of calories absorbed. However, it also reduces the amount of nutrition absorbed. The procedure also results in the alteration of gut hormones, which promotes a feeling of fullness and reduces the appetite. This procedure is not reversible.

Advantages:

Limits the amount of food consumed
Leads to increased energy spending
Long-term weight loss

Disadvantages

Risk of complications
Risk of long-term nutritional deficiency (especially vitamin B12, folate, calcium, and iron)
Long stay in the hospital after the surgery
Mandatory dietary modifications, vitamin supplements, and regular follow-ups

Sleeve gastrectomy:

This procedure is also known as vertical sleeve gastrectomy. It involves removing 80 percent of the stomach, leaving behind a tubular pouch of the stomach, which is like a banana in size and shape. The surgery is performed laparoscopically, in which multiple incisions are made on the upper abdomen. The newly created tubular pouch significantly reduces the capacity of the stomach to hold food, resulting in reduced calorie consumption. This surgery also affects the gut hormones, thereby impacting several factors like satiety, blood sugar control, and appetite.

Advantages:

Reduction in the capacity of the stomach to hold food
Rapid weight loss
Relatively shorter stay at the hospital
Favourable changes in the gut hormone

Disadvantages

Non-reversible procedure
Long-term vitamin and other nutrient deficiencies
High risk of early complications

Adjustable gastric band:

In this method, a small stomach pouch is created by placing an inflated band around the upper portion of the stomach. This causes a feeling of fullness even after eating a small amount of food, thereby aiding in weight loss. Thus, the amount of food taken per meal is restricted and the feeling of hunger is reduced, leading to weight loss.

The size of the opening between the pouch and the remaining stomach can be adjusted by filling the band with saline. The saline is injected from a port, which is placed under the skin.

Advantages:

Food holding capacity of the stomach is reduced
40-50% of weight loss
No cutting or rerouting the intestine
Short hospital stay
Reversible procedure
Band adjustable as per the need
Fewer complications
Minimal risk of mineral/vitamin deficiency

Disadvantages

Slow weight loss as compared to other surgical procedures
Risk of complications due to insertion of a foreign device in the body
Risk of band erosion or band slippage in the stomach
Strict dietary modifications after the procedure
Mandatory follow-ups

Biliopancreatic diversion with duodenal switch:

This method is a two-part surgery. In the first part, a portion of the stomach is removed leaving a small tube-like pouch. In the second part, the end portion of the small intestine is connected to the duodenum (the first part of the small intestine) near the stomach, bypassing the large part of the small intestine (around 3/4th). The procedure limits the amount of food intake, decreases the absorption of the nutrients, and alters the level of gut hormones.

Advantages

Aids in good weight loss (60-70%)
Gives freedom to eat a normal diet
Reduces the absorption of fat
Leads to good changes in gut hormones
Is effective against diabetes

Disadvantages

High complications rates
High mortality rate
Need longer stay in hospital
Risk of nutrient deficiencies
Need for regular follow-ups

Is Bariatric Surgery Safe?

Like all other surgical procedures, bariatric surgeries also have some associated risks. Therefore, before undergoing any procedure, it is important to weigh the benefits against the risks to have a clear picture.

As compared to the risk of living with obesity and its associated complications, the risk of bariatric surgery is very less. Bariatric surgery is a safer surgical procedure than other elective surgeries. Bariatric surgeries performed using the laparoscopic procedure have a lower risk of complications than conventional open surgeries. However, it is important to understand the risk associated with the procedure.

Is Bariatric Surgery Right for Me?

Bariatric surgery may not be the right choice for all obese individuals. These surgeries are recommended for people who have serious health issues due to excessive weight. Everyone undergoing the procedure should be mentally prepared for the possible complications and to modify their lifestyle accordingly.

Bariatric surgeries are preferred in an individual whose BMI is 40 or more. People with a BMI of 35 to 39 with associated health issues like high blood pressure, severe sleep apnea, or type 2 diabetes can also go for bariatric surgery. It may also be performed in people with BMI 30 to 35 with severe health issues.

What Can I Expect After Bariatric Surgery?

The outcomes of any weight loss surgery depend upon the individual and the types of procedure performed. The amount of weight loss in different types of surgeries ranges from 40 % – 70 %.

The success of all types of bariatric surgery depends on how well a patient has adopted the lifestyle and behavioural changes after the surgery. It is important to follow the prescribed diet plan to achieve the desired weight loss.

The patient is provided detailed instructions on diet plan to follow, after the procedure:

In stage 1 : the person must take only a few ounces of clear fluids for initial days after the surgery. Slowly different types of liquids may be added to the diet like skimmed milk, unsweetened juices, thin soup, sugar-free gelatine, and others.
In stage 2 : food in the pureed form will be given. It is recommended to avoid spices in any form to prevent irritation of the stomach. Fibrous vegetables must be avoided and seedless fruits like banana, peaches, and pineapples must be preferred. Vegetables like spinach, green beans, carrots, and spinach in the pureed form can be given.
In stage 3 : easily chewable and soft foods are taken. These foods may include yogurt, whitefish, cottage cheese, beef, canned fruits, ground meat, soft-boiled eggs, and scrambled eggs.
In stage 4 : approximately 2 months after the surgery, solid foods are added to the diet. However, the food should be crushed into small pieces and chewed properly. The food should be introduced slowly to check if the stomach can tolerate it well. It is important to change the diet slowly to avoid any discomfort and complications. Foods like bread products, crunchy food, fried food, popcorn, or tough meat should be avoided.

Along with dietary measures, some other guidelines that must be followed include:

Drink and eat slowly.
Control the portion of the food.
Look for signs of discomfort.
Avoid food rich in saturated fats.
Avoid sweetened beverages during mealtime.
Chew the food properly.

Exercise regimen after the surgery

Start doing exercises only after the body heals completely. In the initial months, perform low impact exercises such as walking, stretching, deep breathing exercises, swimming, or simple yoga.

Some other lifestyle modifications that should be followed are:

Make walking as a habit.
Perform stretching exercises at work.
Avoid sitting for long hours.
Avoid using lifts, instead take stairs.

Outlook

Bariatric surgery is a blessing for people living with excessive weight. It is a hope for individuals who have tried losing weight using all other methods and failed. After undergoing the surgery, it is important to follow the dietary and lifestyle modifications so that the desired and long-term results from the surgery can be obtained.