Bariatric Surgery

Overview

Bariatric surgery, also known as weight loss surgery, is a class of surgical procedures intended to assist individuals who are obese in losing weight. These techniques include of duodenal switch, gastric band, sleeve gastrectomy, and gastric bypass surgery. When treating class III obesity, these procedures have demonstrated effectiveness. Moreover, they support the regaining of normal metabolism, addressing factors like blood pressure, blood sugar, and cholesterol.

In cases when diet and exercise have proven ineffective in reducing weight and if obesity seems to present a worse risk to health than surgery, healthcare providers may suggest bariatric surgery.

In order to control how many calories a patient can ingest and absorb, bariatric surgery operations make modifications to the digestive tract, most commonly the stomach but occasionally also the small intestine. Additionally, they have the ability to lessen the signals of hunger that reach the brain through the digestive tract.

These operations may assist in the treatment and prevention of numerous obesity-related metabolic disorders, such as fatty liver disease and diabetes. Weight loss surgery is not a simple “quick fix.” Successful implementation of this approach needs both prior planning and sustained lifestyle adjustments thereafter.

Types

The following are the types of bariatric surgery.

• Gastric sleeve: The procedure is also known as sleeve gastrectomy. The majority of people can have this simple surgery done without significant risk of complications. A gastrectomy essentially removes roughly 80% of the stomach, leaving behind a tiny, tubular section that resembles a sleeve. There is less room in this smaller stomach for meals. Additionally, it results in a decrease in the hormone ghrelin, which controls hunger and may decrease the urge to eat.
• Gastric bypass: The word “Roux-en-Y,” which translates from French to mean “in the form of the letter Y,” is another name for the gastric bypass. The small intestine will take that shape after this surgery. Using surgical staples, healthcare providers first form a small pouch at the top of the stomach and divide it from the lower part. Afterwards, the small intestine is divided, and the newly created segment is brought up to join the stomach pouch. Only approximately an ounce of food may fit within the resulting pouch, which is roughly the size of a walnut. A person’s stomach can normally hold three pints of food.
  Food passes through this tiny stomach pouch and into the small intestine that is attached to it, bypassing the majority of the stomach and the first segment of the small intestine. Food enters the middle part of small intestine instead.
  This suregry is generally considered irreversible. It functions by reducing the quantity of food you are able to consume in a single meal and reducing the absorption of both fat and calories.
• Biliopancreatic Diversion with Duodenal Switch (BPD-DS): This procedure known as the duodenal switch, combines an intestinal bypass with a sleeve gastrectomy. (It is also known as the Gastric Reduction Duodenal Switch). It is a more extreme version of the Roux-en-Y gastric bypass. Seventy-five percent of the small intestine is bypassed during this operation. This considerably lowers the hormones that cause hunger to be produced in both the stomach and small intestine. Additionally, it greatly limits the capacity of your small intestine to absorb nutrients, which is the key factor that renders the duodenal switch surgery the most potent option for weight loss and for enhancing metabolic conditions such as diabetes.
• Stomach Intestinal Pylorus Sparing Surgery (SIPS): The goal of this more recent treatment is to lessen complications by modifying the original duodenal switch. Other names for it are SADI-s or Loop Duodenal Switch. This version seems to have the potential to someday replace the original duodenal switch, however preliminary results are still being researched. The procedure starts with a sleeve gastrectomy, just like the original, and splits the duodenum, the first segment of the small intestine that comes after the stomach. In this instance, the small intestine is reattached as a loop, necessitating only a single surgical connection (anastomosis) instead of two. This approach also implies that a smaller portion of the small intestine is bypassed, enabling a slightly greater absorption of nutrients.

Reasons for undergoing the procedure

Bariatric surgery stands out as the most successful long-term approach to treating class III obesity. For individuals grappling with class III obesity, sustaining weight loss through diet and exercise alone poses significant challenges. The body’s natural inclination is to revert to its previous, heavier weight once it deems it the new norm. Bariatric surgery addresses this issue by fundamentally changing how the body handles food, resulting in weight loss and long-term health enhancements. This change is accompanied by the adoption of healthier eating habits and lifestyle adjustments.

Obesity is linked to a multitude of chronic medical conditions, some of which could potentially be life-threatening. However, upon successful weight loss through surgery, these symptoms and risk factors often experience significant improvement. When an individual qualifies for bariatric surgery, they might already be grappling with one or more of the following conditions or be at risk of developing them:

• Cancer (breast, endometrial, or prostate)
• High cholesterol.
• High blood pressure.
• Type 2 diabetes or high blood sugar.
• Heart diseases
• Stroke
• Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH).
• Kidney disease.
• Obstructive sleep apnea.
• Osteoarthritis.

In general, bariatric surgery may be considered as an option if:

• Your body mass index (BMI) is 40 or higher, which is classified as extreme obesity.
• Your BMI falls between 35 to 39.9, classified as obesity, and you have a significant weight-related health issue such as type 2 diabetes, high blood pressure, or severe sleep apnea. In some cases, individuals with a BMI between 30 to 34 and serious weight-related health problems may also qualify for certain types of weight-loss surgery.

It’s important to note that bariatric surgery is not suitable for every individual with severe obesity. Meeting specific medical criteria is essential to qualify for this surgery. You will likely undergo a comprehensive screening process to determine your eligibility. Furthermore, you must be prepared to make permanent lifestyle changes to promote a healthier way of living.

Participation in long-term follow-up plans may be required, which may involve monitoring your nutrition, lifestyle, behavior,and managing any medical conditions.

Risk

Bariatric surgery has essential long- and short-term health hazards, much like any major procedure. The following risk includes:

• Bleeding.
• Blood clots.
• Infection.
• Difficulty in breathing.
• Gastrointestinal leakage.

The long-term risks and complications associated with weight-loss surgery differ based on the specific procedure. These potential issues encompass:

• Bowel obstruction.
• Dumping syndrome, a condition characterized by symptoms like diarrhea, flushing, lightheadedness, nausea, or vomiting.
• Development of gallstones.
• Hernias.
• Low blood sugar, referred to as hypoglycemia.
• Malnutrition.
• Ulcers.
• Vomiting.
• Acid reflux.
• The necessity for a subsequent surgery or procedure, known as a revision.
• Extremely rarely, the risk of death.

Procedure

The ideal kind of weight-loss surgery for a patient will depend on their specific needs. The body mass index, dietary habits, other health conditions, prior surgeries, and the risks associated with each procedure are just a few of the numerous variables the surgeon will consider.

Before the procedure

It is the healthcare provider’s responsibility to make sure the patient is both psychologically and physically well enough for the bariatric surgery before scheduling the surgery. They will meet with a group of experts who will assess their mental and physical health and provide them with advice regarding the advantages and disadvantages.

To ensure that the procedure is safe for them, the patient might need to pass certain medical screening exams. Before becoming eligible for surgery, they will have to stop using tobacco, narcotics, or excessive drinking. They can get assistance from the medical staff in this.

In order to get ready for the procedure, the surgeon could also advise them to adhere to a pre-bariatric surgery diet for a few weeks. This is done in order to decrease the amount of fat inside their abdomen, which will make the procedure safer and lower the possibility of complications. They will receive explicit instructions from the surgeon.

During the procedure

General anesthesia is used during bariatric surgery in a hospital. This indicates that the patient is not aware of what is happening during the procedure.

Details regarding your surgical procedure are determined by the patient’s special situation, the type of weight-loss surgery performed, and the hospital’s or physician’s practices. Traditionally, the procedure is done by an open surgery, in which a large abdominal incisions are used in some weight-loss operations.

The majority of bariatric surgery procedures are carried out laparoscopically today. A laparoscope is a tiny, tube-shaped device that has a camera fixed to it. Small incisions made in the abdomen are used to insert the laparoscope. The surgeon can see and work inside the abdomen without making usual large incisions thanks to the tiny camera on the tip of the laparoscope. Although laparoscopic surgery can shorten and speed up recovery, but it may not be the most suitable choice for every individual.

Surgery typically requires multiple hours. Following their procedure, patients are monitored by medical team in a recovery room. Several days in the hospital can be required, depending on the surgery type.

After the procedure

After undergoing weight-loss surgery, patients are typically instructed to abstain from eating for a period ranging from one to two days. This initial fasting period is essential for allowing the stomach and digestive system to heal effectively. Subsequently, they will transition through a carefully structured diet plan over the course of several weeks. Initially, this diet primarily consists of liquids, followed by a phase of pureed and very soft foods, and ultimately, the solid foods. Throughout this process, there may be various restrictions imposed on their food and beverage intake.

Furthermore, patients undergoing weight-loss surgery can expect to have several months of scheduled follow-up appointments with their healthcare provider. These appointments serve to monitor and assess their overall health progress post-surgery. Depending on individual needs, these check-ups may include blood work, laboratory tests, and various other medical examinations.

Outcome

The advantages of bariatric surgery include decreased hunger hormone levels and improved metabolism. Surgery is the exclusive treatment for obesity that adjusts your body’s metabolic programming post-obesity, preventing weight regain.

Surgery for weight loss not only reduces the discomfort and diseases associated with obesity, but it also lengthens and improves life. Extensive scientific research has conclusively shown that bariatric surgery reduces the risk of death from all causes by over 40%.

Gastric bypass and other bariatric procedures offer a viable path to achieving lasting weight loss. The extent of weight loss largely depends on both the specific surgery an individual chooses and the adjustments they make to their lifestyle. Within a span of two years following these procedures, it is possible for individuals to shed as much as half, or potentially even more, of their excess weight.

Apart from reducing weight, bariatric surgery has the potential to improve or address conditions frequently associated with obesity, such as:

• Cardiac diseases.
• High blood pressure or hypertension.
• High cholesterol levels.
• Diabetes mellitus type 2.
• Gastroesophageal reflux disease (GERD).
• Nonalcoholic fatty liver disease (NAFLD)or nonalcoholic steatohepatitis (NASH).
• Sleep apnea.
• Osteoarthritis.
• Skin disorders, such as psoriasis and acanthosis nigricans, which results in a dark discoloration in the creases and folds of the body.