Bariatric (Weight-Loss) Surgery

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Bariatric Surgery

For some people, rigorous exercise and a healthy diet are not enough to lose the necessary weight required to be considered healthy and at an acceptable BMI (Body Mass Index).

People with a BMI of greater than 40 (extremely obese) or a BMI of 35-40 (obese) presenting with others symptoms such as heart disease, diabetes, high cholesterol or obstructive sleep apnea are the typical candidates for the various types of Bariatric Surgery.  In some special cases people with a BMI of 30-34  may qualify for surgery if they present with some serious weight-related health problems, as determined by a physician.  Additionally, a potential bariatric patient must meet other important medical and psychological guidelines to qualify.  Bariatric Surgery is a life-changing procedure that not only results in weight loss and a change in looks, it also affects how a patient lives, eats and socializes the rest of their lives.

The Basics of Bariatric (Weight-Loss) Surgery

In brief, most Bariatric procedures result in weight loss through 3 basic procedures:

  • Restrictive Weight Loss Surgery: The amount of food the stomach can hold at any given time is restricted or reduced.
  • Malabsorptive Weight Loss Surgery: The digestive system is prevented from absorbing all the nutrition in the food that is eaten.
  • A combination of the two above

Restrictive Weight Loss Surgery consists principally of the procedures:

Gastric Banding:

LAP BAND SURGERY. Adjustable gastric banding with a Lap Band is a type of weight loss surgery that is typically recommended for obese patients with a body mass index of 35 or greater.  This procedure employs an inflatable silicone band that is implanted around the top portion of a patient’s stomach via laparoscopic surgery.

Vertical Sleeve Gastrectomy:

GASTRIC SLEEVE SURGERY. In this weight-loss surgical procedure the size of the patient’s stomach is reduced to about 35% of its usual size and “stapled”, thus causing the stomach to take the shape of a sleeve or tube. This procedure is performed via laparoscopic surgery as well.

Gastric Plication Surgery:

One of the newest options being offered in weight loss surgery is Gastric Plication Surgery. It is a size restriction technique that has the advantage of restricting food intake without the use of any foreign implants and without removal of any stomach tissues. This is accomplished by creating folds in the stomach and stitching them thus reducing the overall size of the stomach.

All these procedures restrict (lessen) the space available in the patient’s stomach (either by compressing the stomach with a band or by limiting access to or removing part of the stomach) resulting in a small pouch that then serves as the new stomach.

Malabsorptive Weight Loss Surgery:

Consists of procedures that cause food to bypass (skip) parts of the digestive system, limiting what can be absorbed by the patient and causing other nutrients to pass through undigested.  Some examples of this general concept are:

Gastric Bypass:

The gastric bypass is the most commonly performed operation for weight loss. One of biggest advancements in gastric bypass surgeries has been the use of the laparoscope which has reduced the surgical opening to only several tiny incisions. This minimally invasive technique has greatly reduced the risks of infection, wound healing time and the occurrence of post-surgical hernias as compared with the traditional open incision.

Billiopancreatic Bypass:

(with and without a duodenal switch) Biliopancreatic Diversion with a Duodenal Switch.

How Does Bariatric Surgery cause weight loss?

In brief, bariatric surgery results in weight loss because you are forced to eat less.  With the size of the stomach being reduced to a small pouch, it is nearly impossible to overeat.  In addition, what little food is eaten causes one to have a feeling of fullness for much longer,  thus eating less frequently.  Procedures that include malabsorption, discourage the eating of greasy and sugary foods because the new inability to digest these items often results in severe diarrhea, gut pain or nausea.  Hence, post-surgical bariatric patients must learn to change their diets to avoid these symptoms and this change by definition rules out many foods that are high in calories.

Laparoscopic Surgery is a modern minimally invasive surgical technique where abdominal operations are done through small incisions (usually less than 2cm) as compared to the traditional larger incisions of open surgery.  By using a laparoscope, a thin, flexible tube-like surgical tool often with a miniature video camera, a surgeon can view and work on the
internal organs that are the target of the procedure.  There are many advantages to laparoscopic surgery versus an open surgery and chief among them are:

– Smaller incision (minimally invasive) which reduces recovery time and causes less scarring.
– Reduces recovery time shortens hospital stays and leads to a faster return to everyday life.
– Reduces bleeding, lowering the need for blood transfusions.
– Usually is less painful, therefore requiring less pain medications.
– Reduces risk of infections.

While there are some disadvantages and risks as with all surgeries, the overall effect of using the laparoscopic surgical technique has been a great advance in medical surgery and has come to be the standard technique for most bariatric procedures.

Restrictive Weight Loss Procedures

Laparoscopic Adjustable Gastric Band (LAGB)

LAGB, which is commonly referred to as ‘Lap Band, is a surgical procedure where an inflatable silicone device (the band) is placed around the upper portion of the stomach creating a smaller stomach pouch.  This limits the amount of food that can be consumed at one time and causes a sense of satiation to be reached much sooner.  This is the least invasive of the bariatric surgeries (because no part of the stomach is stapled or removed nor are any of the intestines rerouted) and it is totally reversible.

Vertical Sleeve Gastrectomy

This laparoscopically performed procedure, also called Sleeve Gastrectomy or Gastric Sleeve, reduces the stomach to about 25% of its original size by surgically removing a large portion of the stomach.  The stomach is cut following its major curve with the open edges then joined (often with surgical staples) forming a sleeve (hence the name) or banana-shaped tube.  This procedure is not reversible.  Weight-loss from this procedure is generally quicker than with ‘the band’ and outcomes are similar to gastric bypass.

Gastric Plication Surgery

This laparoscopically performed procedure is very similar to the Sleeve Gastrectomy procedure with the difference that the sleeve is created by folding in then suturing part of the stomach rather than removing tissue.  This method preserves the natural nutrient absorption of the stomach even though its volume has been significantly reduced.  As with the Gastric Sleeve procedure, smaller amounts of food result in quicker hunger satiation. This is a newer procedure that is having very positive outcomes.  Though it is theoretically reversible (by removing the sutures and un-folding), this procedure is not intended to be reversed like ‘the band’ can be.

Malabsorptive Weight Loss Procedures

Gastric Bypass

This group of procedures includes the Roux-En-Y Gastric Bypass and the Mini-Gastric Bypass (MGB).  This procedure is  more drastic and is prescribed to treat morbid obesity, defined by a BMI greater than 40 and typically with comorbid conditions such as type II diabetes, sleep apnea and hypertension.  In general, these surgeries divide the stomach into a small upper pouch and a larger ‘remnant’ pouch and then connects both pouches to a rearranged small intestine.  The various Gastric Bypass procedures have different names given the various forms of rearranging these new connections.  Weight-loss is achieved both by the smaller resulting stomach and the changes in food absorption due to the changes in the small intestines from the new connections.   This procedure is much more invasive than the restrictive bariatric procedures and comes with more potential complications.  Additionally, since there are changes with the small intestine, food absorption is dramatically altered and thus much closer attention needs to be paid to life-long eating habits and supplements to assure proper nutrition.

Billiopancreatic Bypass (with and without a duodenal switch)

This procedure is similar in nature to the Roux-En-Y Bypass surgery in that the digestive tract is rearranged but it has less of the restrictive portion by only reducing less the stomach. The primary weight-loss is accomplished be reducing the amount of small intestine that is available for food absorption especially for absorbing fat.  Type II diabetics have seen a 98% ‘cure’ almost immediately after this procedure due to the metabolic changes that result from the intestinal switch.  A disadvantage with this procedure is that due to the malabsorptive element,  it requires vitamin and mineral supplements well above what is required for a normal population.

As with all medical procedures, they should be thoroughly discussed with your doctor to decide which, if any, of these procedures is right for you.

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