- Institute Of Gastroentrology & Hepatology
- Bariatric Surgery
What is bariatric surgery ?
Bariatric surgery is a surgical procedure to aid weight loss for grossly obese patients. It is being widely preferred, considering the life style changes in today’s mechanical world. There are three to four methods adopted in bariatric surgery methodology, depending on the prognosis of the patient. Many obese patients have seen good results, after the surgery and are happy.
How does this surgery help for obesity ?
Bariatric surgery procedure causes weight loss by restricting or reducing the amount of food the stomach can absorb and hold, by a combination of both gastric restriction and reducing of food intake. Bariatric procedures may also often cause hormonal changes. Most weight loss surgeries now are performed using minimally invasive techniques (laparoscopy based surgery).
When added with a comprehensive treatment plan, bariatric surgery may often act as effective tool to provide one with long term weight loss and help increase the quality of life.
Bariatric surgery has proven effective in treating obesity related disorders such as type 2 diabetes, sleep apnoea, heart problems. The lesser your weight lesser your medication. Weight loss is the mantra for good health.
Who can go in for bariatric surgery ?
Men or women aged above 18 years with a BMI (Body mass index) more than or equal to 40 or more than 100 pounds of weight. Inability to achieve weight loss after sustained efforts, in natural ways such as diet restrictions and exercise. People suffering from morbidity, severe arthritis due obesity may consider going in bariatric surgery.
Why the need for bariatric surgery ?
Severe obesity is the most dangerous stages of obesity. It may suddenly give rise to heart, brain, and gastro related disorders which may be life threatening, by going in for a bariatric surgery these complications can be reduced.
Types of bariatric surgeries :
- Gastric bypass
- Sleeve gastrectomy
- Adjustable gastric band
- Biliopancreatic diversion with duodenal switch (BPD/DS)
Each surgery has its own pros and cons and has to be chosen as per the individual’s case and need.
Gastric bypass surgery :
Gastric bypass often termed as ‘gold standard’. It is a successful and widely performed surgery.
What is the procedure ?
There are dual components to the procedure. Firstly, a small stomach pouch, approximately one ounce or 30 millilitres 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 into two portions, and the bottom end of the sliced 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 to aid the digestion process as in the natural way.
The gastric bypass works in adopting several mechanisms. The newly created stomach pouch is considerably smaller in size and proportion and accommodates significantly smaller meals, which translates into fewer calories consumed. Additionally, there is less digestion of food by the smaller stomach pouch and there is a section of small intestine that would normally absorb calories and nutrients that no longer has going through it, there is probably to some extent less absorption of calories.
Importantly the recounting of the food stream produces changes in gut based hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
- Significant solution of long term weight loss.
- Restricts the amount of food that can be consumed.
- Increased Expenditure of Energy
- Produces favourable changes in gut hormones that reduce appetite and enhance satiety and feeling of fullness.
- It is technically more complex procedure and only well experienced doctors must perform the same.
- Can lead to long term vitamin mineral deficiencies particularly in vitamin B12, iron, calcium and folate, which may lead to anaemia.
- The patient has to be in the hospital for a long term
Sleeve gastrectomy :
The laparoscopic sleeve gastrectomy often called the sleeve procedure is performed by removing more than 80 percent of the stomach. The remaining portion of the stomach resembles a banana.
The procedure works under several techniques. First the new stomach pouch holds a considerably smaller volume than the normal stomach significantly reduces the amount of food that can be consumed. The greater impact is on the gut hormones. The gut hormones increase the feeling of not feeling hungry.
There is also evidence that suggests the sleeve similar to the gastric bypass is effective in improving type 2 diabetes.
- The amount of food the stomach can hold is decreased, hence the person eats less
- Induces rapid and significant weight loss
- Requires no foreign objects and no bypass or re-routing of the food stream
- Involves a relatively short hospital stay approximately 2 days
- Causes favourable changes in gut hormones that suppress hunger, reduces appetite and improves satiety feeling.
- It is a non-reversible procedure
- Has the potential for long-term vitamin deficiencies or fewer levels.
- Has a higher early complication rate than the adjustable gastric band
Adjustable gastric band :
It is often called the band procedure. It involves placement of an inflatable band that is placed around the upper portion of the stomach, creating a little pouch above the band, and the remaining portion of the stomach below the band.
The common way of how this device functions is that with a smaller sized stomach pouch, eating just a small proportion promotes the feeling of fullness. The feeling of complete 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 opening area of the stomach can be adjusted by filling the band with sterile saline, which is injected from port placed under the skin tissues.
Reducing the size of the opening is done gradually over time with repeated adjustments or fills. Only small amount of food can be consumed in proportions. By reducing the food intake number of calories consumed is also reduced.
- Reduces the amount of food the stomach can hold.
- Induces excess weight loss of approximately more than 40-50 percent.
- Involves no cutting of the stomach or rerouting of the intestines.
- Shorter period of stay in the hospital usually below 24 hrs. .
- Is reversible and adjustable.
- Has lowest rate of post-operative complications or mortality among the approved bariatric procedures.
- Has the lowest risk for vitamin mineral deficiencies.
- Slow and less early weight loss than other surgical procedures
- Greater number of patients failing to lose 50 percent of excess body weight compared to other surgeries commonly performed
- A foreign device to remain in the body as long as the patient lives.
- Can result in possible band slipper or band erosion in the stomach in a small section of patients.
- Can result in dilation of the oesophagus if the patient consumes more food
- Surgery has to be repeated in many cases.
Biliopancreatic diversion with duodenal switch (BPD/DS) gastric bypass :
Biliopancreatic diversion with a duodenal switch often abbreviated as BPD/DS is a procedure with two components. First a small tubular stomach pouch is created by pulling out a portion of the stomach quite similar to the sleeve gastrectomy, and then a large portion of the small intestine is bypassed.
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 out and connected to the fresh outlet of the newly created stomach so that when the patient eats, the food goes through a newly created tubular stomach pouch and reaches directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is by-passed by the food passing through.
- Allows patients to eventually eat near normal meals
- Reduces the absorption of fat 70 percent or more
- Causes favourable changes in gut hormones thereby reducing appetite
- The most effective procedure against diabetes than any other procedures.
Has higher complication rates and greater risk of mortality in patients. Requires a longer hospital stay Has a great risk to cause protein deficiencies and long term deficiencies in a number of vitamins and minerals, i.e. iron, calcium, zinc, fat soluble vitamins such as vitamin D Being regular in regard to follow-up visits and strict adherence to dietary and vitamin supplementation are very important to avoid serious complications from protein and certain vitamin deficiencies.
Life after bariatric surgery :
Bariatric surgery or procedure is a major and important event in a patient’s weight loss journey; the event is best seen as a new chapter. Obesity is a permanent disease and there is no operation, diet or medication that can by itself offer a permanent cure. The patient has to follow a certain diet pattern and moderate amount of exercise to maintain the weight loss.
The diet must be nutrition based packed with vitamins and minerals. Immediately after the surgery soft diet will be prescribed mostly consisting of fluids, thereafter low calorie diet consisting of fruits and vegetables is recommended.
Many people with morbid obesity have severe health issues such as diabetes, high blood pressure, High cholesterol and coronary heart disease or related afflictions or gastro related problems. Patients who have undergone bariatric surgery and successfully lose weight see such health conditions reverse and can do away with the medication.
Physical activity or exercise regimen is quite important for long term weight management any day. Different patients may have different needs and abilities and must exercise to maintain the weight loss. As you progress in your fitness regimen the body becomes more efficient, strong and immunity levels improve to a great extent.
KIMS VS other hospitals for Bariatric surgeries :
There are many super speciality hospitals offering bariatric surgeries. A question may prop up in your mind why KIMS ?
- Trained professionals with good success rate
- State of the art equipment
- Peerless service
- Round the clock services
- Patient base with positive outcomes