Bariatric Surgery

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Bariatric Surgery
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Overview

Bariatric surgery is the procedure that causes weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both the methods. Typically performed in morbid obese patients, bariatric procedures often cause hormonal changes. Most bariatric surgeries today are performed using minimally invasive approach, also known as laparoscopic bariatric surgery.

The most common bariatric surgery procedures are laparoscopic adjustable gastric band, gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch.

Gastric Bypass:

In gastric bypass procedure, first a small stomach pouch 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, and the lower end of the divided small intestine is pulled up and joined to the newly created small stomach pouch. In the end, top portion of the divided small intestine is connected to the small intestine further down.

The procedure produces significant long-term weight loss, restricts the amount of food that can be consumed, produces changes in gut hormone that enhance satiety and reduce hunger. It can lead to long term vitamin and mineral deficiencies, particularly iron, calcium, folate and vitamin B12. Also being a complex procedure, the complication rate is high.

Sleeve gastrectomy

Sleeve gastrectomy removes approximately 80 percent of the stomach and the remaining stomach resembles a tubular pouch. The new stomach pouch is much small in size, holds a considerably smaller volume, significantly reduces the amount of food that can be consumed. Gut hormones get affected impacting hunger, satiety, and blood sugar control.

Medical studies indicate that the sleeve gastrectomy is as effective as the roux-en-Y gastric bypass in terms of achieved weight loss and improvement of blood sugar control. It induces significant and rapid weight loss, requires no re-routing of the food passage, and involves a relatively short hospital stay. It is a non-reversible procedure with the potential for long-term vitamin and mineral deficiencies.

Adjustable Gastric Band

In this surgical procedure, an adjustable, inflatable gastric band is placed around the upper portion of the stomach, thus creating a small pouch of the stomach above the band, and the rest of the stomach lies below the band. Due to placement of the band smaller stomach pouch is created. It leads to hunger satisfaction by eating just a small amount of food. The satiety or feeling of fullness depends upon the size of the opening, created by the gastric band, between the gastric pouch and the remainder of the stomach. The size of this opening can be adjusted by filling the band with sterile saline, through a port placed under the skin, which causes tightening of the band.

This procedure reduces the amount of food the stomach can hold, leads to excess weight loss (40-50%), involves no cutting or rerouting of the gastric organs, requires a shorter hospital stay, is reversible, and adjustable. The procedure has the lowest chances of early postoperative complications and mortality among the bariatric procedures. Patient stands at lowest risk for developing vitamin or mineral deficiencies.

It involves slower and less early weight loss than other bariatric procedures. Complications include band slippage, band erosion, and dilatation of esophagus. Adjustable gastric banding requires strict adherence to the postoperative diet plan and to postoperative follow-up visits. Highest rate of re-operation is associated with this bariatric procedure.

Biliopancreatic Diversion with Duodenal Switch Gastric Bypass

This bariatric procedure involves two components. In the first part, a smaller, tubular stomach pouch is created by removing a portion of the stomach. In the next part, a large portion of the small intestine is bypassed.

This procedure results in greater weight loss than all the other bariatric procedures (60-70% percent excess weight loss or greater), at 5 year follow up. It allows patients to eventually eat meals that are nearly normal and cuts down the absorption of fat by 70% or more. It induces beneficial changes in gut hormones to reduce appetite and improve satiety. It is also associated with the highest complication rates and risk for mortality than other bariatric procedures. The surgery requires a longer hospital stay. There are increased chances of development of long term protein, vitamin and mineral deficiencies.