Bariatric surgery is a group of procedures performed on people who are morbidly obese and who are unresponsive to conventional methodologies for weight reduction.
Bariatric procedures target the gastric system of the individual wherein the size of the stomach is reduced by removing a portion and creating a stomach pouch ( gastric bypass). Sometimes a medical device is implanted. This surgery is extremely complicated and should be performed on people who have a Body Mass Index of more than 40 and have shown to be high on risk factors like diabetes, hypertension and cardiovascular diseases.
The treatment modality is typically chosen for patients who do not respond to diet restrictions and exercise and have a host of lifestyle diseases. Since the procedure is very complicated and expensive, a reknowned bariatric surgeon with considerable experience in bariatric procedures should be chosen. The patient’s history, mental make-up and prognosis after the procedure is also assessed.
Types Of Bariatric Procedures
There are basically three categories which cover bariatric procedures. They are as follows –
Biliopancreatic Diversion –
The methodology of the procedure has been slightly revised as it used to create severe mal-nourishment in patients due to a reduced ability to absorb nutrients. The new procedure entails on creating something called as a duodenal switch. Part of the stomach is removed and the size is reduced. The removed part is used to create a smaller pouch. The stomach is then resected.
The small intestine is connected to the stomach pouch, bypassing the duodenum. The patient is free to eat how much ever he wants. Despite the novelty of the procedure, some patients suffer from severe mal absorption. The procedure then may have to be reversed. Nevertheless, patients have to take dietary supplements along with their meals. Gall stones are also very common with the weight loss. This is not an oft chosen procedure.
Endoluminal Sleeve Surgery –
In this procedure a sleeve is created in the small intestine so that lesser food gets absorbed. The efficacy of this procedure on humans is still to be researched. Although carried out successfully in animals, in humans there have been several cases of the sleeve getting detached or removed.
In these a restriction of food intake is created by reducing the size or the volume of the stomach. These are of the following types –
Vertical Banded Gastroplasty –
The stomach is stapled and secured to create a new stomach which is smaller in size.
Adjustable Gastric Band –
In this procedure a silicone band is put on the stomach to reduce its size. The band can also be adjusted. This too significantly reduces food intake and thus leads to weight loss. It is one of the most commonly done procedures with little or no side effects.
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This is by far the most powerful and sought after procedure. Here a large portion of the stomach is operated upon and removed. The open area of the stomach is stitched up leading to a considerable reduction in the size of the stomach. The stomach begins to resemble a banana. The procedure once done is irreversible. The post operative prognosis is generally good with a large number of patients losing almost 60% of their original weight over the next few months.
The surgery is minimally invasive and is done laparoscopically. If the weight loss is not very significant, the procedure may be repeated after a few months. It is a safe procedure with no chance of nutrient mal-absorption occurring as there are no bypasses created. There is no blockage anywhere so maximum absorption of consumed food takes place. Patients have also shown a decreased likelihood of ulcers and other gastric disturbances. There are no dietary restrictions as all kinds of foods are consumed. Only the quantity reduces as the stomach volume has now gone down.
Intra Gastric Balloon –
In this a deflated balloon is placed in the stomachs of patients and then inflated to reduce the stomach space. This is a temporary procedure to reduce stomach size and can be opted by patients who are not morbidly obese. It is also a less costly procedure. The balloon however has to be removed after 6 months and the patient may have to resort to other procedures.
Gastric Plication –
This is a slight variation to the gastric sleeve surgery. Here the sleeve is created by suturing up a part of the stomach to give a tube like shape to the stomach. This gives the same effects as that of a sleeve gastrectomy and also preserves the normal functioning of the stomach. Patients who have undergone this procedure have not reported any major or severe complications.
In These A Combination Of The Restrictive And Malabsorbtive Procedures Are Applied. They Are As Follows –
Gastric Bypass Surgery –
In this a small stomach pouch is created with the help of staples or clips and a bypass is given to the small intestine. The upper part of the small intestine is re-attached as a Y shaped figure. It is one of the most popular procedures carried out internationally. Very strict standards of post operative care have to be however maintained and the patient has to adopt a strict lifestyle with moderate eating and exercise.
Sleeve Gastrectomy With A Duodenal Switch –
A part of the stomach is resected with a volume of about 150 ml. This reduces the size of the stomach. The stomach is disconnected from the duodenum and reattached to the smaller intestine. The duodenum is attached to the bigger part of the small intestine separately.
Post Operative Care
Any kind of bariatric surgery is immediately followed by a fluid diet which comprises of clear soups and fruit juices. Once internal healing takes place, pureed foods like porridge, vegetable broth etc can be introduced. There after the patient can start on semi solids. However quantities are severely curbed as the stomach takes time to get used to its new size and overeating may cause the patient to vomit. A low fat diet and mineral and vitamin supplements are recommended for life.
Prognosis And Side Effects Of Bariatric Surgery
Significant amount of weight loss occurs over a 3 -4 year period ranging from a scale of 70 to 110 Pounds. Complications have been observed in some patients ranging from ulcers, gall bladder stones, bloating, vomitting and even cases of hernia. Stitches and sutures can also open up. Because of reduced absorption of nutrients, bone diseases, vitamin deficiency and anaemia are known to occur. A lot of this can be prevented through proper care and being under the supervision of only an expert bariatric surgeon.