Bariatric surgery, also known as weight loss surgery or metabolic surgery is used to describe surgical procedures to help a person lose weight. These terms are used in order to reflect the impact of these operations on patients’ weight and the health of their metabolism (breakdown of food into energy). In addition to their ability to treat obesity, these operations are very effective in treating diabetes, high blood pressure, sleep apnea and high cholesterol, among many other diseases. These operations also have an ability to prevent future health problems. The benefits allow patients with obesity who choose to undergo treatment to enjoy a better quality of life and a longer lifespan. Today’s bariatric operations have been refined over the course of many decades and are among the best studied treatments in modern medicine. They are performed with small incisions using minimally invasive surgical techniques (laparoscopic and robotic surgery). These advancements allow patients to have a better overall experience with less pain, fewer complications, shorter hospital stays and a faster recovery.
Bariatric surgery comes in many forms. Some popular ones include the following:
-Sleeve gastrectomy (vertical)
-Roux-en-Y Gastric bypass
-Bilopancreatic diversion with duodenal switch
The goal of these bariatric surgery is to modify the stomach and intestines to treat obesity and related diseases. The operations may make the stomach smaller and also bypass a portion of the intestine. This results in less food intake and changes how the body absorbs food for energy resulting in decreased hunger and increased fullness. These procedures improve the body’s ability to achieve a healthy weight.
-You Live Longer: A 2018 JAMA study reported that people who underwent bariatric surgery lived longer when compared to people of similar age, sex, and BMI who had not undergone bariatric surgery.
-Your Risk for Cardiovascular Disease Is Reduced -Data presented at the 2018 American Society for Metabolic Surgery meeting provided further evidence that people who undergo weight loss surgery experience a significant decrease in their risk for coronary artery disease. The study participants also saw significant decrease in their risk for diabetes, high blood pressure, and stroke.
-You Experience Less Sleep Apnea and Joint-Related Problems - Weight loss, by any method, is a well-documented treatment for sleep apnea. Experience a reduction in sleep apnea and joint-related problems.
-Your Quality of Life Improves - In addition to increasing your mobility, which allows you to enjoy more of life's daily joys, weight loss surgery increases your self-esteem, work and social interactions, and sexuality. At the same time, it can decrease feelings of depression and anxiety.
-Risks Associated with Medical Conditions
- Medical conditions you may already have -- such as blood clots, liver disease, heart disease, and kidney stones -- can worsen after surgery.
-Physical, Social and Psychological Concerns
- In the months following bariatric surgery, you may be at increased risk for the following conditions:
-Depression, especially in people who experienced depression before surgery
-Alcohol- and substance-abuse disorders
-Social relationship changes
-Additional Surgeries May Be Necessary - Obesity is a chronic, lifelong disease that you will battle for the rest of your life. Surgery is the best option for long-term weight loss. However, it is only the first step, and additional concerns may arise. Some people will need to undergo additional surgeries to achieve additional weight loss, to remove sagging skin, to address additional medical concerns, or to induce loss of weight that was regained after surgery. Your doctor will help you manage your health and address additional concerns as they arise.
Each bariatric sugrical procedure is different to one another. The inforrmation below briefly descirbes what happens in each kind of procedure: 1. Sleeve gastrectomy: The Laparoscopic Sleeve Gastrectomy, often called the "sleeve", is performed by removing approximately 80% of the stomach. The remaining stomach is the size and shape of a banana. The new stomach holds less food and liquid helping reduce the amount of food (and calories) that are consumed. By removing the portion of the stomach that produces most of the “hunger hormone”, the surgery has an effect on the metabolism. It decreases hunger, increases fullness, and allows the body to reach and maintain a healthy weight as well as blood sugar control. The simple nature of the operation makes it very safe without the potential complications from surgery on the small intestine. 2. Roux-en-Y bypass: The Roux-en-Y Gastric Bypass, also known as a gastric bypass a has now been performed for more than 50 years. It is one of the most common operations and is very effective in treating obesity and obesity related diseases. The name is a French term meaning “in the form of a Y”. First, the stomach is divided into a smaller top portion (pouch) which is about the size of an egg. The larger part of the stomach is bypassed and no longer stores or digests food. The small intestine is also divided and connected to the new stomach pouch to allow food to pass. The small bowel segment which empties the bypassed or larger stomach is connected into the small bowel approximately 3-4 feet downstream, resulting in a bowel connection resembling the shape of the letter Y. Eventually the stomach acids and digestive enzymes from the bypassed stomach and first portion of the small intestine will mix with food that is eaten. The gastric bypass works in several ways. Like many bariatric procedures, the newly created stomach pouch is smaller and able to hold less food, which means fewer calories are ingested. Additionally, the food does not come into contact with the first portion of the small bowel and this results in decreased absorption. Most importantly, the modification of the food course through the gastrointestinal tract has a profound effect to decrease hunger, increase fullness, and allow the body to reach and maintain a healthy weight. 3. Gastric band: The Adjustable Gastric Band is a device made of silicone that is placed around the top part of the stomach to limit the amount of food a person can eat.The impact on obesity related diseases and long-term weight loss is less than with other procedures. Its use has therefore declined over the past decade. The gastric band is placed and secured around the top part of the stomach creating a small pouch above the band. The feeling of fullness depends upon the size of the opening between the pouch and the rest of the stomach. The opening size can be adjusted with fluid injections through a port underneath the skin. Food goes through the stomach normally but is limited by the smaller opening of the band. It is less successful against type 2 diabetes and has modest effects on the metabolism. 4. BIliopancreatic diversion with duodenal switch (BPD-DS): The Biliopancreatic Diversion with Duodenal Switch, begins with creation of a tube-shaped stomach pouch similar to the sleeve gastrectomy. It resembles the gastric bypass, where more of the small intestine is not used. Following creation of the sleeve-like stomach, the first portion of the small intestine is separated from the stomach. A part of the small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through the sleeve pouch and into the latter part of the small intestine. The smaller stomach, shaped like a banana, allows patients to eat less food. The food stream bypasses roughly 75% of the small intestine, the most of any commonly performed approved procedures. This results in a significant decrease in the absorption of calories and nutrients. Patients must take vitamins and mineral supplements after surgery. Even more than gastric bypass and sleeve gastrectomy, the BPD-DS affects intestinal hormones in a manner that reduces hunger, increases fullness and improves blood sugar control. The BPD-DS is considered to be the most effective approved metabolic operation for the treatment of type 2 diabetes.
Bariatric surgery is just one component of a major lifestyle change. As with anything, taking it one step at a time can make it easier to build healthy habits that you will stick with long-term. Before your surgery, your doctor and nutritionist will suggest a preoperative diet that will help reduce the size of your liver. This diet will be low in carbohydrates and high in protein, causing your body to use your excess fat as energy. Other lifestyle changes you’ll want to make before bariatric surgery include: Smoking cessation Limiting or stopping your alcohol intake Small amounts of exercise Taking a multivitamin Changing your eating habits
Patients spend an average of two to five days in the hospital following bariatric surgery, or longer if complications develop. Patients who undergo laparoscopic bariatric surgery usually have a shorter hospital stay. When you return to your hospital room after surgery, you will be closely monitored by your nurses. Along with periodic monitoring of your vital signs — blood pressure, pulse, temperature and respiration — your nurses will encourage and help you to perform deep breathing, coughing, leg movement exercises and to get out of bed. These activities can help prevent complications. Report any symptoms of nausea, anxiety, muscle spasms, increased pain or shortness of breath to your nurse. To varying degrees, it is normal to experience fatigue, nausea and vomiting, sleeplessness, surgical pain, weakness, light-headedness, loss of appetite, gas pain, flatulence, loose stools and emotional ups and downs in the early days and weeks after surgery.
Common Post-Op Risks and Side Effects Associated with Bariatric Surgery include:
Chronic nausea and vomiting
Dilation of esophagus
Inability to eat certain foods
Obstruction of stomach
Weight gain or failure to lose weight
Bariatric Surgery Long-Term Risks include:
Dumping syndrome, a condition that can lead to symptoms like nausea and dizziness
Low blood sugar
Am I a candidate for this procedure?
Body mass index 40 kilograms per square meter or higher Body mass index 35 kilograms per square meter or higher with obesity-related complications History of chronic obesity History of weight loss failure when using non-surgery methods No endocrinology-related disorder and/or mental disorder confirmed by a specialist. Able to be cooperative to the treatment
When can I go back to work after surgery?
After surgery, most patients return to work after two to four weeks. Some may be able to work from home as early as one week after surgery. Because of the significantly reduced calorie intake, many patients have low energy for 1-2 weeks after surgery. However, most patients gain their energy back once they start to have soft food.
What is the Body mass index (BMI) and why is it important?
Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity and help determine whether bariatric intervention is required. Clinically severe obesity describes a BMI of over 40 kg/m2 or a BMI of over 35 kg/m2 in combination with severe health problems. Health problems associated with obesity include type 2 diabetes, arthritis, heart disease, and severe obstructive sleep apnea. The Food and Drug Administration (FDA) approves the use of adjustable gastric banding for patients with a BMI of 30 kg/m2 or more who also have at least one of these conditions.