Bariatric Surgery / Weight Reduction Surgery

Obesity is a serious health problem prevailing mainly the in Western counties.

Bariatric surgery is a collective term that is used to describe all forms of surgeries performed to reduce weight of an individual by making changing in the digestive system.

All these surgeries are major surgeries and carries immense risk. 

Surgical solutions have evolved dramatically over the past few years and researches have proved that dramatic and more durable weight loss can be achieved by surgical methods rather than non surgical interventions.

But bariatric surgery is not for everyone, there is a separate selection criteria to check whether that individual is eligible for this surgery.


Important Facts

  • Everyone is not eligible to undergo bariatric surgery
  • All bariatric surgeries are major surgeries and carry a lot of risk 
  • Surgery will not guarantee the amount of weight loss that you desire
    • Usually bariatric surgery reduces 15 – 30% of the patient’s starting weight on average
  • Surgery alone will not help to maintain lost weight
  • Healthy lifestyle and exercise should go hand in hand to maintain the weight at an acceptable level
  • It is an expensive surgery 



Cases Selection / Eligibility Criteria For Bariatric Surgery

  • BMI ⋝ 40 kg/m2 or between 35 – 40 kg/m2 along with other potentially life threatening, weight related problems 
    • Type 2 diabetes mellitus
    • Hypertension
    • Sleep apnoea
  • Pre-requisites for surgery 
    • All non surgical methods have failed to achieve or maintain the adequate clinical beneficial weight loss for at least 6 months
    • Will receive intense specialist management
    • Patient should be fit for anaesthesia and surgery
    • They should commit for long term follow up 
    • Adults more than 40 kg/m2 and awaiting surgery should start orlistat as first line management 



Types Of Bariatric Surgery

  1. Laparoscopic adjustable gastric band
  2. Gastric bypass / Roux-en-Y gastric bypass
  3. Sleeve gastrectomy 
  4. Biliopancreatic diversion with duodenal switch (BPD/DS) – Rarely performed 


Laparoscopic Adjustable Gastric Band

  • An adjustable / inflatable band is placed laparoscopically around the proximal stomach, so that it will create a small pouch 
  • A port is placed underneath the skin to inflate and deflate the band by injecting a fluid though that port 
  • Acts by making the patient feel fuller with a small intake of food
  • Advantages 
    • Reversible
    • No modifications of the intestine
  • Disadvantages
    • Takes a longer time to achieve the target weight
    • Frequent follow up 
    • Band erosion, slippage 
    • May need re-interventions to remove the band 
 


This video perfectly explains how the adjustable gastric band works.
I recommend everyone to watch this video.


Gastric Bypass / Roux-en-Y gastric bypass

  • Stomach is resected leaving behind a small pouch of the proximal stomach 
  • This makes the patient feel fuller with a small amount of food
  • Small intestine is cut to by pass a small segment of the small intestine 
  • Distal segment  of the small bowel is anastomosed with the stomach 
  • Proximal segment of the small bowel is anastomosed back with the small intestine, a bit distal to the first anastomosis , so that the digestive juices will reach the intestine 
  • As the length of the small bowel is reduced, absorption of calories are less
  • Advantages 
    • More effective weight loss
    • No foreign bodies placed inside 
  • Disadvantages 
    • Irreversible 
    • Risk of anastomotic leak (In 2% of cases)
    • Vitamin B12 deficiency (In 50 % of cases)
 


Please watch the video for more understanding.


Sleeve Gastrectomy

  • 80% of the stomach is removed and stapled afterwards creating a banana shaped stomach 
  • This reduces the volume of the stomach, so the patient feel fuller sooner than before
  • Advantages 
    • More effective weight loss
    • No modification to the intestine
    • No foreign bodies placed inside 
  • Disadvantages
    • Irreversible 
    • Acid reflux
    • Initial promising results cannot be sustained
 


This video will provide you will a clear idea on how this surgery is done.


Complications Of Surgery

  • Excessive bleeding 
  • Anaesthetic hazards 
  • Wound infection 
  • Anastomotic leak
  • Failure to achieve targeted results 
  • Bowel obstruction 
  • Dumping syndrome
  • Hypoglycemia
  • Vitamin B12 deficiency
  • Malnutrition 
  • Acid reflux
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