What is bariatric surgery?
There are different forms of bariatric surgery, but they all aim to shrink the stomach and sometimes affect nutrient absorption to help the patient lose weight.
Bariatric surgery is an operation on the digestive system to help an obese person lose weight. The surgery restricts calorie intake by reducing the size of the stomach. Some types of bariatric surgery restrict the size as well as absorption of nutrients. Regardless of the approach, a successful bariatric surgery results in significant weight loss.
Why is a bariatric surgery done?
A bariatric surgery helps an obese person lose weight by reducing the capacity of their digestion and appetite. A person with a body mass index of 30 or more is considered obese. Other factors like muscle mass and waist circumference also factor into a diagnosis of obesity.
People consider bariatric surgery when the BMI is 40 or above. It might also be recommended for people with a BMI between 30 and 40 if they also have diseases such as diabetes, high blood pressure, fatty liver, or sleep apnea.
Obesity can cause a host of health issues including
- diabetes
- heart disease
- high blood pressure
- liver disease
- digestive issues
- incontinence
- sleep apnea
- back pain
- osteoarthritis
- psychological issues
Obesity is a major health problem worldwide, and bariatric surgery provides the most significant and sustained weight loss solution for obese patients. Nevertheless, patients should consider bariatric surgery only after exhausting other options for weight loss like dieting, exercise, and drug treatments.
What are the types of bariatric surgery?
Bariatric surgery may be “restrictive,” which reduces the amount of food intake, or “restrictive/malabsorptive,” which restricts intake and interferes with the digestion as well. Currently, there are four standard types of bariatric surgery procedures as follows:
Laparoscopic adjustable gastric banding
- This is a restrictive surgery in which the surgeon places an inflatable band over the top portion of the stomach.
- This divides the stomach into two sections, creating a small pouch on top of the main stomach, connected to it by a small channel.
- This slows down the passage of food that goes into the main stomach, consequently reducing the quantity of intake.
- The opening to the main stomach can be controlled by inflating or deflating the band with a port implanted under the skin.
- This surgery is reversible as the band and port can be removed if no longer needed.
Gastric sleeve or sleeve gastrectomy
- This is a restrictive laparoscopic surgery in which the surgeon removes about 75% to 85% of the stomach and leaves only a small pouch which is stapled.
- This reduces the quantity of food intake and does not affect the absorption of nutrients.
- It reduces the production of the stomach hormone that stimulates appetite, and curbs hunger.
- This is sometimes performed as the first step in a series of weight loss surgeries.
- This is not reversible.
Gastric bypass or Roux-en-Y surgery
- This surgery is restrictive/malabsorptive and involves two procedures.
- The surgeon first staples the stomach creating a small pouch.
- Then they cut the small intestine and attach the lower part of it directly to the pouch, bypassing a major part of the stomach and small intestines.
- The bypassed section is then connected farther down the small intestine to allow digestive juices in.
- The bypass causes changes in gut bacteria and gut hormones, and induces malabsorption besides restricting calorie intake.
- It is a difficult procedure to reverse this but can be done if medically necessary.
Biliopancreatic diversion with duodenal switch
- This is a restrictive/malabsorptive surgery performed in two steps.
- First a sleeve gastrectomy is performed in which 50% of the stomach is removed.
- Then the surgeon connects the pouch to the end of the small intestine bypassing most of it.
- The bypassed section is connected farther down to allow entry of digestive juices.
- This surgery is not reversible.
What is the safest form of bariatric surgery?
Each type of bariatric surgery has its own benefits and drawbacks. The surgeon suggests the type of surgery based on the individual’s health and needs. All surgeries carry a certain amount of risk, but restrictive surgeries are safer than restrictive/malabsorptive surgeries as they do not permanently interfere with the digestive system.
Gastric Banding
This the simplest and safest procedure of the bariatric surgeries. The weight loss is lower than the other surgeries, however. Also, individuals with gastric banding are more likely to regain weight in the long run. Because the surgery doesn’t affect nutrient absorption, there is less risk of nutrient deficiency.
Sleeve Gastrectomy
This is a relatively safe and simple surgery for morbidly obese people who have other health complications. The weight loss is significant and nutrient absorption is not affected. This is a newer procedure and long-term benefits and risks are still under evaluation.
Gastric Bypass
This surgery enables swift weight loss that continues up to 2 years. It is useful for patients suffering with obesity-related conditions to improve their health quickly. It also has good long-term results in keeping weight off. The drawbacks are hernias, and nutrient deficiencies because of malabsorption. It can also cause dumping syndrome where the food is dumped from the stomach into the intestines before it is properly digested.
Duodenal Switch
This is more complicated and riskier than the other surgeries and less commonly performed. It results in quicker weight loss, but the risks of hernias, nutrient deficiency and dumping syndrome are higher.