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Bariatric Surgery

Introduction

Obesity has reached epidemic proportions globally, with more than 1.7 billion people falling in the overweight/obese category (as per WHO). Weight loss can range from being relatively simple to being almost unattainable, depending on several factors such as type and severity of obesity, the age and lifestyle of the individual and the psychological mindset. It is often seen that in the few spurts of knowledge dispersed on weight loss, people across resort to dieting, exercising and a host of other methods, though not always intelligently. Some in spite of balancing these are unable to shed and/or maintain their weight. These treatment options may prove to be beneficial for overweight people, however, incase of morbid obesity, which is estimated to afflict 20% of the obese population, there exists a 98% recidivism rate with such weight loss methods.

A viable treatment option for such people is Bariatric surgery. The word ‘bari’ is the plural of ‘baros’. In Greek, “baros” means burden or load. From this stems “Baris” referring to the obese or overweight people. With the help of this surgery, these candidates also can take care of the myriad of comorbidities like diabetes, hypertension, hyperlipidemia, asthma, stroke, cancer and depression to name a few. Bariatric surgery should not be mistaken as a cosmetic procedure. It is a life saving alternate for obese people who fail to show weight loss by the age old conventional methods.

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Lap. Gastric Banding

Restrictive weight loss surgery works by reducing the amount of food consumed at one time. The theory is simple; due to the restriction created, you feel satiated with small amounts of food and because of a smaller outlet, food stays in the stomach for a longer time. The net result is - a reduction in daily caloric intake without a feeling of deprivation.

Procedure

Entails laparoscopic implantation of a Silastic band around the stomach just below the gastro-esophageal junction to section off a small portion called as stomach pouch creating an hour-glass effect. A small outlet, about the size of a pencil eraser, is left at the bottom of the stomach pouch.

Effects

The hour glass configuration only constricts the upper stomach thus acting as a pure restrictive operation. Since the outlet is small, food stays in the pouch longer and one also feels satiated for a longer time.

In a cooperative and compliant patient, the reduced stomach capacity, along with behavioral changes, can result in consistently lower caloric intake and consistent weight loss. Patients who see the best results from a restrictive procedure are those who learn to eat slowly, eat less, and avoid drinking too many caloric fluids, particularly carbonated beverages. If the patient fails to follow these guidelines, they can stretch the stomach pouch and/or the stoma outlet and defeat the purpose of the surgery. The effectiveness of a restrictive procedure is reduced by constant snacking or by drinking high-calorie, high-fat liquids.

Possible Complications

  • Band Infection and migration

  • Leakage

  • Slippage and dilatation

  • Punctures
     

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Lap. Gastric Bypass

Procedures that alter digestion are known as malabsorptive procedures. Malabsorptive techniques reduce the length of intestine that comes in contact with food so that the body absorbs fewer calories. According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is completely stapled shut and divided from the stomach pouch. It is not completely removed. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, called the Roux limb, thus eliminating the duodenum and a small portion of the jejunum from the absorptive circuit. The omitted segment is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be adjusted to produce lower or higher levels of malabsorption.

Risks

  • The duodenum being bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia.

  • A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.

  • A condition known as "dumping syndrome" can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.

  • Metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones.

  • All the above listed deficiencies can be easily managed through a proper diet and vitamin and calcium supplements. It is mandatory for patients undergoing gastric bypass to consume a multivitamin and calcium supplement daily.

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Sleeve Resection

This is the latest procedure in the Bariatric surgery group. It is performed laparoscopically (keyhole surgery). It involves removing the lateral 2/3rds of the stomach with a stapling device. It basically leaves a small stomach tube instead of a big stomach sack. The residual stomach capacity is about 150mls so a generous entry should be possible. Grehlin, which is an enzyme produced in the fundus of stomach, is responsible for hunger and craving for food. In this operation, Grehlin producing area of stomach is also removed, with the result that patient has satiety even after eating little bit of food and the person does not crave for food in between meals.
 

         

The greatest advantage of the procedure is that the anatomy and physiology of the intestinal tract is not altered, because of which patient does not need long term replacement of nutrients, minerals or vitamins. It gives excellent results in the form of weight loss as seen in numerous scientific studies performed over last five years, where the average weight loss is shown to be 60 to 70% of excess weight in the first year. However since it is a relatively newer procedure and long term results are awaited. This procedure is also offered to patients as part one of a two stage Bypass operation particularly if they are super obese ( BMI>60) because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically, when they are at a safer weight. It was seen in different studies that most of such super obese patients, in whom it was offered as stage one of two stage procedure, lost adequate weight and did not require second stage procedure. This procedure is not reversible.

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Bariatric Surgery | Lap. Gastric Banding | Lap. Gastric Bypass | Sleeve Resection | Duodenal Switch | Center of Obesity Support | Am i eligible for weight loss surgery? | Procedure of weight loss surgery? | Effects of weight loss surgery? | Complications of weight loss surgery? | Benefits of weight loss?
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