Bariatric Surgery (Weight Loss)
What is Bariatric Surgery ?
Exercise and diet alone often fails to effectively treat people with extreme and excessive obesity.Bariatric surgery, also referred to as weight loss surgery, is the procedure done for those people who are severely obese. In this weight loss procedure, the size of the stomach is reduced by implanting gastric banding medical device. This can also be done by re-routing and resecting the small intestines to a small stomach pouch and the process is termed as gastric bypass surgery. The other way could be a removal of the stomach (Biliopancreatic diversion with duodenal switch or sleeve gastrectomy).
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Principles of bariatric surgery
The basic principle of bariatric surgery is to restrict food intake and decrease the absorption of food in the stomach and intestines.
The digestion process begins in the mouth where food is chewed and mixed with saliva and other enzyme-containing secretions. The food then reaches the stomach where it is mixed with digestive juices and broken down so that nutrients and calories can be absorbed. Digestion then becomes faster as food moves into the duodenum (first part of the small intestine) where it is mixed with bile and pancreatic juice.
Bariatric surgery is designed to alter or interrupt this digestion process so that food is not broken down and absorbed in the usual way. A reduction in the amount of nutrients and calories absorbed enables patients to lose weight and decrease their risk for obesity-related health risks or disorders.
Who should consider Bariatric Surgery ?
The candidates should possess these following qualifications so that they can be considered for this weight-loss surgery –
Apart from these, a Bariatric surgery candidate should also be –
What is Body Mass Index (BMI) ?
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.
Types of Bariatric Surgery
There are various types of bariatric surgeries that can be performed. Surgery may be performed using an “open” approach, which involves cutting open the abdomen or by means of laparoscopy, during which surgical instruments are guided into the abdomen through small half-inch incisions. Today, most bariatric surgery is laparoscopic because compared with open surgery, it requires less extensive cuts, causes relatively minimal tissue damage, leads to fewer post-operative complications and allows for earlier hospital discharge.
Gastric Sleeve - Gastric Sleeve surgery, also referred to as Sleeve Gastrectomy, is primarily performed to remove about 85% of the stomach. The rest 15% of the original capacity of the stomach is left for shaping in the form of a sleeve.
Gastric Bypass Surgery - The purpose of this procedure is to separate the stomach into two unequal sections. Only 5 percent of the stomach area is left for food consumption. The food gets emptied from this small stomach pocket in the upper intestine at the time of digestion.
Biliopancreatic Diversion - Just like gastric bypass surgery, it also creates a smaller stomach. In this, ingested food is not fully absorbed in the intestine.
Lap Gastric Band - The surgery is primarily performed for decreasing the amount of food consumption at a time. The purpose is to create restriction so that a person feels satisfied with little amounts of food. Due to smaller outlet, the food remains in the stomach for a long time. The idea is to decrease daily calorie intake without a feeling of deprivation.
The benefits of gastric band include –
Malabsorptive procedures-Roux -En- Y Gastric Bypass - This procedure helps in altering the digestion. The length of the intestine is reduced by using Malabsorptive techniques. When the food comes in contact with the intestine, fewer calories are absorbed. Roux-en-Y is regarded as the gold standard procedure for weight loss surgery.
The benefits of Roux-En-Y include –
Each of the surgery types has advantages and disadvantages and various patient factors affect which procedure is chosen including BMI, eating habits, health problems related to obesity, and number of previous stomach surgeries. The patient and provider should discuss the most suitable option by considering the benefits and risks of each type of surgery.
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