Sunday February 25, 2024

Bariatric Surgery

Bariatric surgery (weight loss surgery) includes a variety of procedures that are performed on the stomach or intestines to induce weight loss in individuals with morbid obesity. Morbid obesity changes the body and makes it highly resistant to weight loss through diet and exercise alone. Surgical intervention is the most effective option to treat morbid obesity and to improve the health of individuals with this medical condition.

Morbid obesity causes changes
in the body that makes it very
resistant to weight loss
with diet and exercise alone.

Surgical treatment involves making changes to the body's digestive system which help a person lose weight through either food restriction (limits food intake) or malabsorption (reduces food absorption).

The most common surgical options are gastric bypass surgery, sleeve gastrectomy, adjustable gastric band, and duodenal switch. Each type of bariatric surgery has its own set of advantages and benefits, side effects and drawbacks. It is important for individuals who are looking into having a bariatric surgery procedure to take the time to learn about the pros and cons of the various options and to consult with a qualified bariatric surgeon before making a decision. A bariatric surgeon can help you determine the most appropriate method of bariatric surgery based on your personal health, medical history, and lifestyle factors.

Approaches to Bariatric Surgery

Bariatric surgery involves making changes to the body's digestive system. The changes either restrict the amount of food that can be eaten or reduce the amount of food that is absorbed by the body.

The weight loss methods used in bariatric surgery are:

  • Restrictive
  • Malabsorptive
  • Combination Restrictive/Malabsorptive

Restrictive Bariatric Surgery

The basis for weight loss through restrictive surgery is through decreased food intake. It involves reducing the size of the stomach so that a person eats less, fills full more quickly, and fills full for a longer amount of time with less food. The reduced calorie consumption will lead to weight loss over time. Although restrictive measures will help a person control eating, it requires that the patient make healthy food choices for successful results.

Restrictive Bariatric Procedures

  • Laparoscopic Adjustable Gastric Banding (LAP-BAND and REALIZE Band)
  • Gastric Sleeve, also called Vertical Sleeve Gastrectomy (VSG)

Benefits of Restrictive Bariatric Surgery

  • Limits the amount of food which can be eaten at any one time
  • Increases satiety
  • Body fully absorbs food and nutrients (thus, does not cause nutritional deficiencies)
  • Can help an individual achieve successful amount of weight loss over the years

Possible Drawbacks of Restrictive Bariatric Surgery

  • Lack of satisfaction with eating
  • Unsatisfactory weight loss
  • Requires patient to make healthy eating choices for best results

Malabsorptive Bariatric Surgery

The basis for weight loss with malabsorptive procedures is through reduced food absorption. It involves rerouting the small intestine so that food is poorly digested and not completely absorbed by the body. By reducing food absorption, it reduces the amount of calories as well, resulting in weight loss. The malabsorptive procedures also involve reducing the size of the stomach pouch, but not to the extent of restrictive or combination methods. Malabsorptive bariatric procedures are often very successful in achieving weight loss, but careful monitoring is necessary in order to avoid nutritional deficiencies.

Malabsorptive Bariatric Procedures

  • Extended (distal) roux-en-Y gastric bypass
  • Biliopancreatic diversion with duodenal switch

Benefits of Malabsorptive Bariatric Surgery

  • High degree of patient success
  • High degree of patient satisfaction with hunger fulfillment
  • Great success with excess weight loss and long-term weight loss maintenance

Possible Drawbacks of Malabsorptive Bariatric Surgery

  • Lifelong vitamin supplement intake
  • Bowel movement problems, bloating, and flatulence
  • Increased risk of gallstones and gallbladder problems
  • Possible intestinal irritation

Combination Restrictive/Malabsorptive Bariatric Procedures

  • Roux-en-Y gastric bypass

The Roux-en-Y gastric bypass is one of the most common bariatric procedures performed in the United States. It involves stapling off a large portion of the stomach as well as bypassing the first section of the small intestine (the duodenum), thus both limiting food intake and food absorption.

Benefits of Combination Restrictive/Malabsorptive Bariatric Surgery

  • Higher average weight loss than with solely restrictive surgery
  • Large amount of excess weight loss and weight loss maintenance over time
  • Improves certain pre-existing health conditions, including diabetes

Possible Drawbacks of Combination Restrictive/Malabsorptive Bariatric Surgery

  • Poor absorption of iron and calcium, causing anemia and metabolic bone disease
  • Dumping syndrome, which can cause nausea, diarrhea, and weakness

Choosing the Best Type of Bariatric Surgery

The best type of bariatric surgery is the procedure which best fits your situation. Each type of bariatric surgery has it's benefits and drawbacks. The best procedure for one patient may not be the best method for another patient.

Gastric bypass surgery has been the most commonly performed procedure over time and shown successful results, but it is a major procedure and may not be the right choice for every patient. The LAP-BAND or REALIZE Band are safer and less drastic options, benefitting teens and older patients who do not qualify for other methods of surgery. Sleeve gastrectomy (gastric sleeve) is emerging as the most popular choice, with results and a safety profile sitting between gastric bypass and gastric banding. The duodenal switch is the most drastic procedure and is often recommended for patients who are very obese (BMI over 50).

Make sure you discuss the benefits and drawbacks of the various options with your doctor so you can make a fully informed decision. With consideration of your current health status, past medical and surgical history, amount of excess weight, concerns about side effects and results, and lifestyle preferences, your doctor can help guide you to the type of bariatric surgery that is best for you.

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Do You Qualify?

An appropriate candidate for bariatric surgery has a BMI of 40 or higher, or a BMI of at least 35 with significant related obesity comorbidities; must have attempted a medical weight loss program, and is highly motivated to make lifestyle changes.

Long-term weight loss following laparoscopic adjustable gastric banding surgery is approximately 50% to 60% over 5 years.