Bariatric Surgery

Bariatric Surgery or Weight Loss Surgery is indicated in those patients who have been unable to achieve lasting weight loss with lifestyle changes alone.
The basic requirements for weight loss surgery are:

  • Body mass index (BMI) of 40 or above
  • BMI of 35 to 40 for people with heart disease, diabetes, high cholesterol, or obstructive sleep apnea

What is morbid obesity?
Obesity is a condition in which one has too much body fat (adipose tissue). Obesity is determined by calculating the Body Mass Index (BMI), which measures weight for height and is stated in numbers.

BMI = Weight (in kg)
Height (in m2)

BMI Status

Below 18.5 Underweight
18.5 - 24.9 Normal
25 - 29.9 Overweight
30 - 34.9 Obese
35 - 39.9 Severe Obesity
> 40 Morbid Obesity
> 50 Super morbid Obesity

"This is not just to lose weight or get rid of diabetes, This will totally change your lives."
Before undergoing weight loss surgery, patient is thoroughly evaluated which includes counselling and various tests.
There isn't an accepted "gold standard" in weight loss surgery.
All weight loss surgery, whether open or laparoscopic, is done under general anesthesia and involves a short hospital stay. Laparoscopy is a technique used to operate without cutting open the abdomen to get at the organs. Laparoscopy leaves smaller scars than open surgery and tends to have fewer complications and quicker recovery time.
Weight loss after bariatric surgery can be dramatic and immediate. After gastric bypass surgery, for example, people may lose as much as a pound a day for the first three months.
Commonly performed bariatric procedures


Sleeve gastrectomy
Sleeve gastrectomy  is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach.The open edges are then attached together (typically with surgical staples, sutures, or both) to leave the stomach shaped more like a tube with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.
Most patients can expect to lose 30 to 50% of their excess body weight over a 6–12 month period with the sleeve gastrectomy.

  • Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts.
  • Removes the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin), although the durability of this removal has yet to be confirmed.
  • Dumping syndrome is less likely due to the preservation of the pylorus (although dumping can occur anytime stomach surgery takes place).
  • Minimizes the chance of an ulcer occurring.
  • By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are significantly reduced.
  • Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2).
  • Limited results appear promising as a single stage procedure for low BMI patients (BMI 35–45 kg/m2).
  • Appealing option for people with existing anemia, Crohn's disease, irritable bowel syndrome, and numerous other conditions that make them too high risk for intestinal bypass procedures.

Gastric bypass surgery

A common form of gastric bypass surgery is the Roux-en-Y gastric bypass. Here, a small stomach pouch is created with a stapler device, and connected to the distal small intestine. The upper part of the small intestine is then reattached in a Y-shaped configuration.
The gastric bypass had been the most commonly performed operation for weight loss in the United States, and approximately 140,000 gastric bypass procedures were performed in 2005. Its market share has decreased since then and by 2011, the frequency of gastric bypass has been reduced by 50% of all the weight loss surgeries done. 

Adjustable gastric band

Intragastric balloon (gastric balloon)

Gastric plication

Biliopancreatic diversion

Jejunoileal bypass.

Endoluminal sleeve

Vertical banded gastroplasty

Sleeve gastrectomy with duodenal switch

Implantable gastric stimulation


Eating after bariatric surgery

Immediately after surgery, the digestive system will be very tender. "It's like being a baby."
For the first day or two after bariatric surgery, you will only have a tiny amount of clear liquids such as water, fruit juice, and broth. After that you may start to sip denser liquids such as milk, smooth cooked cereal, and pudding. For the next three to four weeks, you'll eat several tiny portions each day of pureed food and liquids. In the second month, you may begin to eat soft, moist, chewed food. Three months after bariatric surgery, you may be back to a regular diet. Nevertheless, you'll never be able to eat big portions again.
Post-surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting. Diet restrictions after recovery from surgery depend in part on the type of surgery. Many patients will need to take a daily multivitamin pill for life to compensate for reduced absorption of essential nutrients. Because patients cannot eat a large quantity of food, a diet that is relatively high in protein and low in fats and alcohol is recommended.

Fluid recommendations

It is very common, within the first month post-surgery, for a patient to undergo volume depletion and dehydration. Patients have difficulty drinking the appropriate amount of fluids as they adapt to their new gastric volume. Limitations on oral fluid intake, reduced calorie intake, and a higher incidence of vomiting and diarrhea are all factors that have a significant contribution to dehydration. In order to prevent fluid volume depletion and dehydration, a minimum of 6-8 cups  should be consumed by repetitive small sips all day. 

Reduced mortality and morbidity
Several recent studies report decrease in mortality and severity of medical conditions after bariatric surgery.

Common problems after bariatric surgery are:
Gastric dumping syndrome (bloating, diarrhea after eating, requiring small meals or medication) ( 20%),
Leaks at the surgical site (12%)
Incisional hernia (7%),
Infections (6%) and  
Pneumonia (4%)  
Mortality 0.2%.

Metabolic bone disease manifesting as osteopenia and secondary hyperparathyroidism have been reported after Roux-en-Y gastric bypass surgery due to reduced calcium absorption.

Rapid weight loss after obesity surgery can contribute to the development of gallstones as well by increasing the lithogenicity of bile.
Hyperoxaluria that can potentially lead to oxalate nephropathy and irreversible renal failure is the most significant abnormality seen on urine chemistry studies. Rhabdomyolysis leading to acute kidney injury, and impaired renal handling of acid and base has been reported after bypass surgery.
Nutritional derangements due to deficiencies of micronutrients like iron, vitamin B12, fat soluble vitamins, thiamine, and folate are especially common after malabsorptive bariatric procedures.

All the problems are manageable

"Benefits of surgery OUTWEIGH the chances of problems."

 

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