Obesity & Weight Loss Treatment
Bariatric surgery is a procedure to aid weight loss. This surgery involves reducing the size of the stomach and leads to rapid weight loss.
It is usually considered when dietary changes, exercise, and other weight loss pursuits are not able to give results.
The most common bariatric procedures are:
- Gastric Bypass
- Gastric Sleeve Surgery
- Gastric Band Surgery
Both gastric sleeve surgery and gastric bypass reduce the stomach from its regular size to a small pouch. This causes weight loss due to the following reasons:
- The pouch fills up quickly so it reduces the amount of food you can eat as you quickly feel full
- The amount of ghrelin, commonly known as the “hunger hormone,” is reduced
The two procedures however differ in the way the new stomach pouch is created.
Gastric bypass is more complicated than gastric sleeve surgery as it is a two-step procedure, while gastric sleeve only involves one step.
Both procedures are done laparoscopically. This involves inserting a lighted scope with a camera called a laparoscope and other tools through several small incisions in the abdomen to perform the surgery.
Gastric Sleeve Surgery (LSG)
During gastric sleeve surgery or Laparoscopic Sleeve Gastrectomy, the surgeon permanently removes approximately 80 percent of the stomach. What remains is a tubular pouch resembling a banana.
Advantages
- Restricts the amount of food the stomach can hold
- Induces rapid and significant weight loss
- Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
- Involves a shorter hospital stay of approximately 2 days
- Causes favorable changes in gut hormones that suppress hunger, reduce appetite, and enhance satiety
Disadvantages
- It is a non-reversible procedure
- It can lead to long-term vitamin deficiencies
- Has a higher early complication rate than the AGB
Gastric Bypass Surgery (RYGB)
This procedure is also called Roux-en-Y gastric bypass. The surgeon creates a small stomach pouch by removing or bypassing most of the stomach and the first part of the small intestine. The new stomach pouch is reconnected to the remaining small intestine.
The bypassed top part of the stomach is attached to the small intestine further down, so it continues providing the acid and digestive enzymes which eventually mix with the food.
The portion of the small intestine that’s bypassed is responsible for absorbing some nutrients and calories. Following the bypass there is no food passing through it, so the absorption of those calories doesn’t occur which contributes to weight loss. In addition, the rerouting of the food stream produces changes in gut hormones that suppress hunger.
Advantages
- Produces significant long-term weight loss (60 to 80 percent excess weight loss)
- Restricts the amount of food that can be consumed
- May lead to conditions that increase energy expenditure
- Produces favorable changes in gut hormones that reduce appetite and enhance satiety
Disadvantages
- It’s a more complex procedure than the AGB or LSG
- It can lead to long-term vitamin/mineral deficiencies
- Requires a longer hospital stay than the AGB
- Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance
Adjustable Gastric Band (AGB)
In this procedure, a small stomach pouch is created by placing an inflatable band around part of the stomach.
This works on the fact that with the smaller stomach pouch, eating just a small amount of food satisfies hunger and promotes the feeling of fullness. This feeling of fullness depends on the size of the opening between the pouch and the rest of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin of the abdomen.
Gastric band surgery can be easily reversed by removing the band.
Advantages
- Reduces the amount of food the stomach can hold
- Causes excess weight loss of about 40 – 50 percent
- Doesn’t involve removal of the stomach or rerouting of the intestines
- A shorter hospital stay, normally less than 24 hours
- Reversible and adjustable
- The lowest rate of early postoperative complications
- The lowest risk for vitamin/mineral deficiencies
Disadvantages
- Slower weight loss than other surgical procedures
- A greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed
- Requires a foreign device to remain in the body
- Can result in possible band slippage or band erosion into the stomach in a small percentage of patients
- Can have mechanical problems with the band, tube, or port in a small percentage of patients
- Can result in dilation of the esophagus if the patient overeats
- Requires strict adherence to the postoperative diet and to postoperative follow-up visits
- The highest rate of re-operation
Important dietary guidelines that one needs to follow after gastric sleeve or gastric bypass surgery:
The pouch will stretch over time. It’s important not to overeat after bariatric surgery because the pouch can stretch enough to regain the weight lost.
The type of bariatric surgery that’s suitable for the patient depends on various factors such as:
- Weight
- Medical history
- Health conditions
- Expectations
Complications Associated with Bariatric Surgery
Bariatric surgery is a relatively safe procedure.
According to the American Society for Metabolic and Bariatric Surgery, the risk of a major complication is about 4 percent. This is much lower than the risk of developing serious obesity-related health complications.
Some factors that can complicate any surgery, including bariatric surgery, include:
- Blood loss (hemorrhage)
- Blood clotting in the leg (deep vein thrombosis) or lungs (pulmonary embolism)
- Side effects from general anesthesia
- Infection from incision
- Postoperative pain
- Pneumonia
If you are considering bariatric surgery, speak to your doctor about the possible risks and benefits of these procedures specific to your condition.
Hospitals
Recommended Hospitals
SRCC Children’s Hospital, Mumbai
Apollo Hospitals, Mumbai
Nanavati Hospital, Mumbai
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