Bariatric Surgical Procedures

What is Bariatric Surgery?

Gastrointestinal surgery for obesity is called Bariatric surgery, which alters the digestive process so that patients lose weight safely & effectively. First, find out if you are the right candidate for Bariatric Surgery. To know whether weight loss surgery is an appropriate weight-loss tool for you, let’s look at the medical guidelines established by the National Institute of Health for Bariatric Surgery.

You may be a candidate for surgery if you meet at least one of the following two criteria:

• Have a Body Mass Index (BMI) of at least 40
• Have a BMI of at least 35 with one or more serious obesity-related conditions

And meet both of the following criteria:

• Have failed more conservative weight loss alternatives, such as supervised diet, exercise and behaviour modification programs.
• Are at least 18 years of age

BMI = weight in kilograms / height in meter2 (Kg/m2)

There are other things to consider too. You need to think about your determination and ability to make some serious changes in the way you live your life. Bariatric surgery is a tool to help improve your health. As with any new tool, you must actively learn how to use it to get the best benefits.

Laparoscopic Or Minimally Invasive Surgery

Laparoscopic surgery is a minimally invasive technique used in a wide variety of general surgeries, including bariatric and metabolic surgery.

When a laparoscopic operation is performed, a small video camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. Benefits, as compared with open surgery, may include a marked decrease in surgery-related discomfort, reduced time in hospital and hospital costs, and an earlier return to a full, productive lifestyle.

Laparoscopic procedures for bariatric surgery use the same principles as open surgery and produce similar excess weight loss results; however, not all patients are candidates for this approach.

Metabolic Operations

The operations in this group help patient lose weight by altering their gastrointestinal tracts. Examples include the vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RNYGB), and the biliopancreatic diversion with duodenal switch (BPD/DS). By doing this, it changes the patient’s physiological response to fat loss. After metabolic surgery, there is a change in the way that gut hormones are secreted. The result is that after surgery, in the face of fat loss, patients don’t have to fight their hunger which is helpful when attempting to lose weight.

Recent research indicates that each bariatric surgery works not only through the anatomical and mechanical changes from the procedure itself but through metabolic changes in the ―gut hormones.‖ Numerous studies have examined pre-operative and post-operative gut hormone levels after bariatric surgery. A brief summary of hormonal changes after each bariatric procedure is provided in the next sections. Some of these hormones are:
Ghrelin: functions primarily to stimulate appetite
Glucagon-like peptide 1 (GLP-1): mechanism of action includes increased satiety and reduced stomach emptying
Peptide YY (PYY): reduces appetite and increases the efficiency of digestion and nutrient absorption

GASTRIC SLEEVE

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 25% of its original size, by surgical removal of a large portion of the stomach along the greater curvature.
The result is a sleeve or tube-like structure. The procedure permanently reduces the size of the stomach. This sleeve will typically hold between 50-150 ml of food & liquid.

How does it work to help you lose weight?

By creating a smaller stomach pouch, the gastric band limits the amount of food that can be eaten at one time, so you will feel full sooner & stay full longer. As you eat less food, your body will stop storing excess calories and start using its fat supply for energy.

• Reduced stomach volume increases the feeling of fullness.
• Does not require disconnecting or reconnecting of the intestines.
• Stomach functions normally allowing most foods to be eaten, just in smaller amounts.
• In performed laparoscopically.
• Simpler procedure than the gastric bypass.
• No foreign bodies used as a band surgery
• The procedure is less likely to cause complications such as the malabsorption of vitamins.
• It allows females to conceive and deliver healthy babies.
• It will cure obesity-related diseases like Diabetes, high blood pressure, and sleep apnea.

Because of significant weight loss, patients will find tremendous relief from back pain, hip pain, knee pain, and foot pain allowing them to walk and exercise more. It increases the self-confidence of individuals.

Follow up:

Postoperatively patients monitored as like any other laparoscopic surgery. 2nd postoperative day contrast scan can be performed to see any contrast leak followed by patients will be started the liquid diet as tolerated and can be discharged on the same day. Further, follow up will be after a week and diet will be gradually increased from clear liquid to full liquids and to soft diet as tolerated under the guidance of an experienced dietician.

Gastric Sleeve Procedure Benefits:

• Cost-effective
• No major morbidity & almost nil mortality
• Very short hospital stay, early return to activity
• Restrictive bariatric surgery with effective weight loss by limiting intake & decreasing hunger
• No functional, major anatomical disturbance
• It does not involve any digestive anastomosis, no mesenteric defects are created eliminating the risk of internal hernia
• It is not associated with Dumping syndrome, the risk of peptic ulcer is low and the absorption of nutrients, vitamins, minerals and drugs are not altered.

At APOLLO, we perform Laparoscopic sleeve gastrectomy as a multidisciplinary team with well trained and qualified laparoscopic and bariatric surgeons, high-end anaesthesiologists, well-trained staff including nurses and technicians and good quality equipment, ICU set up as back up if necessary, dieticians, psychologists and behavioural therapists and fitness experts on a regular basis and achieving effective & satisfactory results. Our patients usually discharge on 2 nds postoperative day with a liquid diet. And patients are back to work in less than a week. We have seen effective weight loss of around 60% percentile in 6 months without major nutritional disturbances. However, bariatric surgery is not a resort in cases of childhood obesity because the child needs to attain his full growth potential until the age of 18 and so as to not interfere with normal growth physiology

GASTRIC BYPASS

Procedure Description: Gastric Bypass is a combination of restrictive & malabsorptive surgical technique. In this procedure, a small stomach pouch is created and a section of the small intestine is directly attached to this pouch. This allows food to bypass a portion of the small intestine. By creating a smaller pouch, a Gastric bypass limits the amount of food that can be eaten at one time, so you feel full sooner & stay full longer. On bypassing a portion of the small intestine, it also causes your body to absorb fewer calories.

How it works to help you lose weight?
As you eat less food and absorb fewer calories, your body will stop storing excess calories and start using its fat supply for energy.

Mini Gastric Bypass

Procedure Description: Mini gastric bypass (MGB or Loop Gastric Bypass) is a malabsorption procedure with good short term and long term weight loss. Here the lesser curvature of the stomach is detached from the stomach and attached to the loop of the small bowel. It causes both restriction and malabsorption, causing good long term weight loss.

• Reduced stomach volume increases the feeling of fullness.
• Does not require disconnecting or reconnecting of the intestines.
• Stomach functions normally allowing most foods to be eaten, just in smaller amounts.
•  Stomach portion that produces a hunger-stimulating hormone (Gherlin) is removed.
• Is performed laparoscopically.
• Simpler procedure than the gastric bypass
• No foreign bodies used as a band surgery
• The procedure is less likely to cause complications such as the malabsorption of vitamins.
• It allows females to conceive and deliver healthy babies.
• It will cure obesity-related diseases like Diabetes, high blood pressure, and sleep apnea.
• Because of significant weight loss, patients will find tremendous relief from back pain, hip pain, knee pain, and foot pain allowing them to walk and exercise more. It increases the self-confidence of individuals.

Duodenal Switch

Procedure Description: Biliopancreatic diversion with duodenal switch (also called Duodenal switch, or BPD-DS) is a procedure that induces weight loss by sleeve gastrectomy and intestinal bypass. Approximately 60-70 per cent of the stomach is removed so that the stomach takes the shape of a tube (sleeve gastrectomy). The lower intestine is then divided much further downstream than with gastric bypass so that two thirds or more of the intestine is bypassed, leaving only a few feet of the intestine where food and digestive enzymes meet. This is the intestinal bypass portion of the operation. The name duodenal switch comes from the fact that in this operation the intestinal bypass starts at the duodenum. The first part of the intestine, the duodenum, is divided and attached to the lower portion of the small intestine, the ileum.

Risks

Weight loss surgery, as with any major surgery, has risks of which you should be made aware: These may include:

• An internal infection from leakage of digestive juices into the body cavity
• Wound infections at incision sites
• Hernias or a weakening of the abdominal wall
• Development of gall bladder disease and/or gall stones – due to rapid weight loss
• Blood clots – may cause a more serious condition called a pulmonary embolism
• Vitamin deficiencies – may be preventable by taking daily vitamin supplements. Periodic lab testing may also be required
• As with any surgical procedure, there is a risk of morbidity and mortality.