Bariatric Surgery (also known as obesity surgery or weight loss surgery) includes a variety of
procedures performed on people suffering from obesity. It is done to help you lose excess
weight and reduce your risk of potentially life-threatening weight-related health problems,
including: type 2 diabetes, hypertension, infertility, sleep apnoea and others, that are
documented to reduce life span of an obese patient by 7-10 years.
Diet and Exercise should be the first choice of treatment for obese patients. Bariatric Surgery is advised only if weight does not reduce or if it bounces back quickly in spite of a strict diet and exercise regimen.
Who is a Candidate for Bariatric Surgery?
In general, qualifications for bariatric surgery include:
- Body mass index (BMI) ≥ 37.5, or more than approx. 100 kilograms
- BMI ≥ 35 and at least one or more obesity-related co-morbidities, such as type 2
diabetes (T2DM), hypertension, sleep apnoea and other respiratory disorders, non-
alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders,
or heart disease - Inability to achieve a healthy weight loss sustained for a period of time with prior weight
loss efforts
How Does Bariatric Surgery Work?
Bariatric surgery, such as gastric bypass and gastric sleeve work by changing the anatomy of
your gastrointestinal tract (stomach and digestive system) or by causing different physiological
changes in your body that change your energy balance and fat metabolism. Regardless of
which bariatric surgery procedure you and your surgeon decide is best for you, it is important to
remember that bariatric surgery is a “tool.” Weight loss success also depends on many other
important factors, such as nutrition, exercise, behaviour modification, and more.
By changing your gastrointestinal anatomy, certain bariatric procedures affect the production of
intestinal hormones in a way that reduces hunger and appetite and increases feelings of
fullness (satiety). The end result is reduction in the desire to eat and in the frequency of eating.
How Can Bariatric Surgery Help You?
When combined with a comprehensive treatment plan, bariatric surgery may often act as an
effective tool to provide you with long term weight-loss and help you increase your quality of
health. Bariatric surgery has been shown to help improve or resolve many obesity-related
conditions, such as type 2 diabetes, high blood pressure, heart disease, and more. Frequently,
individuals who improve their weight, find themselves taking less medications to treat their
obesity-related conditions.
Types of Procedures
Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach
can hold, or causing malabsorption of nutrients, or by a combination of both gastric restriction
and malabsorption. Most weight loss surgeries today are performed using minimally invasive
techniques (laparoscopic surgery).
Procedures
- Gastric balloons
Laparoscopic Procedures
- Gastric bands
- Roux-en-Y (RNY) Gastric Bypass
- Mini Gastric Bypass
- Sleeve Gastrectomy
- Revision Surgery
The Roux-en-Y Gastric Bypass, often called gastric bypass, is considered the ‘gold standard’ of
weight loss surgery.
The Procedure
There are two components to the procedure. First, a small stomach pouch is created by dividing
the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine
is divided, and the bottom end of the divided small intestine is brought up and connected to the
newly created small stomach pouch. The procedure is completed by connecting the top portion
of the divided small intestine to the small intestine further down so that the stomach acids and
digestive enzymes from the bypassed stomach and first portion of the small intestine will eventually
mix with the food.
The gastric bypass works by several mechanisms. First, similar to most bariatric procedures,
the newly created stomach pouch is considerably smaller and facilitates significantly smaller
meals, which translates into less calories consumed. Additionally, because there is less
digestion of food by the smaller stomach pouch, and there is a segment of small intestine that
would normally absorb calories as well as nutrients that no longer has food going through it,
there is probably to some degree less absorption of calories and nutrients.
Most importantly, the rerouting of the food stream produces changes in gut hormones that
promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity
induces type 2 diabetes.
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 favourable changes in gut hormones that reduce appetite and enhance satiety
- Typical maintenance of > 50% excess weight loss
Mini-gastric bypass (MGB) is a promising bariatric procedure. It is a simpler procedure to
perform compared to Roux-en-bypass. Mini gastric bypass has only one anastomosis between the
small pouch of stomach created just after oesophagus and the second part of small intestine called
jejunum compared to Roux-en-Y bypass that has two anastomoses.
Advantages
- Completely reversible procedure
- Early sense of fullness and satisfaction
- Good for Indian patients
- Better weight loss than other bariatric procedures
The Laparoscopic Sleeve Gastrectomy, often called the sleeve, is performed by removing
approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that
resembles a banana.
The Procedure
This procedure works by several mechanisms. First, the new stomach pouch holds a
considerably smaller volume than the normal stomach and helps to significantly reduce the
amount of food (and thus calories) that can be consumed. The greater impact, however, seems
to be the effect the surgery has on gut hormones that impact a number of factors including
hunger, satiety, and blood sugar control.
Short term studies show that the sleeve is as effective as the Roux-en-Y gastric bypass in terms
of weight loss and improvement or remission of diabetes. There is also evidence that suggests
the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of
the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric
band and the Roux-en-Y gastric bypass.
Advantages
- Restricts the amount of food the stomach can hold
- Induces rapid and significant weight loss that comparative studies find similar to that of
the Roux-en-Y gastric bypass. Weight loss of > 50% for 3 – 5+ year data, and weight
loss comparable to that of the bypass with maintenance of > 50% - Requires no foreign objects (AGB), and no bypass or re-routing of the food stream
(RYGB) - Involves a relatively short hospital stay of approximately 2 days
- Causes favourable changes in gut hormones that suppress hunger, reduce appetite and
improve satiety