Bariatric Surgery

Bariatric 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