WHAT IS BARIATRIC SURGERY? PROCEDURES CLASSIFICATION

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WHAT IS BARIATRIC SURGERY?

For some people who are extremely obese, just dieting and exercise will not help them lose weight. As their obesity makes getting up and exercising difficult for them ,their obesity wrecks havoc on their lives as it leads to health complications like type 2 diabetes, arthritis, severe obstructive sleep apnea and heart disease.

It is people suffering from such extreme obesity who can undergo bariatric surgery for weight loss. It is a safe, effective, recognized and accepted weight loss treatment which also helps treat the above mentioned health conditions which arise due to severe obesity.

Bariatric surgery induces weight loss by restricting the stomach’s food holding capacity or gastric restriction, causing the imperfect absorption of nutrients in the small intestine or by a combination of both. Besides all this, bariatric surgery also induces hormonal changes and most of the surgeries are performed laproscopically.

However not everyone who is severely obese qualifies for bariatric surgery. There are some criteria to be met to undergo the surgery. Most important, your body mass index (BMI) should be within a certain range.

Generally, your body mass index should be 40 and above or, if it’s between 35 and 40 you have serious obesity related problems like diabetes, sleep apnea, joint problems and others. Gastric balloon is the only procedure which is performed in people with BMI between 30 and 35, and not on people with a BMI above 40. Even vBloc therapy is conducted only on those with a BMI between 35 and 45.

BASIC PRINCIPLES

The basic principles of bariatric surgery are helping at reducing your food intake, and reducing food absorption in stomach and intestines. Digestion in the human body starts when food is chewed and mixed with saliva and enzyme secretions in the mouth.

Food mixes with digestive juices in the stomach to break down and facilitate the absorption of calories and nutrients. Digestion quickens after this where food is mixed with bile and pancreatic juice in the duodenum.

Bariatric surgery alters this very digestion process so that food doesn’t end up broken and absorbed as it usually is. So by reducing the amount of nutrients and calories absorbed, bariatric surgery helps patient lose weight, and thus reduce the chances of their suffering from obesity related health problems.

BMI

Now what is BMI you may wonder? Well, it is a measure of height with weight, and used for defining obesity levels and to finally decide if a bariatric surgery is required.

Evidence has proven that obese people who undergo bariatric surgery have a lower death rate. The results and benefits are more pronounced in those people who follow a healthy diet and lifestyle changes after their surgery.

HEALTH BENEFITS OF BARIATRIC SURGERY

Bariatric surgery gives you a new lease of life as you lose weight rapidly after the operation, and continue to do so for about 18 to 24 months after the surgery. It is one of the most effective and longest lasting treatments for obesity related problems like migraine, hypertension, depression, sleep apnea, asthma, cardiovascular disease and in some cases even eliminates diabetes after the surgery.

Most of the people who undergo bariatric surgery feel better and tend to start participating in recreational and physical activities. They gain much more self-confidence than they had before surgery, which helps them face the world as they are no longer embarrassed about their obese physique.

health-benefits-of-bariatric-surgery

Generally, patients lose 30-50% of their excess weight in the first 6 months and 77% of their excess weight within 12 months of surgery.  They also manage to maintain 50-60% loss of excess weight for 10-14 years after surgery.

Those with a higher initial BMI tend to lose more total weight while those with lower initial BMI lose a higher percentage of excess weight to reach their ideal body weight. Those with Type 2 diabetes lose less excess weight than those who don’t have Type 2 diabetes.

Only few people eventually reach their ideal body weight after bariatric surgery but this is nothing to worry about as this is not it’s goal. Its goal is to lose as much of your excess body weight to help end your suffering from obesity related health problems.

BARIATRIC SURGERY PROCEDURES CLASSIFICATION

There are various types of bariatric surgery procedures performed based on the patient and their extent of obesity and related health problems. Surgery is performed either on an ‘open’ basis which involves cutting open the abdomen, or through laparoscopy where small half-inch incisions are made and surgical instruments are then guided into the abdomen through them.

Between the two, laparoscopic surgery is more common and popular as it requires less extensive cuts with minimal tissue damage, making recovery faster and easier. It also leads to fewer complications after surgery and an earlier discharge from the hospital.

These are the most common bariatric surgery procedures, with their individual advantages and disadvantages:

  1. Gastric sleeve or sleeve gastrectomy
  2. Gastric bypass
  3. Lap band or adjustable gastric band
  4. Gastric balloon
  5. Gastric plication

Download PDF : Click Here

Note : If the PDF does not working kindly click any Advertisment ads ads for Your pdf file 
From Highland Hospital, downloadable plans:

  • Diet #1 (Discharge Diet): Liquid Meal Plan.
  • Diet #2: Pureed Meal Plan.
  • Diet #3: Soft Meal Plan .
  • Diet #4: Lifestyle Meal Plan (Face Sheet).
    • Fruit: Lifestyle Meal Plan (Fruit).
    • Protein: Lifestyle Meal Plan (Protein).
    • Starch: Lifestyle Meal Plan (Starch).
    • Fats: Lifestyle Meal Plan (Fats).

From Brigham + Women’s Hospital, Boston:

  • Preoperative Diet: For Patients Who Do NOT Have Diabetes
  • Preoperative Diet: For Diabetics
  • Postoperative Diet: Gastric Bypass
  • Postoperative Diet: Lap Band

GASTRIC SLEEVE

gastric-sleeve
Gastric sleeve surgery is also called sleeve gastrectomy or bariatric sleeve surgery and involves removing a large part, about 75% of the stomach, to create a long, narrow tube or sleeve connecting the oesophagus to the small intestine.

There is no removal of the intestines or bypassing procedures but the sleeve is stapled while the rest of the stomach is removed. Some surgeons also reinforce the staple line, just as a precautionary measure.

Most of Vsg vertical sleeve gastrectomy surgeries are performed laproscopically and take about one or two hours to perform. Its shorter operative time when compared to the gastric bypass make this a better option for obese people suffering from severe lung or heart disease.

WEIGHT LOSS

It is by reducing the size of the stomach and thus limiting the amount of food eaten at a time that the VSG procedure helps with weight loss. The small stomach makes the patient feel full sooner after eating small amounts of food.

Moreover removing a part of the stomach leads to the secretion of fewer hunger-causing hormones and a consequent drop in appetite. Generally patients who had undergone this surgery lose about 21% of their total body weight by the third year of surgery.

HORMONAL AND METABOLIC CHANGES

The bariatric surgery sleeve not only reduces the stomach size, but also reduces the amount of the ‘hunger hormone’ ghrelin that is produced by the stomach. While it’s not clear how long this effect lasts, most patients generally feel less hungry after the operation.

POSSIBLE COMPLICATIONS

There is only a 5-10% risk of major complications after the operation because there is no division and reconnection of the small intestine during the procedure. It is this reduced risk of the surgery that makes this operation a better bariatric surgery option for high-risk patients.

The possible risks include leaking from the sleeve which results into an infection or abscess, narrowing of the sleeve which requires endoscopic dilation, bleeding and blood clotting or pulmonary embolism. It’s only in less than 5% of the patients that there are major complications requiring reoperation after the surgery.

As bariatric sleeve surgery is a relatively new procedure, there is not much information about the amount of weight lost or gained after three years. However the risk of death from the surgery is only 0.2% within a month of surgery. So it proves that VSG has been successfully performed on different people suffering from severe obesity.

CONCLUSION

Gastric sleeve surgery can lead to significant weight loss. However like any weight loss procedure, the results are longer lasting and more prominent if there are healthy lifestyle and behavioural changes made with the surgery.

GASTRIC BYPASS

gastric-bypass
Gastric bypass is also called Roux-en-Y gastric bypass or RNY and has been performed since the late 1960’s to help the severely obese lose weight. It involves reducing the stomach size so that you feel fuller quicker after eating and bypassing a part of the intestine so that gut hormones are released to make you feel less hungry and the body absorbs fewer minerals.

The surgery can be performed through a single, long, open incision or laparoscopically through various small incisions. The surgery consists of three parts:

  1. The first part involves dividing the large stomach into two to staple and create a small proximal pouch of stomach at the top portion, near the end of the oesophagus and a large remnant or larger excluded lower pouch of stomach attached to the top of small intestines.
  2. Then the surgeon traverses further down into the small intestine to bypass it and create the short Intestinal Roux Limb by attaching to the pouch.
  3. The third step involves taking the end of the small intestine connected to the proximal pouch of stomach and attaching it to the base of the ‘Roux limb’. The stomach’s digestive juices thus ‘meets’ the food in intestines.

It takes about two hours or less to perform this surgery. The exact time depends on various factors. Patients have to stay in the hospital for 2-3 days after the operation and will be able to return to full activity in a few weeks’ time.

WEIGHT LOSS

You can understand the benefits of the surgery if you understand human digestion. The food swallowed reaches the stomach through the oesophagus, where the food is churned and mixed with digestive juices and broken down into liquid form. This is when the food leaves the stomach to enter the small intestine and get absorbed to fuel the body.

While the stomach can naturally hold large amounts of food, the gastric pouch created during the surgery limits the amount of food and calories a person consumes at a meal. The pouch initially holds only about a tablespoon of food.

After a year, gastric bypass patients will be able to eat as much as a 7-8 year old child eats. Though meals are much smaller after gastric bypass surgery, the patient still feels as satisfied as they did with larger meals.

The small intestine cannot absorb food till it’s broken down into liquid form. After the gastric bypass, the food doesn’t liquefy till it leaves the ‘Short Intestinal Roux Limb’ which thus doesn’t absorb the nutrients from food eaten.

DUMPING SYNDROME

As vitamins and minerals of food are not well absorbed, gastric bypass patients need to take supplements for the rest of their lives. Moreover, as the ‘Short Intestinal Roux Limb’ doesn’t handle sugar and starches well, gastric sleeve patients have to limit its consumption.

Failing which they may experience ‘Dumping Syndrome’ where they experience symptoms like abdominal pain, shakiness, fainting, sweating, dizziness, low blood pressure, flushing skin, rapid heart rate, diarrheal or vomiting within 10-15 minutes of eating starchy or sugary foods.

This lasts for about 30-45minutes and fades away. It’s usually Dumping, or its fear, that make gastric sleeve patients make better food choices and avoid the sugary and starchy foods they were tempted by in the past, and thus don’t regain any weight.

POTENTIAL WEIGHT LOSS AND HORMONAL CHANGES

Bypass patients lose about 4% of their total body weight by the first year and by the third year; they lose about 31.5% of their original total body weight. Gastric sleeve surgery not only reduces the size of the stomach, but also reduces the amount of ghrelin ‘hunger hormone’ produced by the stomach. While it’s not clear how long it lasts, patients don’t feel that hungry after the operation.

POSSIBLE COMPLICATIONS

Possible complications after gastric bypass surgery include bowel blockages, infections, bleeding, leakage, blood clots in the lungs and death. There is a 0.2-0.5% chance of dying within a month of a gastric bypass.

Possible long-term complications after a gastric bypass surgery includes regained weight, strictures, hernias, ulcers, vitamin and mineral deficiency and consequent malnutrition. However most of these problems can be prevented with the help of your healthcare team.

FINAL VERDICT

Gastric bypass is bariatric surgery which helps induce significant and sustained weight loss by reducing the quantity of food eaten and changing gastrointestinal hormones. Like any surgery, there are short and long-term risks associated with the surgery which can be prevented through follow-ups. Moreover, best results are achieved by making healthy lifestyle changes and following a bariatric surgery diet after the surgery.

LAP BAND

lap-band
The lap band surgery is also called gastric band or laparoscopic adjustable gastric band and has been around since the 90s but got FDA approval in 2001. Its popularity has however dropped because of its high long-term failure rate.

The maker of Lap Band however insists that these failures were not a consequence of the surgery, but because patients didn’t follow the surgery’s strict follow-up. They have thus reinvented their support process to improve their reputation.

THE PROCEDURE

The surgery involves sewing a silicone and Silastic band around to squeeze a narrow section of the stomach’s upper-middle part. It separates the stomach into a tiny upper pouch and a bigger lower pouch.

A tubing connects the band to a port located below the abdominal wall skin, usually around the belly button. The exact spot of the port site varies with the surgeon but cannot be seen or even felt from the outside.

There is a balloon located inside the belt, in the inner band surface which is filled by fluid passed through the port. The filled balloon slows the passage of food from the upper to lower pouch and as the band is progressively filled, patients start feeling full quicker and eat smaller amounts of food.

Your surgeon will determine the number of band fills or adjustments you will require. He may add or remove saline solution to make the balloon tighter or looser where the tighter it is, the less hungry you feel.

AMOUNT OF WEIGHT LOSS

You can expect slow and steady weight loss after an adjustable gastric band surgery. On an average, patients lose about one to two pounds a week in the first year following band placement.

So by the first year, the patient may lose about 14% of their total body weight at the time of the procedure. By the third year, the patient ends up losing about 15.9% of their total body weight.

METABOLIC AND HORMONAL CHANGES

The adjustable gastric band surgery is appealing to those considering bariatric surgery mainly because there is minimal stress placed on the body at the time of surgery. The band is usually done laporascopically without any cutting of the stomach, or rerouting of the intestines.

As it is laparoscopic surgery, patients can return home on the same day, or the next morning. It’s also why recovery from the surgery is usually quick, and most people can start working within a week or so of surgery.

Another point which sets this surgery apart from others is its band adjustability. Doctors can make band adjustments based on the patient’s individual weight loss goals and requirements. Moreover, as there is no bypassing of the stomach or intestines, there is a reduced risk of any mineral and nutrition problems occurring after banding.

There however are some programs where vitamin supplementation is advised after banding. Though this is non-metabolic procedure, some patients claim fewer hunger pangs.

POSSIBLE COMPLICATIONS

If you are thinking of undergoing adjustable gastric banding, remember that you will end up with a medical device in your body for life. So you need to be mentally ready and comfortable with this thought.

The band does have an excellent safety profile. However like any weight-loss operation, there is always a chance of complications occurring after the surgery. It’s thus important that you comply to your doctor’s routine follow-up for constant monitoring and to ensure adjustments are made when required.

About 30-50% of patients who have undergone this surgery usually undergo a second operation to take care of band complications. There is the possible risk of band slippage or gastric prolapsed, the band eroding through the stomach and even the risk of tubing leakage. There is a 0.1% or less risk of death occurring after 30 days of the band surgery. However some centres do report lower rates.

While there is the option of removing the adjustable gastric band, if necessary, the band is not a temporary fix. It should be left in your body indefinitely. There are no long term effects associated with the band as yet.

Patients need to attend their regular follow-ups with their healthcare team, especially in the first year of surgery as the band may have to be more frequently adjusted. So keep this in mind if you are thinking of undergoing gastric banding surgery. You need to consider the amount of time you’ll be spending, and the distance you have to travel to make all these adjustments.

As banding patients don’t have many adverse effects after eating sugars like the Dumping Syndrome, they have to be more disciplined with their diet. Eating chocolates and cakes will not help you lose the amount of weight you want to lose.

FINAL VERDICT

All this proves that gastric banding is indeed an effective weight-loss operation which leads to eventual long-term weight loss. Just remember that no matter what bariatric surgery you opt to undergo, you have to change your lifestyle for the better or healthier, for its success.

GASTRIC BALLOON

gastric-balloon
Gastric balloon or intragastric balloon is the latest in weight loss surgery where an inflated balloon is placed in the stomach to reduce the stomach space so that there’s less room for food. You thus end up feeling full sooner and tend to eat less.

However as the balloon has to be removed within 6 months’ time, this is a temporary solution undertaken to jump-start a long-term exercise and diet program. So the procedure is a restrictive weight-loss surgery which restricts the amount of food your stomach holds so that you feel fuller without eating much.

PROCEDURE

Intragastric balloon is a minimally invasive weight-loss surgery procedure which helps reduce the stomach’s capacity by about 3 ounces. Unlike gastric banding, there is no use of any implanted devices, and it is a reversible procedure as no portion of the stomach is removed. Neither is there any rerouting or reconnection of intestines.

It is performed by the surgeon first numbing the throat using a spray and giving you a sedative. Then a plastic mouth guard is inserted into the patient’s mouth for passing the endoscopic camera through the mouth into the stomach. If there are no abnormalities, the scope is then removed, and the balloon passed into your stomach.

Depending on the balloon type, it is inflated with either air or saline solution through a small filling tube attached to the balloon. The doctor gently removes the tube by pulling on its external end when the balloon is full, while leaving the balloon in the stomach.

A scope is again passed into the stomach to check if the balloon is positioned in the correct place and everything is okay. The procedure takes about 20 minutes, after which the patient is monitored for a while. The patient is usually discharged within 2 hours of balloon insertion.

IDEAL CANDIDATE

The best candidates for intragastric balloon are those need to lose 10-30 kilograms of weight. They should have a BMI of 27 or greater. It’s also performed on individuals who cannot undergo other weight loss surgeries. It is generally performed to help the individual lose some weight before surgery and thus reduce the possibility of risks of surgical procedure on the obese.

While the balloon is placed in the stomach for 6 months, if your doctor recommends using it for longer than 6 months, replace the balloon with a new one after the six months. If you are worried about the gastric balloon deflating, don’t.

Your doctor will place some colored methyliene blue in the balloon which helps identify early deflation or leakage by changing your urine colour to green. If you notice this change, do notify the clinic immediately to remove the balloon.

REMOVAL

The balloon is removed just as it was placed; through the oesophagus and mouth. Your physician introduces a catheter through the mouth into the stomach, using the help of an endoscopic camera.  The balloon is then punctured, deflated, grasped and removed.

POSSIBLE WEIGHT LOSS

As the intragastric balloon is only a weight loss tool, you need to follow a healthy diet, exercise and behaviour modification program after undergoing the procedure. Your weight loss depends on how well you follow your diet, and make life-term lifestyle changes.

POSSIBLE RISKS AND COMPLICATIONS

You may get nauseatic within a few days of placing the balloon in the stomach where your doctor will prescribe medications for its relief. There’s obviously the risk of your losing minimal weight as the procedure cannot guarantee much weight loss. Its success lies in your hands and lifestyle changes!

RECOVERY

You need to take at least 3 days rest to recover from the procedure. Depending on how well your body adjusts to the balloon, you can resume your normal activities after 3 days. While there may be some discomfort of the balloon’s presence for the first few days after the procedure, you later start feeling full because of the balloon.

You will have to visit your lifestyle team at least once a month in the first six months after inserting the balloon to learn new lifestyle habits. Once the ball is removed, you need to make bi-monthly visits for another 6 months wherein your progress is evaluated, and you learn all about health, exercise and nutrition for long-term weight loss success.

DIET

There are no food restrictions after your gastric balloon procedure. However you will not feel like eating as much as you used to eat and you may feel unwell if you eat fatty or sweet foods. It’s also not advisable to eat excessively with the balloon in place as it’s dangerous.

GASTRIC PLICATION

gastric-plication
Gastric plication is a weight-loss surgery performed laparoscopically to reduce the stomach size by folding its lining inside itself. The procedure takes about 40 minutes to 2 hours to perform wherein the stomach’s size and capacity is reduced by 75% so that you feel full faster with smaller amounts of food.

Patients have to stay in the hospital for a day or two after the surgery, and recovery takes a week before the patient can return to work. Moreover, the patient has to make healthy lifestyle changes which ensure weight loss like following a healthy diet and doing some regular exercise.

ADVANTAGES AND DISADVANTAGES

The advantage of gastric plication is that there is no rearrangement of the digestive system like in the gastric bypass. There is also no need of any additional adjustment surgeries like gastric banding nor is there need of any implantation of banding devices in the stomach. The surgery is also reversible like gastric banding, and unlike gastrectomy or gastric bypass.

Though this is a relatively new procedure, midterm results prove it’s an effective bariatric procedure. Patients can lose as much as 57% of their weight by the first year and as much as 68% of their original weight in four years’ time.

While there is a relatively low risk of complications associated with the procedure in about 1 to 9% of patients, the most significant complication is nausea and vomiting which lasts for about a week after surgery.

Other risks are similar to the risks associated with any surgery like separation of stitched areas and leaks from sutured areas which may require additional surgery. Moreover, you have to first check with your insurance provider to ensure the bariatric surgery cost is covered.

The ideal candidate for the surgery is someone whose BMI has been 30 or more for several years, who is willing to make major healthy lifestyle changes and whose many serious nonsurgical weight-loss attempts have been unsuccessful.

CONCLUSION

So you can see that all of these different bariatric surgery types have its individual advantages and risks and complications. Moreover, the different procedures have different factors which affect the effectiveness of the procedures like BMI, obesity related health problems, eating habits and if any stomach surgeries were earlier performed.

This is why you need to discuss the feasibility and the best surgical option for your obesity with your provider by taking a look at bariatric surgery before and after pictures. The bariatric surgery pictures, and your doctor’s advice based on the risks and benefits of each surgery and your present help helps make the final decision.

Whichever bariatric surgery suited for your obese condition, you will have to follow a pre bariatric surgery diet to reduce the fat around your liver and spleen. Follow the diet for a week or two before the surgery as if it’s not followed, there is a chance of the surgery getting delayed or cancelled in the middle of the procedure.

Remember bariatric surgery is not an easy way out of obesity; it just helps you lose weight. It is left to you to follow healthy lifestyle changes after the surgery to maintain the weight loss and healthy quality of life.

Download PDF : Click Here

Note : If the PDF does not working kindly click any Advertisment ads ads for Your pdf file 
From Highland Hospital, downloadable plans:

  • Diet #1 (Discharge Diet): Liquid Meal Plan.
  • Diet #2: Pureed Meal Plan.
  • Diet #3: Soft Meal Plan .
  • Diet #4: Lifestyle Meal Plan (Face Sheet).
    • Fruit: Lifestyle Meal Plan (Fruit).
    • Protein: Lifestyle Meal Plan (Protein).
    • Starch: Lifestyle Meal Plan (Starch).
    • Fats: Lifestyle Meal Plan (Fats).

From Brigham + Women’s Hospital, Boston:

  • Preoperative Diet: For Patients Who Do NOT Have Diabetes
  • Preoperative Diet: For Diabetics
  • Postoperative Diet: Gastric Bypass
  • Postoperative Diet: Lap Band
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