Bariatric surgery is the most effective weight-loss surgery for the morbidly obese. Lap banding and gastric bypass are the most common types of d weight loss surgeries with good results and minimal complications.
Obesity is one of the most common nutritional disorders in the world. A Body Mass Index (BMI) of 30 kg/m2 and above defines it. BMI is calculated as weight (in kilograms)/height squared (in meters).
Morbid obesity is regarded as a metabolic disease linked with numerous medical problems. The list of co-morbidities is long. The most prevailing problems are the combination of arthritis and degenerative joint disease, sleep apnea, asthma, hypertension, diabetes, and gastroesophageal disorders.
Bariatric surgery (Etymology: Greek words "baros," meaning "weight," and "iatrikos," meaning "medicine") is the term for a surgery that helps you lose weight. It originated in the 1950s. The significant risks associated with this surgery prevent it from being used in every individual who is obese. The success of medical therapy for severe obesity is limited.
Due to the current high levels of obesity among people in US of all age groups, and the lack of success with non-surgical weight loss methods:
1. Bariatric surgery is now becoming a very important option for severely obese patients.
2. It is estimated that approximately 170,000 bariatric operations were performed in the US in the year 2005.
The procedure was developed out of modifications on cancer/ulcer operations that involve the removal of a part of the stomach or small intestine. It was noticed that patients undergoing these operations lost weight afterwards, and the doctors developed the idea of using similar types of surgery to treat morbid obesity.
These surgical procedures are major gastrointestinal operations that work on the principles-
1. To bypass most of the stomach to reduce the amount of food one can eat.
2. To rearrange the small intestine so as to reduce the calories the bodies can absorb.
There are several different types of bariatric weight loss procedures, and they are collectively called as 'bariatric surgery.”
These surgical procedures are major gastrointestinal operations that work on the principles-
1. To bypass most of the stomach to reduce the amount of food one can eat.
2. To rearrange the small intestine so as to reduce the calories the bodies can absorb.
There are several different types of bariatric weight loss procedures, and they are collectively called as 'bariatric surgery.”
CELECTION OF PATIENTS
Patients must meet the following criteria for consideration for bariatric surgery:
BMI >40 kg/m2 or BMI >35 kg/m2 with an associated medical co morbidity worsened by obesity Generally when a person’s weight is 220kg or over, they are considered for this surgery. Dietary therapy has failed to achieve results Mentally (psychiatrically) stable without alcohol dependence or illegal drug use Fully informed about the operation and its consequences Motivated No medical problems that would possibly prevent survival from surgeryCertain other factors taken into account include:
If a person is obese for at least 5 years No previous history of alcohol abuse No history of depression or another major psychiatric disorderAge is a controversial area for selection of patients for the surgery. Food and Drug Administration (FDA) approved LAP-BAND for use in patients 18 years and older. The age of 60s is generally set as a cut off for performing gastric bypass. Increasing experience will be required to decide what type of surgery benefits which age group.
Preparing For Weight Loss Surgery
The success of medical therapy for severe obesity is limited. Despite this limited success, a medically supervised diet program is first tried on every severely obese patient. Consultation with an array of specialists is scheduled before the surgery:
It is necessary for persons to undergo a thorough certain examinations to determine eligibility for gastric bypass surgery such as:
Medical Nutritional PsychiatricThese evaluations are done to protect the patient's interests, and to give the surgical team proper information necessary for the procedure.
A detailed work up is done to rule out any of the contra indications. For details refer to the FAQs section of this article.
Pre Operative Period of Bariatric SurgeY
Patient getting admitted for the procedure will have to be prepared for
Admission one or two days prior to the surgery.
Routine blood and urine tests will be undertaken on the patients.
This is the time for the patient to clear all the leftover doubts with the surgeon about the surgery and its results.
Breathing exercises should be practised to help in the postoperative period.
Smoking should be given up.
One should be prepared to stay on for a few days after surgery if there are any complications.
In the morning of their surgery they are taken to the pre-operative room, where they change into a hospital gown and receive intra-venous (IV) fluids.
Families can stay with the patient until they are taken to the operating theatre, at which time the family will be taken to the waiting room.
Admission one or two days prior to the surgery. Routine blood and urine tests will be undertaken on the patients. This is the time for the patient to clear all the leftover doubts with the surgeon about the surgery and its results. Breathing exercises should be practised to help in the postoperative period. Smoking should be given up. One should be prepared to stay on for a few days after surgery if there are any complications. In the morning of their surgery they are taken to the pre-operative room, where they change into a hospital gown and receive intra-venous (IV) fluids. Families can stay with the patient until they are taken to the operating theatre, at which time the family will be taken to the waiting room.
Type of Bariatric Surgey
Lap banding and gastric bypass are the most commonly used Bariatric Surgery or Weight loss surgeries. All surgeries fall into two groups: restrictive and restrictive-malabsorptive.
Several types of weight loss surgeries (Bariatric surgeries) are available. Lap banding and gastric bypass are the most commonly used ones.
Roux-en-Y gastric bypass
Laparoscopic adjustable gastric banding (LAGB)
Biliopancreatic diversion (BPD)
Duodenal switch (DS)
Vertical banded gastroplasty (VBG)- abandoned
Weight loss surgeries (Bariatric surgeries) fall into two groups: restrictive and restrictive-malabsorptive. In a restrictive surgery, the amount of food the stomach can hold is limited and the rate of gastric emptying is slowed down.
Laparoscopic adjustable gastric banding (LAGB) is the most commonly performed restrictive operation. An adjustable band (the lap-band) is used around the opening of the stomach. The band is connected to a reservoir that is implanted under the skin. Injection or removal of saline into the reservoir constrains or loosens the band's internal diameter. The size of the gastric opening can thus be altered.
There are three restrictive-malabsorptive bypass procedures: Roux-en-Y gastric bypass (RYGB), Biliopancreatic diversion (BPD), and Biliopancreatic diversion with duodenal switch (BPDDS). They work by combining the elements of gastric restriction and selective malabsorption.
Roux-en-Y gastric bypass (RYGB) is the most commonly performed and accepted bypass procedure. A small pouch is created in the stomach and it is attached to the small intestine. The procedure can be performed as an open surgery (by making an incision on the abdomen) or laparoscopically (via smaller incisions, using smaller instruments). The surgery usually involves a 5-7 day hospital stay in case of open and 2-3 days in case of laparoscopic procedures. Most people may return to their normal activities within 3 to 5 weeks.
Patients who have an extremely high BMI and are high operative risks benefit from a two-stage duodenal switch (DS) procedure. This includes sleeve gastrectomy where the size of the stomach is reduced to a narrow tube. This procedure is however not as commonly done as the previously mentioned ones.
Post Operative Care After Bariatrict Surgery
Bariatric surgery generally takes 2-2 ½ hrs, and the surgeon will normally inform the family after surgery has been completed.
The patient recovers in the recovery room from the effects of anaesthesia, after 2-3 hr
Once fully recovered the patient will be wheeled to their bed or room in the hospital.
Patients may have a nasogastric tube (NG), an IV and a Foley catheter in their bladder.
The NG is usually removed 1-2 days later, after an x-ray of the new pouch has been taken.
After 2-3 days the patient can begin drinking water and about 60ml of a dietary supplement such as Boost, Horlicks or other similar food supplements.
The patient will remain on liquids for the first 2 weeks after surgery, drinking the supplement for meals.
The other liquids patients may have are decaffeinated coffee or tea, skimmed milk, broth (kanji), water, diluted fruit juice (1/3 juice mixed with 2/3 water) and sugar-free ice candies.
The patient must avoid at all costs sweetened and/or carbonated beverages and adding sugar in their liquids.
Average hospital stay is from 5 to 7 days depending on the physique of the patient.
Patients must be able to drink adequate amounts of fluid before they can be discharged home.
Complications and Risks of Bariatric Surgery
Surgical mortality from bariatric surgery is generally less than 1%. Risks involved vary with the procedure, patient’s age and medical conditions, and the expertise of the operating team.
Males have increased risk for morbidity and mortality compared to females undergoing this surgery.. What follows is a list of the possible complications of bariatric surgery:
Bleeding from the intestines
Infection of the wound
Blockage, tear in the bowels
Food intolerance
Vomiting or straining after surgery before the incision heals can cause a hernia. Laparoscopy assisted surgery greatly reduces hernia risk.
Depression
Nutritional consequences: Deficiency of calcium, vitamin D, vitamin B-12, iron.
Gastroesophageal reflux
Hiccups and bloating may occur due to the enlargement of the bypassed stomach
Ulcer
Blood clots in the legs or lungs
Heart attack
Pneumonia
Urinary tract infection
Anesthetics problems may occur as in any major operation.
In bariatric surgery a condition called "rapid gastric emptying" or Dumping syndrome can occur. Dumping syndrome occurs when the lower section of the small intestine (jejunum) fills up too quickly with undigested food from the stomach, causing unpleasant digestive effects. Dumping syndrome can also be triggered in gastric surgery patients by consumption of simple carbohydrates (sugar, or some starches) or carbohydrates with a high glycemic index.
There are two variants of rapid gastric emptying: early and late dumping.
Early dumping typically starts during or immediately after a meal with symptoms like:
1. Abdominal cramps
2. Bloating
3. Palpitations
4. Nausea
5. Vomiting
6. Diarrhea
7. Shortness of breath
Late dumping typically occurs 1-3 hours after eating with symptoms like:
1. Weakness
2. Dizziness
3. Fatigue
Diet of Bariatric Surgery
Patients would be started on to solid food in about 2 weeks after surgery.
At this time the patient will be instructed to start a soft diet, in 60ml, portions, focusing on eating proteins.
The diet will be advanced slowly so that the patient may add new foods every 1-2 week for the first 8 weeks.
At the end of 2 months the patient will be able to try new foods, in small amounts. Around 6 month after surgery, the patient should be able to eat a child-sized meal.
There are some foods like those high in sugar that could cause "dumping syndrome" and patients should avoid them, these include-
1. Sweetened sodas
2. Ice cream
There may be some foods like bread that patients may not tolerate initially after the surgery but would be able to eat several months later.
Every patient will need to find what foods they best tolerate during the different phases of their weight loss process.
Result of Bariatric Surgery
Safety & Effectiveness of Weight Loss Surgery (Bariatric Surgery)
Bariatric surgery is the most effective weight-loss therapy for the morbidly obese. The result of the surgery is well acceptable and has made this surgery safe for the morbidly obese. The first follow-up has to occur within a month after surgery.
Studies have shown that bariatric surgery is the most effective weight-loss therapy for the morbidly obese. Morbid obesity is defined as a BMI>40 kg/m2. Most of the weight loss occurs in the first 1 to 2 years after surgery. Loss of weight will bring down medical problems associated with obesity.
An ideal weight need not be attained after bariatric surgery. A 50 to 60% of excess body weight is sufficient to declare the surgery to be a success.
Follow-Up after Surgery
A long-term follow-up is always required. The first follow-up has to occur within a month after surgery when the doctor evaluates oral intake, tolerance to food, the status of the wounds (progress of healing) and weight loss. With time, the frequency of visits decreases. The advice from your nutritionist is to be tightly adhered to. Vitamin supplements are often required.
A commitment to staying healthy for life is an absolute must.
Lap banding and gastric bypass are the most commonly used Bariatric Surgery or Weight loss surgeries. All surgeries fall into two groups: restrictive and restrictive-malabsorptive.
Several types of weight loss surgeries (Bariatric surgeries) are available. Lap banding and gastric bypass are the most commonly used ones.
Roux-en-Y gastric bypass Laparoscopic adjustable gastric banding (LAGB) Biliopancreatic diversion (BPD) Duodenal switch (DS) Vertical banded gastroplasty (VBG)- abandonedWeight loss surgeries (Bariatric surgeries) fall into two groups: restrictive and restrictive-malabsorptive. In a restrictive surgery, the amount of food the stomach can hold is limited and the rate of gastric emptying is slowed down.
Laparoscopic adjustable gastric banding (LAGB) is the most commonly performed restrictive operation. An adjustable band (the lap-band) is used around the opening of the stomach. The band is connected to a reservoir that is implanted under the skin. Injection or removal of saline into the reservoir constrains or loosens the band's internal diameter. The size of the gastric opening can thus be altered.
There are three restrictive-malabsorptive bypass procedures: Roux-en-Y gastric bypass (RYGB), Biliopancreatic diversion (BPD), and Biliopancreatic diversion with duodenal switch (BPDDS). They work by combining the elements of gastric restriction and selective malabsorption.
Roux-en-Y gastric bypass (RYGB) is the most commonly performed and accepted bypass procedure. A small pouch is created in the stomach and it is attached to the small intestine. The procedure can be performed as an open surgery (by making an incision on the abdomen) or laparoscopically (via smaller incisions, using smaller instruments). The surgery usually involves a 5-7 day hospital stay in case of open and 2-3 days in case of laparoscopic procedures. Most people may return to their normal activities within 3 to 5 weeks.
Patients who have an extremely high BMI and are high operative risks benefit from a two-stage duodenal switch (DS) procedure. This includes sleeve gastrectomy where the size of the stomach is reduced to a narrow tube. This procedure is however not as commonly done as the previously mentioned ones.
Post Operative Care After Bariatrict Surgery
Bariatric surgery generally takes 2-2 ½ hrs, and the surgeon will normally inform the family after surgery has been completed.
The patient recovers in the recovery room from the effects of anaesthesia, after 2-3 hr
Once fully recovered the patient will be wheeled to their bed or room in the hospital.
Patients may have a nasogastric tube (NG), an IV and a Foley catheter in their bladder.
The NG is usually removed 1-2 days later, after an x-ray of the new pouch has been taken.
After 2-3 days the patient can begin drinking water and about 60ml of a dietary supplement such as Boost, Horlicks or other similar food supplements.
The patient will remain on liquids for the first 2 weeks after surgery, drinking the supplement for meals.
The other liquids patients may have are decaffeinated coffee or tea, skimmed milk, broth (kanji), water, diluted fruit juice (1/3 juice mixed with 2/3 water) and sugar-free ice candies.
The patient must avoid at all costs sweetened and/or carbonated beverages and adding sugar in their liquids.
Average hospital stay is from 5 to 7 days depending on the physique of the patient.
Patients must be able to drink adequate amounts of fluid before they can be discharged home.
The patient recovers in the recovery room from the effects of anaesthesia, after 2-3 hr Once fully recovered the patient will be wheeled to their bed or room in the hospital. Patients may have a nasogastric tube (NG), an IV and a Foley catheter in their bladder. The NG is usually removed 1-2 days later, after an x-ray of the new pouch has been taken. After 2-3 days the patient can begin drinking water and about 60ml of a dietary supplement such as Boost, Horlicks or other similar food supplements. The patient will remain on liquids for the first 2 weeks after surgery, drinking the supplement for meals. The other liquids patients may have are decaffeinated coffee or tea, skimmed milk, broth (kanji), water, diluted fruit juice (1/3 juice mixed with 2/3 water) and sugar-free ice candies. The patient must avoid at all costs sweetened and/or carbonated beverages and adding sugar in their liquids. Average hospital stay is from 5 to 7 days depending on the physique of the patient. Patients must be able to drink adequate amounts of fluid before they can be discharged home.
Complications and Risks of Bariatric Surgery
Surgical mortality from bariatric surgery is generally less than 1%. Risks involved vary with the procedure, patient’s age and medical conditions, and the expertise of the operating team.
Males have increased risk for morbidity and mortality compared to females undergoing this surgery.. What follows is a list of the possible complications of bariatric surgery:
Bleeding from the intestines
Infection of the wound
Blockage, tear in the bowels
Food intolerance
Vomiting or straining after surgery before the incision heals can cause a hernia. Laparoscopy assisted surgery greatly reduces hernia risk.
Depression
Nutritional consequences: Deficiency of calcium, vitamin D, vitamin B-12, iron.
Gastroesophageal reflux
Hiccups and bloating may occur due to the enlargement of the bypassed stomach
Ulcer
Blood clots in the legs or lungs
Heart attack
Pneumonia
Urinary tract infection
Anesthetics problems may occur as in any major operation.
In bariatric surgery a condition called "rapid gastric emptying" or Dumping syndrome can occur. Dumping syndrome occurs when the lower section of the small intestine (jejunum) fills up too quickly with undigested food from the stomach, causing unpleasant digestive effects. Dumping syndrome can also be triggered in gastric surgery patients by consumption of simple carbohydrates (sugar, or some starches) or carbohydrates with a high glycemic index.
There are two variants of rapid gastric emptying: early and late dumping.
Early dumping typically starts during or immediately after a meal with symptoms like:
1. Abdominal cramps
2. Bloating
3. Palpitations
4. Nausea
5. Vomiting
6. Diarrhea
7. Shortness of breath
Late dumping typically occurs 1-3 hours after eating with symptoms like:
1. Weakness
2. Dizziness
3. Fatigue
Males have increased risk for morbidity and mortality compared to females undergoing this surgery.. What follows is a list of the possible complications of bariatric surgery:
Bleeding from the intestines Infection of the wound Blockage, tear in the bowels Food intolerance Vomiting or straining after surgery before the incision heals can cause a hernia. Laparoscopy assisted surgery greatly reduces hernia risk. Depression Nutritional consequences: Deficiency of calcium, vitamin D, vitamin B-12, iron. Gastroesophageal reflux Hiccups and bloating may occur due to the enlargement of the bypassed stomach Ulcer Blood clots in the legs or lungs Heart attack Pneumonia Urinary tract infectionAnesthetics problems may occur as in any major operation.
In bariatric surgery a condition called "rapid gastric emptying" or Dumping syndrome can occur. Dumping syndrome occurs when the lower section of the small intestine (jejunum) fills up too quickly with undigested food from the stomach, causing unpleasant digestive effects. Dumping syndrome can also be triggered in gastric surgery patients by consumption of simple carbohydrates (sugar, or some starches) or carbohydrates with a high glycemic index.
There are two variants of rapid gastric emptying: early and late dumping.
Early dumping typically starts during or immediately after a meal with symptoms like:
1. Abdominal cramps
2. Bloating
3. Palpitations
4. Nausea
5. Vomiting
6. Diarrhea
7. Shortness of breath
Late dumping typically occurs 1-3 hours after eating with symptoms like:
1. Weakness
2. Dizziness
3. Fatigue
Diet of Bariatric Surgery
Patients would be started on to solid food in about 2 weeks after surgery. At this time the patient will be instructed to start a soft diet, in 60ml, portions, focusing on eating proteins. The diet will be advanced slowly so that the patient may add new foods every 1-2 week for the first 8 weeks. At the end of 2 months the patient will be able to try new foods, in small amounts. Around 6 month after surgery, the patient should be able to eat a child-sized meal. There are some foods like those high in sugar that could cause "dumping syndrome" and patients should avoid them, these include-1. Sweetened sodas
2. Ice cream
There may be some foods like bread that patients may not tolerate initially after the surgery but would be able to eat several months later. Every patient will need to find what foods they best tolerate during the different phases of their weight loss process.
Result of Bariatric Surgery
Safety & Effectiveness of Weight Loss Surgery (Bariatric Surgery)
Studies have shown that bariatric surgery is the most effective weight-loss therapy for the morbidly obese. Morbid obesity is defined as a BMI>40 kg/m2. Most of the weight loss occurs in the first 1 to 2 years after surgery. Loss of weight will bring down medical problems associated with obesity.
An ideal weight need not be attained after bariatric surgery. A 50 to 60% of excess body weight is sufficient to declare the surgery to be a success.
Follow-Up after Surgery
A long-term follow-up is always required. The first follow-up has to occur within a month after surgery when the doctor evaluates oral intake, tolerance to food, the status of the wounds (progress of healing) and weight loss. With time, the frequency of visits decreases. The advice from your nutritionist is to be tightly adhered to. Vitamin supplements are often required.
A commitment to staying healthy for life is an absolute must.
Bariatric surgery is the most effective weight-loss therapy for the morbidly obese. The result of the surgery is well acceptable and has made this surgery safe for the morbidly obese. The first follow-up has to occur within a month after surgery.
Studies have shown that bariatric surgery is the most effective weight-loss therapy for the morbidly obese. Morbid obesity is defined as a BMI>40 kg/m2. Most of the weight loss occurs in the first 1 to 2 years after surgery. Loss of weight will bring down medical problems associated with obesity.
An ideal weight need not be attained after bariatric surgery. A 50 to 60% of excess body weight is sufficient to declare the surgery to be a success.
Follow-Up after Surgery
A long-term follow-up is always required. The first follow-up has to occur within a month after surgery when the doctor evaluates oral intake, tolerance to food, the status of the wounds (progress of healing) and weight loss. With time, the frequency of visits decreases. The advice from your nutritionist is to be tightly adhered to. Vitamin supplements are often required.
A commitment to staying healthy for life is an absolute must.
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