Bariatric Surgery

Bariatric surgery, also known as weight loss surgery, is a highly effective option for severely obese individuals who have struggled to lose weight through other means. Utilizing minimally invasive laparoscopic techniques, these surgeries restrict the amount of food the stomach can hold, leading to weight loss through both gastric restriction and malabsorption. Additionally, they often induce hormonal changes that further facilitate weight loss. Common procedures include gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with a duodenal switch.

Obesity is a major health concern, with symptoms often identified through body mass index (BMI), which categorizes individuals as underweight, normal, overweight, or obese. A BMI between 18.5 and 25 is normal, 25 to 30 is overweight, and 30 or higher is obese. Regular BMI monitoring helps in early detection and prevention of weight-related issues.

The patient with a BMI of 35 or more and an increasing trend, of obese patients with obesity-related diseases or conditions are the ones who need bariatric surgery for weight loss. The metabolic actions in these people have changed due to obesity, which results in the overproduction of ketone bodies and other symptoms like acidosis and hyperglycemia. In such patients, surgical intervention is necessary as it helps reverse the metabolic actions that occur because of obesity.

Bariatric surgery candidates typically fall within the age range of 20-40 years with a BMI between 35-40 and an obesity-related condition like diabetes mellitus or hypertension. They should also be within 5 or more pounds of their ideal weight. Additionally, candidates should commit to exercising for at least ninety minutes weekly and have demonstrated short-term success with previous weight loss attempts. Other considerations include a history of being overweight for more than 5 years, readiness to make lifestyle changes, and absence of auto-immune diseases.

• Gastric Bypass: Involves dividing the upper stomach and small intestine, resulting in reduced food intake and increased satiety.
• Biliopancreatic Diversion (BPD): Creates a smaller stomach and limits nutrient absorption by closing off part of the intestine.
• Gastric Sleeve (Sleeve Gastrectomy): Removes a portion of the stomach to create a smaller gastric "sleeve," restricting food intake.
• Gastric Ballooning: Minimally invasive procedure involving the inflation of a balloon in the stomach to reduce its size.
• LAP-BAND Surgery: Involves placing an adjustable band around the top of the stomach to restrict food intake.
• SILS (Single Incision Laparoscopic Surgery): Next-generation laparoscopic surgery using a single port for various abdominal procedures.
• Endoscopic Bariatric Surgery: Effective for treating morbid obesity, reducing disease risk factors like hypertension and diabetes. Can be used as a primary treatment or when other procedures fail.

Restrictive Procedure - The Lap Gastric Band

The restrictive surgery is done by placing the band in the upper part of the stomach. This creates a small outlet which limits the amount of food consumed at one time, making one feel full after eating smaller amounts of food. The idea is to decrease daily calorie intake without excess weight gain or loss.

• Gastric Band Surgery: Permanent reduction in stomach size, shorter recovery period, no cutting or stapling, adjustable outlet size controlled by surgeon.
• Roux-en-Y Gastric Bypass: Creates smaller stomachs, bypasses part of small intestine, controls appetite and prevents overeating.
• Vertical Gastrectomy: Permanently reduces stomach size without affecting appetite, performed laparoscopically with minimal incisions, results in significant weight loss.
• Benefits of Gastric Banding: Easily controlled pouch outlet size, adjustable band for food passage control, no external drain required.

• Adherence to Healthy Lifestyle: Surgery alone does not guarantee success; maintaining weight requires a healthy lifestyle.
• Early Satiety: Feeling full after small meals aids in following a low-calorie diet plan, limits caloric intake, and prevents overeating.
• Weight Maintenance: Prolonged feeling of fullness helps minimize weight regain, supporting long-term weight management.