Bariatric surgery has now become a highly specialized department that offers latest technology, operation techniques and management protocols for morbid obesity and weight related ailments.
Bariatric surgery refers to a range of surgical procedures designed to help severely obese people lose weight. With millions people suffering from severe obesity, the number of bariatric procedures has risen exponentially over the last two decades.
Bariatric surgical procedures are an option for treating severe obesity, by reducing intake or absorption of calories. There are various procedures, all of which have potential complications. Bariatric surgery should always be performed in a specialist centre, and long-term follow-up of patients is necessary.
These procedures can be categorized according to their modes of action. Some limit food intake, generally by decreasing the size of the stomach so that patients feel sated sooner than they did before surgery. Others restrict the body’s ability to absorb some components of food, including calories. A third category incorporates aspects of both methods.
Morbid Obesity & Health Hazards
Obesity is a condition in which one has too much body fat (adipose tissue). Obesity is determined by calculating the Body Mass Index (BMI), which measures weight for height and is stated in numbers.
Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on normal body functioning. These “co-morbidities” affect nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life threatening. The cumulative effect of these co-morbidities can interfere with a normal and productive life and can shorten life as well. The risk of developing these medical problems is proportional to the degree of obesity.
The morbidly obese have to seriously consider surgery for reducing weight to avoid its ill effects. Surgery for Morbid Obesity is for the following situations:
- The person’s BMI is over 40, or is 35 or higher and a serious medical problem (hypertension, diabetes, heart disease, joint problems, reflux) that is made worse by obesity is present.
- If it has not been possible to reduce or maintain weight under a medically supervised program.
- If the person has been obese for at least 5 years.
Surgical options for treating Morbid Obesity
Laproscopic Adjustable Gastric Binding
- An Inflatable Gastric Band is used, thus creating an Hourglass structure to the Stomach.
- This procedure may lead to about 39% of the excess weight being reduced within 18 months after the surgery.
- This procedure needs a high level of compliance from patient regards lifestyle and diet post surgery.
- There is always a risk of the Band eroding into the stomach, slipping out of place, and can also produce vomiting, development of GERD or sometimes the device can also fail to function.
Laproscopic Sleeve Gastrectomy
- Laparoscopic Sleeve Gastrectomy is safer than other procedures.
- In this procedure, 80% of the stomach is stapled and removed which induces weight loss by restriction in food intake and early satiety, due to loss of hunger producing hormones.
- Digestion and absorption is normal.
- By eating less the body draws the required energy from its own fat stores and thus you lose weight.
The R OUX-EN-Y Gastric Bypass
- In this procedure, a small, 15 to 20 cc, pouch is created at the top of the stomach.
- The small bowel is divided. The bilio-pancreatic limb is reattached to the small bowel and the other end is connected to the pouch, creating the Roux limb.
- The small pouch releases food slowly, causing a sensation of fullness with very little food intake.
- The bilio-pancreatic limb preserves the action of the digestive tract.
Bilio Pancreatic Diversion With Duodenal Switch
- In this procedure, greater weight loss can happen with less dietary compliance from the patient.
- There may be an increased risk of malnutrition and vitamin deficiency and intermittent diarrhoea can also occur.
- Constant follow-up is needed for this procedure in order to monitor for complications.
Dr. Chirag Desai
Dr. Mohit Bhandari