Obesity & Weight loss (Bariatric)Surgery

Different type of weight loss surgeries is collectively called Bariatric surgery. Primary aim of these surgeries is to make changes in the digestive system of the body so that amount of nutrients absorbed is reduced and help lose weight. Bariatric surgery is considered when all other conservative methods like diet and exercise have failed. It can also be considered for those who face serious complications due to their weight. These procedures can:

Limit how much one can eat
Reduce body’s ability to absorb nutrients
Limit eating and reducing nutrient absorption both.

Bariatric surgeries offer many benefits, but healthy lifestyle changes including diet and exercise must be done to maintain benefits of surgery over long term.

Primary aim of Bariatric surgery is to help lose excess weight and reduce risk of weight related potentially life-threatening health problems like:

Heart disease
Stroke
High blood pressure
Fatty liver disease
Obstructive Sleep disorder
Diabetes
Gastric reflux

Bariatric surgery should be an option for morbidly obese people if:

Body mass index (BMI) is 40 or higher (extreme obesity).
BMI is 35 to 39.9 (obesity), associated with serious weight-related health problem, like type 2 diabetes, high blood pressure or severe obstructive sleep apnea.
In some cases, BMI is 30 to 34 with serious non treatable weight-related health problems.

Risks

Bariatric/Weight loss surgery is a major surgery and as with any major procedure, poses potential health risks, both in the short term and long term.

Short term risks associated with the bariatric surgical procedure are:

Bleeding
Infection
Reactions to anesthesia/medications
Blood clotting
Lung or breathing problems
Leakages in your gastrointestinal system at surgery site
Death (rare)

Longer term risks and complications of weight-loss surgery vary depending on the type of bariatric surgery. These risks are:

Bowel obstruction or blockage
Dumping syndrome – diarrhea, flushing, lightheadedness, nausea or vomiting
Gall bladder stones
Hernia
Blood sugar fluctuations
Malnutrition
Ulcers
Vomiting
Acid reflux
Need for a second, or revision, surgery
Death (rare)

Now a days most types of bariatric surgery are performed by minimally invasive techniques laparoscopically. Laparoscope is a small, tubular instrument with a camera and lens system attached. Through a small incision Laparoscope is inserted in the abdomen. Laparoscopic surgery makes recovery faster and hospital stay shorter. It may not be suitable for everyone and decision is taken case to case basis.

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Type of bariatric surgery depends on case to case basis.

Types of bariatric surgery

Roux-en-Y gastric bypass procedure is the most commonly done gastric bypass procedure. Roux-en-Y gastric bypass decreases the gastric capacity limiting amount of food one can eat. The new connections also bypass food directly to middle part of intestine hence limiting absorption of nutrients as well. This surgery is a non-reversible procedure.
Sleeve gastrectomy is a procedure to remove about 80% of stomach making it a tube like, limiting amount of food one can eat. This achieves significant weight loss and no rerouting of the intestines is done. This being a smaller procedure need shorter hospital stay.
Biliopancreatic diversion with duodenal switch procedure involves both sleeve gastrectomy with bypassing of intestine. This surgery limits both how much one can eat and the absorption of nutrients. This procedure is marred with complications of malnutrition and vitamin deficiencies.

Bariatric surgeries can help weight loss in long-term. Success of surgery depends a lot on type of surgery and change in lifestyle habits. It is usually possible to lose half, or even more, of excess weight within couple of years.

Bariatric surgeries not only prevent health conditions related to obesity and improve quality of life but may even resolve certain health problems like:

Heart disease
High blood pressure
Obstructive sleep apnea
Diabetes
Fatty liver disease
Gastroesophageal reflux disease (GERD)
Knee Osteoarthritis (joint pain)

When weight-loss surgery doesn’t work mostly when one cannot make necessary changes in his/her lifestyle.

Alternatives to weight loss / Bariatric surgery

Laparoscopic sleeve gastroplasty – a band is tied around the stomach decreasing the volume and limiting food intake.
Intra-gastric ballooning – a balloon is inflated in the stomach and left to reduce gastric volume.

FAQs

What is the safest weight loss surgery?

Sleeve gastrectomy is safest form of weight-loss/ bariatric surgery. It has a complication rate of about 3% compared to 5% complications rate in gastric bypass surgery.

Is Weight Loss Surgery dangerous?

Severe complications like dumping syndrome, renal stones, bowel obstruction can occur. Death is a rarity after weight loss surgery.

What is the least invasive surgery for weight loss?

Intra-gastric ballooning is least invasive weight loss procedure.

What are the different types of weight loss / bariatric surgery?

Roux-en-Y gastric bypass
Sleeve gastrectomy
Biliopancreatic diversion with duodenal switch
Band/sleeve gastroplasty
Intra-gastric ballooning

Which Surgery Is Better, Gastric Bypass or Sleeve gastrectomy?

Gastric bypass cause loss of upto 80% of excess weight in 1-2 years whereas sleeve gastrectomy can help lose upto 70% of excess weight within same time frame.

Does gastric bypass shorten lifespan?

In fact, people undergoing gastric bypass has 40% lesser chance of dying within 7 years of surgery.

What is the simplest weight loss surgery?

Sleeve gastrectomy is a simple weight loss surgery and has the option of conversion to gastric bypass if expected weight loss is not seen.

What is the newest weight loss surgery?

Bariatric Arteriale Embolization (BAE) is minimally invasive newer technique for weight loss.

Why is weight loss surgery bad?

Due to occasional serious complications bariatric is considered risky, but benefit of improvement in quality of life and improvement in Diabetes and blood pressure far outweighs the risks.

How do one get rid of belly fat after gastric sleeve?

Losing belly fat is the most difficult but with overall weight loss, fat from abdominal area is also reduced. Besides following may also help:

High fiber diet
High protein diet
Exercise
Healthy fats
Enough sleep

Can one regain weight after gastric sleeve?

Regaining weight after sleeve gastrectomy is an unfortunate truth but maintain healthy lifestyle and eating habits helps prevent weight gain.

Does gastric sleeve surgery work long term?

Long term maintenance of weight loss depends on lifestyle modification after any weight loss surgery.

What is the dumping syndrome?

It is a known complication of weight loss surgery characterised by rapid emptying of contents of the stomach into the intestine. Signs and symptoms, such as abdominal cramps and diarrhea, develop 10 to 30 minutes after eating.

Is gastric sleeve an outpatient procedure?

Endoscopic sleeve gastroplasty procedure can be done as an outpatient procedure.

Does everyone have loose skin after gastric sleeve?

Loose skin is a cosmetic cause of concern to most people after weight loss bariatric surgery. Most people do have loose skin after weight loss but proper exercise and diet may help.

How can one avoid saggy skin when losing weight?

Losing weight slowly after bariatric surgery to let skin adjust to new shape is the best way to avoid loose skin.

Does loose skin after weight loss go away?

People who have lost up to moderate amount of weight see skin retracting and readjusting to the new body. For those who have lost significant amount of weight quickly may need body contouring procedures.