Bariatric surgery is a weight loss option when other attempts fail. Bariatric surgery is a major surgical procedure and the decision to elect this choice for weight loss needs your full consideration. As a healthcare consumer considering bariatric surgery, the following information may help you better understand the risks and benefits of the procedure. Your better understanding of bariatric surgery will help you discuss this option with your doctor.
Bariatric Surgery Basics
While there are several surgical procedures available, bariatric surgery produces one of three results. The end results of bariatric surgery are calorie restriction, malabsorption, and a combination of both.
Calorie restriction by decreasing the size of the stomach is one way bariatric surgery helps a person lose weight. Malabsorption is another way bariatric surgery leads to weight loss. However, procedures resulting in malabsorption only are no longer performed due to the complications. Finally, a combination of calorie restriction and malabsorption is the third way bariatric surgery leads to weight loss. Calorie restriction is achieved by reducing the size of the stomach through the creation of a pouch. Malabsorption of those calories and nutrients results when the newly created pouch is connected to the small intestine bypassing areas that result in absorption of fewer calories and nutrients.
Bypass surgery has been around for over 40 years. The first procedure, intestinal bypass surgery, created malabsorption of calories consumed, which led to weight loss. While the calories were malabsorbed, the procedure also led to malabsorption of essential nutrients required to maintain health. Side effects, some fatal, developed and intestinal bypass surgeries were no longer used for weight loss.
Digestion of Food
As food is eaten and chewed, digestive enzymes begin to breakdown the nutrients of the food in the mouth. From the mouth, food travels down the tube (esophagus) to the stomach. Stomach fluids known as hydrochloric acid further breaks food down the food and aids digestion. The average stomach holds approximately 6 cups of food at one time. From the stomach, food travels into the first part of the small intestine known as the duodenum. Within the duodenum, bile and pancreatic juices speed up the rate of digestion. From the duodenum, food travels to the jejunum and then to the ileum. The jejunum and the ileum make up the remainder of the small intestine. The small intestine is nearly 20 feet long. Nearly all calories and nutrients are absorbed in the small intestine. Any food that cannot be digested travels to the large intestine where is it stored until it is eliminated.
Bariatric Surgery Candidates
Doctors recommend Bariatric surgery for patients with a body mass index (BMI) greater than or equal to 40 kg/m2. A body mass index of 40 kg/m2 is approximately 100 pounds overweight for a man and 80 pounds overweight for a woman. In addition, the morbidly obese person has multiple failed attempts at weight loss by traditional means of calorie restriction and exercise.
Other patients with a BMI greater than or equal to 35 kg/m2 and who experience complications such as cardiovascular disease, type 2 diabetes, and sleep apnea may also be candidates for bariatric surgery.
Benefits of Bariatric Surgery
Bariatric surgery leads to weight loss. Weight loss in general is known to improve conditions such as type 2 diabetes, high blood pressure, heart disease, high cholesterol levels, sleep apnea, and Gastroesophageal reflux disease (GERD).
Types of Bariatric Surgery
Bariatric surgeries either restrict calories due to stomach size reduction or bypass the small intestine which leads to malabsorption of calories. These techniques lead to reduced calories which results in weight loss. Restrictive surgeries limit the amount of food a person can consume by reducing the stomach size. Depending on the procedure, a significant portion of the stomach is either stapled, removed or a band is applied to reduce the size and limit food intake. Initially, a person can only tolerate about 1 ounce of food without feelings of discomfort, such as nausea. However, as the stomach stretches, up to 3 ounces may be tolerated without discomfort.
Because of the restricted size of the stomach, fluids must be limited with meals to sips only. You must eat 5 to 6 small meals daily for you to receive your daily requirement of nutrients. In addition, supplements are used to ensure you receive the adequate amount of vitamins and minerals for your body.
There are four types of Bariatric surgery and include the Adjustable Gastric Band (AGB), the Roux-en-Y Gastric Bypass (RYGB), the Biliopancreatic Diversion with Duodenal Switch (BPD-DS), and the Vertical Sleeve Gastrectomy (VSG).
Adjustable Gastric Band (AGB)
The Adjustable Gastric Band procedure results in calorie restriction because the stomach size is reduced. A small band is placed at the top of the stomach which creates a pouch of approximately 2 inches. This reduction in the size of the stomach results in less available space to hold food which leads to calorie restriction. The pouch is adjustable through the injection of saline into a circular balloon. The surgeon controls the size of the pouch is dependent on your needs.
Roux-en Y Gastric Bypass (RYGB)
Gastric bypass surgery is a major surgical procedure known as Roux-en-Y gastric bypass. This type of bariatric surgery involves a qualified surgeon making a pouch at the top of your stomach. This pouch allows food to bypass your stomach, upper intestine, and duodenum, and route directly to your small intestine. This helps reduce the absorption of calories from food.
The gastric bypass can be done traditionally as an open procedure or by laparoscope. The open procedure takes on average 4 hours under general anesthesia. The hospital stay after an open gastric bypass surgery is approximately 3 to 5 days.
A laparoscope gastric bypass is a procedure using small incisions and a camera to guide the surgeon during the procedure. The laparoscopic procedure has a quicker recovery period and a shorter hospital stay. The surgeon makes the decision which procedure is best for you.
Biliopancreatic Diversion with Duodenal Switch (BPD-DS)
The Biliopancreatic Diversion with Duodenal Switch is a two-step procedure that results in both reduction in stomach size and bypass from the small intestine. As a result both calorie reduction and absorption result. After a significant portion of the stomach is removed in the first step, the remaining portion of the stomach is attached to the small intestine through the technique known as Gastric Sleeve procedure. The small pouch of the stomach that remains is connected to the small intestine, bypassing the duodenum and jejunum, leading to malabsorption of calories and nutrients. While weight loss is known to be successful, there are significant risks associated with the Biliopancreatic Bypass with Duodenal Switch procedure. Your doctor will discuss whether this procedure is recommended for you.
Vertical Sleeve Gastrectomy (VBG)
The Vertical Sleeve Gastrectomy, procedure is usually the first step of the Biliopancreatic Diversion with Duodenal Switch procedure. However, more recent information shows that the procedure is also effective as an individual bariatric surgery strategy. The Vertical Sleeve Gastrectomy reduces the size of the stomach resulting in calorie reduction; however, there is no bypass involved. The Gastric Sleeve is an irreversible procedure where a significant portion of the stomach is removed. Recommended for patients at high risk for other procedures, patients who undergo Vertical Sleeve Gastrectomy as bariatric surgery usually experience major complications from obesity. The Vertical Sleeve Gastrectomy bariatric surgery may reduce the hormone ghrelin which is known to produce sensations of hunger.
Risks of Bariatric Surgery
As with any surgical procedure, there are risks associated with Bariatric surgery. The risks of Bariatric surgery include:
- Blood clots that form in the leg and may travel to the heart and lungs
- Dumping syndrome where food passes too quickly to the small intestine causing nausea, vomiting, diarrhea, dizziness and sweating
- Staple line leaking
- Hernia or weakening at the incision
- Nutrient deficient complications such as anemia and bone mineral depletion
- Gallstones due to weight loss
- Complications at the opening between the stomach and small intestine require additional surgery. Mineral supplements and vitamins may be prescribed to prevent deficiencies.
The decision to undergo Bariatric Surgery is an important step in learning how to lose weight and becoming obesity free forever. Whether you decide upon surgery or not, it is important to remember that you need a healthy eating and exercise plan along for long term success. Your doctor can advise you best on whether Bariatric surgery is right for you.