Bariatric Surgery (also called Weight Loss Surgery) is performed on obese patients for reduction of weight & also for relief from co-morbidities like diabetes, hypertension and obstructive sleep apnoea. This weight loss is typically achieved by reducing the dimensions of the stomach with an implanted medical device (gastric banding); or through removal of some of the stomach (sleeve gastrectomy); or by resecting and re-routing the small intestines to a stomach pouch (Roux en y gastric bypass/Mini gastric bypass surgery). In this article, Dr. Samrat Jankar who is one of the best Pune based gastroenterologist will discuss the most common bariatric surgery procedures.
Types of Bariatric Surgery
Laparoscopic Adjustable Gastric Banding:
The adjustable gastric band is merely a restrictive and reversible procedure. The small intestine isn’t altered during this procedure. The adjustable silicone ring is placed round
the stomach 1-2 cm centimeters below the oesophagus. One can feel this port slightly below the skin within the center of the abdomen. This is often how the surgeon adds or subtracts water to form the band smaller or bigger. Weight loss is because of the restriction of nutrient intake that’s created by the tiny gastric pouch and therefore the narrow outlet. Gastric bands got to be adjusted a average of 4 to 6 times within the first year after surgery. These are done to ensure the band isn’t too tight or too loose and/or to encourage continued weight loss. Band adjustments are painless. According to the specialists, patient can lose 40 to 50% of excess weight on the average.
Laparoscopic Sleeve Gastrectomy:
Laparoscopic Sleeve Gastrectomy which is also known as Gastric Sleeve is basically a surgical weight-loss restrictive and irreversible procedure during which the size of stomach is reduced to about 15% of its original size, by surgical removal of an outsized portion of the stomach, following the main curve. The open edges are then attached together with the help of surgical staples or sutures. The procedure is irreversible which means that it permanently reduces the size of the stomach. The gastric sleeve may be a restrictive procedure only. Unlike a roux-en-y gastric bypass or the duodenal switch, there’s no bypass of the small intestines with the gastric sleeve, so all nutrients are absorbed and in contrast to gastric banding surgeries, no foreign objects are left within the body during the procedure. The patient can lose 60 to 70% of excess weight.
Laparoscopic Roux-en-Y Gastric Bypass:
A common sort of gastric bypass surgery is that the Roux-en-Y gastric bypass. Here, a small stomach pouch (25-30 ml) is made with a stapler device, and connected to the intestine. The upper part of the small intestine is then reattached during a Y-shaped configuration. The patient can lose about 70 to 80% of excess weight. The patients need to have vitamins and minerals and iron supplements for an extended time (sometimes lifelong). Dumping Syndrome, mineral and vitamin deficiencies are few of the complications related to this procedure.
Laparoscopic Mini Gastric Bypass:
Laparoscopic Mini Gastric Bypass consists of forming an extended gastric tube and attaching it right down to small bowel with single anastomosis. The disadvantage is bile reflux which is mentioned but practically only a few patients observe it.
FAQ About Bariatric Surgery
What is Minimal Access Surgery or Keyhole Surgery?
Minimal Access Surgery also known as laparoscopic surgery is a complicated technique for doing all kinds of surgical procedures. A skinny telescope referred to as laparoscope and dealing instruments are inserted through small incisions (3-12mm). The laparoscope is connected to a small video camera which projects the inner view of patient’s body to a high resolution monitor. These incisions are usually covered with surgical glue/ closed with absorbable sutures and after a couple of weeks are barely visible thus avoiding any follow-up visit for suture removal.
Who are the candidates for Bariatric/Weight Loss surgery?
- BMI > 37.5 kg/m2.
- BMI > 32.5Kg/m2 along with other associated problems like Hypertension, Diabetes, etc.
- Failed supervised medical weight-loss program.
- Age between 18 to 65 years.
- Committed and motivated.
- If you’re fit enough to undergo an anesthetic procedure and surgery.
When am i able to start walking after surgery?
Same day after surgery doctors might ask you to get up and move once you have recovered fully from anesthesia.
What about the post surgery Scars?
Scars like all other laparoscopic surgery are almost invisible in patients with good healing and with the use of absorbable sutures there’s no need of stitch removal.
Can I get pregnant after Surgery?
Yes, But it’s strongly advised that pregnancy should be postponed for a minimum of one year after surgery & you must consult your surgeon and get tested before you opt for pregnancy.
When am I able to resume my normal sexual activity?
As early as you’re pain free and once you resume your normal activity. Vigorous sexual intercourse should be avoided till 2 months after surgery.