Bariatric Surgery

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Bariatric Surgery

Indication:
No studies evaluate the commonly used indications for bariatric surgery. Consensus guidelines suggest that the surgical treatment of obesity should be reserved for patients with a body-mass index (BMI) >40 kg/m(2) or with BMI >35 kg/m(2) and 1 or more significant co morbid conditions, when less invasive methods of weight loss have failed and the patient is at high risk for obesity-associated morbidity and mortality (strength of recommendation: C, based on consensus guidelines). Types:

There are two basic types of weight loss surgery -- restrictive surgeries and malabsorptive/restrictive surgeries. They help with weight loss in different ways. Restrictive surgeries: work by physically restricting the size of the stomach and slowing down digestion. A normal stomach can hold about 3 pints of food. After surgery, the stomach may at first hold as little as an ounce, although later that could stretch to 2 or 3 ounces. The smaller the stomach, the less you can eat. The less you eat the more weight you lose.

Malabsorptive/restrictive surgeries: are more invasive surgeries that work by changing how you take in food. In addition to restricting the size of the stomach, these surgeries physically remove or bypass parts of your digestive tract, which makes it harder for your body to absorb calories. Purely malabsorptive surgeries -- also called intestinal bypasses -- are no longer done because of the side effects. Specific Types of Weight Loss Surgery

There are many different surgical procedures for weight loss, and each has several variations.

Adjustable Gastric Banding
Gastric banding is among the least invasive weight loss treatments. This surgery uses an inflatable band to squeeze the stomach into two sections: a smaller upper pouch and a larger lower section. The two sections are still connected; it's just the channel between them is very small, which slows down the emptying of the upper pouch. Gastric banding physically restricts the amount of food you can take in at a meal. Most people can only eat a ½ to 1 cup of food before feeling too full or sick. The food also needs to be soft or well-chewed.

There are several brands of adjustable gastric bands available. They include LAP-BAND and REALIZE. Pros. The advantage to gastric banding is that it's simpler to do and safer than gastric bypass and other operations. It's routinely done as minimally invasive surgery, using small incisions, special instruments, and a tiny camera called a laparoscope. Recovery is usually faster. You can also have it reversed by surgically removing the band.

Because the band is connected to an opening just beneath the skin in the abdomen, it can be easily loosened or tightened in the doctor's office. To tighten the band and further restrict the stomach size, more saline solution is injected into the band. To loosen it, the liquid is removed with a needle. The Cons. People who get gastric banding often have less dramatic weight loss than those who get more invasive surgeries. They may also be more likely to regain some of the weight over the years. The Risks. The most common side effect of gastric banding is vomiting, a result of eating too much too quickly. Complications with the band aren't uncommon. It might slip out of place, or become too loose, or leak. Sometimes, further surgeries are necessary. As with any surgery, infection is always a risk. Although unlikely, some complications can be life-threatening.

Sleeve Gastrectomy
This is another form of restrictive weight loss surgery. In the operation, which is usually done with a laparoscope, about 75% of the stomach is removed. What remains of the stomach is a narrow tube or sleeve, which connects to the intestines. Sometimes, a sleeve gastrectomy is a first step in a sequence of weight loss surgeries. It can be followed up by gastric bypass or biliopancreatic diversion, if more weight loss is needed. However, in other cases, it might be the...
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