What does Bariatric Surgery mean?

Bariatric surgery is popularly known as weight loss surgery or metabolic surgery. It is a surgical procedure that causes weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or combining both gastric restriction and malabsorption. Bariatric procedures also often cause hormonal changes. Minimally invasive techniques (laparoscopic surgery) are the new ways of performing most weight-loss surgeries.  Picture Courtesy: My upchar  

What are the types of bariatric surgery procedures?

Picture Courtesy: Old delmar The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band, biliopancreatic diversion, and a duodenal switch. Each surgery has its advantages and disadvantages.  

Why is bariatric surgery done?

Bariatric surgery is generally advised for someone who is obese, severely overweight, which can lead to life-threatening conditions such as:

• • • Heart disease and stroke
    • Type 2 diabetes mellitus
    • High blood pressure
    • Sleep apnoea
    • Non-alcoholic fatty liver disease or non-alcoholic steatohepatitis.
    • Inability to cope with physical activities
    • Breathlessness
    • High cholesterol, etc [1].

Who is a good candidate for Bariatric Surgery?

A person must meet specific medical guidelines to qualify for weight loss surgery. The right candidate for bariatric surgery is:

• • • An extremely obese person having a BMI (Body Mass Index) of 40 or above.
    • BMI of the patient between 35 – 39.9 is associated with severe health-related conditions such as type 2 diabetes, high blood pressure, or sleep apnoea [2].
    • History of multiple failed attempts with diet plans, exercises, behavioral changes, and medical therapy.
    • Patients suffering from other severe health conditions associated with morbid obesity are- hyperlipidemia, asthma, impaired glucose tolerance, obstructive sleep apnoea, PCOS, increased risk of pregnancy, fetal abnormalities, and male hypogonadism.
    • Psychological conditions caused due to obesity are- depression, body image disturbance, and eating disorders [3].

What are the major risk factors associated with bariatric surgery?

Major risk factors associated with bariatric surgery are:

1. Short term risk factors: 

• • • Excessive bleeding
    • Post-surgical infections
    • Risks associated with anesthesia
    • Breathing problems
    • Blood clots
    • Leak in the GI system.

2. Long term risk factors:

• • • Bowel obstruction
    • Hernias
    • Dumping syndrome (group of symptoms such as diarrhea, nausea, light-headedness, vomiting that are caused by rapid gastric emptying)
    • Malnutrition
    • Hypoglycemia (low blood sugar) [4]

  What are the steps to prepare for the surgery? Steps to prepare for the surgery:

Before the procedure

A patient who wants to undergo bariatric surgery has to undergo a couple of blood tests such as CBC, liver function tests, thyroid tests, complete chemistry panel, lipid profile, coagulation tests, iron profile, blood typing, urinalysis, BMI, and a few radiological tests such. A bariatric surgeon generally operates weight-loss surgeries. The doctor will thoroughly examine the patient and record the patient’s medical history, such as medicines history, surgical history, and genetic history. Later the surgeon explains and counsels the patient regarding the pros and cons of the procedure and evaluates whether the patient is fit for the procedure or not. Once the patient is fit for the procedure, the doctor suggests the type of surgery suitable for the patient.  The surgeon will give the patient a couple of instructions, which have to be followed strictly. They are:

• • • Avoid smoking, drug abuse, and alcohol as they are harmful to health.
    • The patient should lose a few kilograms of weight by following a healthy diet plan and simple workouts before the surgery.
    • Read articles about the surgery, procedure, benefits, expected results, and complications.
    • Avoid certain medications such as aspirin, diabetes, anti-inflammatory, and many more per the doctor’s instructions.

At the time of the procedure

On the day of surgery, the patient is asked not to eat or drink anything for at least 6hours before the surgery. Bariatric surgeries are generally done under general anesthesia. Due to the advancements in technology and improvisational skills of the surgeons, most bariatric surgeries are performed laparoscopically (minimally invasive method). A small incision (cut) is made in the abdomen, and a small thin tubular instrument with a camera is placed inside the abdomen. Two-three more small incisions are made, through which other instruments are placed. The advantage of laparoscopic surgery is the recovery time for the patient is shorter. The disadvantage is that laparoscopic surgery is not suited for everyone. There are pros and cons associated with each bariatric surgery. Types of bariatric surgeries are:

1. Gastric sleeve surgery- In this procedure, a part of the stomach is separated and removed from the body, while the remaining part of the stomach is formed into a tube-like shape which would reduce the appetite (food intake)

Picture Courtesy: Medline plus  

2. Roux-en-Y gastric bypass surgery is the most common method of gastric bypass surgery. This is an irreversible procedure. During this procedure, a small pouch is created at the top of the stomach, limiting the food intake at any given time.

  Picture Courtesy: Surgery.edu  

3. Biliopancreatic diversion with a duodenal switch is a two-step procedure, where the first step involves removing a large part of the stomach. In contrast, the second step of the surgery involves joining the duodenum near the stomach to the end portion of the intestine, thereby bypassing most of the intestine.

  Picture Courtesy: Foothills  

4. Laparoscopic adjustable gastric banding – Before being fixed in place, a balloon, which can be inflated or deflated to regulate how much quantity of food to eat, is fitted around the upper part of the stomach [5].

  Picture Courtesy: Medical news  

After the surgery

After the procedure, the nurses will closely move the patient to the ICU to monitor their vitals. Initially, the patient will be kept fasting for a few days. Once the patient gets their bowel movements, they will be allowed to stay on a liquid diet for a few days, followed by a soft diet. The patient should take proper care in the operated area, should keep the area clean, and stitches will be removed 7days after the procedure. The patient has to undergo a couple of blood tests after the procedure. Once the patient is hemodynamically stable, the patient can go home and follow a couple of instructions advised by the doctor strictly and have a regular check-up with the doctor, where the doctor checks the healing progression of the patient’s condition. Here are a couple of instructions that the patient has to follow strictly.

• • • The patient might experience severe pain in the operated area for the first few days. The doctor advises a few painkillers that the patient has to take regularly.
    • The patient needs to follow a healthy lifestyle for the rest of their lives.
    • If the patient feels any discomfort in the operated area, the patient should contact the surgeon immediately.
    • The patient should remain on a high protein and low-fat diet and take a few additional supplements such as multivitamins, iron, and calcium supplements.
    • One should perform nutritional and metabolic tests frequently.
    • Quit smoking and drinking [6]
    • The patient should start some physical workouts daily to maintain weight.

 

FAQ

1. 1. Is bariatric surgery safe?

Every surgery has its pros and cons. Due to advancements in technology and advanced surgeon skills, morbidity and mortality rates are reduced. Some of the most severe complications are- dumping syndrome, compartment syndrome, high risk associated with anesthesia, etc. 

2. Contraindications for bariatric surgery?

Conditions where bariatric surgery is contraindicated, are:

• • • Severe heart failure
    • Unstable coronary heart disease
    • End-stage lung disease
    • Active cancer treatment
    • Portal hypertension
    • Drug-alcohol dependency
    • Impaired intellectual capability [7].

3. Which bariatric surgery can be reversed?

Reversible bariatric surgeries are- Gastric bypass (Roux-en-Y bypass surgery) and adjustable gastric band [8].

4. Will bariatric surgery cure diabetes?

Gastric bypass surgery is considered the most effective therapy to treat or reverse type 2 diabetes mellitus in severely obese patients [9]. 

5. Will bariatric surgery cure hypothyroidism?

Bariatric surgery can be used as a treatment option to treat hypothyroidism.

6. Which bariatric surgery is most effective?

According to the study, gastric bypass surgery is considered the most effective for weight loss. Gastric bypass surgery resulted in an average 31% loss of total body weight in the first year and 25% of total body weight after five years [10].

7. Can I drink alcohol after bariatric surgery?

The patient is advised to live a quality life and develop a healthy lifestyle after bariatric surgery. Quit smoking, and avoid alcohol.

8. What are the principles of bariatric surgery?

The basic principle of bariatric surgery is to restrict food intake and decrease the absorption of food in the stomach and intestine [11].

 

 

References

1. https://www.webmd.com/connect-to-care/bariatric-surgery/what-is-bariatric-surgery
2. https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
3. https://emedicine.medscape.com/article/197081-clinical
4. https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
5. https://oldedelmarsurgical.com/blog/bariatric-surgery-weight-loss-timeline/
6. https://emedicine.medscape.com/article/197081-treatment#d8
7. https://www.ncbi.nlm.nih.gov/books/NBK513285/
8. https://weightlossandwellnesscenter.com/can-bariatric-surgery-be-reversed/
9. https://www.news-medical.net/news/20200820/Gastric-bypass-surgery-is-the-most-effective-therapy-to-treat-type-2-diabetes.aspx#:~:text=Gastric%20bypass%20surgery%20is%20the%20most%20effective%20therapy%20to%20treat%20type%202%20diabetes,-Download%20PDF%20Copy&text=Aug%2020%202020-,Gastric%20bypass%20surgery%20is%20the%20most%20effective%20therapy%20to%20treat,no%20longer%20require%20diabetes%20medications.
10. https://www.webmd.com/diet/obesity/news/20181030/which-weight-loss-surgery-is-best#:~:text=The%20study%20found%20that%20gastric%20bypass%20appeared%20to%20be%20most,body%20weight%20after%20five%20years.
11. https://www.news-medical.net/health/What-is-Bariatric-Surgery.aspx