Bariatric Surgery for Obesity
Bariatric surgery – advanced surgical methods to help reduce excess weight – is known to be the most effective and long lasting treatment for morbid obesity and many related conditions. Recent mounting evidence suggests that it may be among the most effective treatments for metabolic diseases and conditions including Type-2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnoea.
Surgical options for weight loss have been in existence since some decades. It is thus important to state that surgery for severe obesity goes way beyond mere weight loss. Bariatric surgery results in the complete remission or significant improvement of Type 2 diabetes and other life-threatening diseases in most patients.
This field of science has evolved significantly in last decade due to obesity becoming a global epidemic. The availability of new technology and instrumentation also allowed for these procedures to be performed in a safe, minimally invasive approach. Through this method, the patient can expect very little pain and quick recovery, since the surgical procedures are performed with usage of very small skin incisions and camera guidance. There are several surgical options currently available to treat morbid obesity, as listed in this article.
Laparoscopic Adjustable Gastric Band Placement
In this operation, a silicone gastric band is placed around the upper part of the stomach, creating a small pouch. The small size of the pouch means that you feel full sooner with reduced food intake. The band can be adjusted by your doctor (takes just five minutes!) by inflating or deflating the band, based on requirements. This in turn, can effectively control the amount of food it takes to provide early satiety.
The gastric band is an elegant weight loss procedure and yields similar weight loss compared to all other procedures over a course of two to three years. And like with all weight-loss procedures, this requires patient’s adherence to diet and lifestyle modification guidelines.
Laparoscopic Gastric Sleeve Resection
Approximately 85 per cent of the stomach is removed during this surgery, leaving just a narrow, tube-like stomach. This also removes that portion of the stomach, which produces a hormone called ghrelin. It is this hormone which informs the brain that
your body has to be fed.
Reduced levels of this hormone are certainly advantageous. The ghrelin level in your stomach increases before eating and decreases after a meal. Since it stimulates the appetite, it causes your body weight to increase, making you obese. Meanwhile, since the surgery reduces the capacity of your stomach dramatically by making it tubular, you would be able to eat less, and achieve
Good weight loss is seen with this procedure. However, concern exists regarding the possibility of re-enlargement of the stomach tube. This should not result though, if the appropriate diet guidelines are followed.
Laparoscopic Roux-en-Y Gastric Bypass
This is considered the ‘gold standard’ among weight loss procedures not without reason: it combines the restrictive factor (by reducing the amount of food the body can consume) while adding the component of mal-absorption (by rerouting the small intestine).
Laparoscopic roux-en-y gastric bypass involves the creation of a small gastric pouch, which is completely separated from the remainder of the stomach, and is re-attached to the small intestine directly. There is another additional attachment (called the anastamosis) between two loops of small intestine – which facilitates the flow of food material. The length of the small intestine used varies, based on the amount of excess body weight or BMI of the person.
After this surgery, excellent weight loss is noted. Due to the component of mal-absorption, some may experience deficiency in vitamins, calcium, iron, etc. These can be supplemented successfully to avoid such issues.
A balloon is placed in the stomach with an endoscope (a flexible tube containing a camera, inserted through the mouth), and is filled with 450-550 ml of water. This balloon effectively occupies most of the space in stomach and creates satiety with consumption of a small quantity of food. This balloon can last for six months, further to which, it needs to be removed or replaced.
Laproscopic Gastric Imbrication
The greater curvature of the stomach is folded into itself and doubly sutured in a laparoscopic fashion. Doing this will reduce the capacity of stomach, similar to a gastric sleeve surgery. This procedure can be a low cost alternative to current bariatric surgeries, though long-term results of this procedure are still awaited.
Emerging Surgical Approaches
Intuitive surgical minds are constantly exploring the possibilities of newer and innovative procedures that can alsosurgically correct health ailments like diabetes and metabolic syndrome.
- Duodeno-Jejunal Bypass: The stomach is separated from the duodenum (the first section of the small intestine) and is bypassed with the jejunum (the middle section of the small intestine). This prevents the duodenum (which plays a major role in glucose homeostasis) from being exposed to the consumed food. The bypass is thought to be the main factor for improving diabetes in this procedure.
- Ileal Transposition Surgery: Here, approximately 200 cm of the ileum (the distal small intestine) is interposed between the proximal jejunum. This method exposes the ileal mucosa to food much quicker than in a normal gastrointestinal tract, setting off hormonal changes believed to resolve/ improve diabetes. This procedure is at times combined with the gastric sleeve procedure.
Regardless of the bariatric procedure performed, the efficacy of these surgical procedures is unquestionable – and they significantly improve the quality of life.