What is Bariatric Surgery and how it works?

Written by Paris Kazemian

There are 5 different ways to lose weight

Bariatric Surgery

Bariatric Surgery involves making adjustments to your digestive system to help you lose weight.

In such operations, either the amount of food you can eat will be limited or the body’s capacity to absorb nutrients. Some procedures combine the two. Your doctor can help determine if you’re a candidate and, if so, which option will work best for you.

Although bariatric surgery has many advantages, all weight-loss surgeries are big procedures with serious risks and negative effects. To help assure the long-term effectiveness of bariatric surgery, you must also make permanent healthy life-style, dietary changes, and exercise on a regular basis.

Note:

You should only consider Bariatric surgery after trying alternative ways with no success.
Bariatric surgery is not for everyone!

What are Eligibility Criteria for Weight Loss Surgery

Eligibility criteria for surgery are mainly based on body mass index (BMI) and the presence of obesity-related complications:

individuals with BMI >50
individuals with BMI >40 with serious type 2 diabetes, or other health problems
individuals with BMI >35 with one or more obesity‑related complications.

Who could benefit from bariatric surgery?

High blood pressure
High cholesterol
Heart disease
Sleep apnea
Lung disease
Nonalcoholic fatty liver disease

and

In obese individuals with type 2 diabetes, surgery is recommended for

All individuals withT2DM and BMI ≥40

Individuals with BMI 35–40 with inadequate blood sugar control despite lifestyle and optimal medical therapy.

Note:

After bariatric surgery in order to lose weight and maintain it, you need to make permanent changes in your lifestyle
you will get nutritional advice from a dietitian on how to change your eating habits to keep healthy while losing weight.

Types of bariatric surgeries

The most commonly performed operations for the treatment of obesity in Australia and worldwide are

Gastric Balloon (non-surgical)
Adjustable Gastric Banding (AGB)
Sleeve Gastrectomy (SG)
Gastric bypass (Roux-en-Y)

There are two other surgeries that are less common in Australia

Biliopancreatic Diversion Without Duodenal Switch (BPD)
Biliopancreatic diversion with duodenal switch (BPD-DS)

Gastric Balloon (non-surgical)

Although It is not classified as a surgery, a gastric balloon is placed in the stomach endoscopically for up to 6 months to reduce stomach capacity and enhance feelings of fullness that lead to weight loss. Following sedation, a tube that has a camera is inserted through the mouth all the way to the stomach, with the balloon mounted on the tube. Upon reaching the stomach, the balloon is inflated to varying amounts of saline solution for a period of not more than 6 months. The inflated balloon inhibits the intake of large amounts of food by providing a feeling of fullness in the stomach. After 6 months, the endoscopic tube is inserted to remove the balloon, in the same way, it was put.

Adjustable Gastric Banding (AGB)

A restrictive band is placed around the upper part of the stomach, forming a small pouch with a narrow opening to the lower stomach. An access port connected to the band is placed deep under the skin. The band allows food to be retained in your upper pouch for a longer period of time, causing you feel fuller more quickly. Then, the food passes to the lower stomach and digestion happens normally. There is no change in the way food is absorbed.

The band will need to be adjusted based on your appetite and symptoms. The band can easily be adjusted by your doctor via the access port and does not require an additional surgical procedure. If the band is too tight, you may have reflux, nausea, and vomiting. If it is not tight enough, you will be able to eat too much and it won’t be effective. Initially, the band may need to be adjusted monthly until the best fill level is reached.

Sleeve Gastrectomy (SG)

Sleeve gastrectomy, also known as Gastric sleeve surgery or Vertical Sleeve Gastrectomy (VSG), is a weight-loss procedure that involves removing a major portion of the stomach. After the surgery, even a tiny amount of food makes you feel full. A smaller stomach produces lower levels of a hormone called ghrelin, which causes hunger, therefore the Sleeve gastrectomy operation makes individuals feel less hungry.

If you have gastric sleeve surgery, you will first start with liquid foods. After a few weeks you will transition to pureed food, then solid meals.

Gastric bypass (Roux-en-Y)

The gastric bypass procedure is one of the most common types of bariatric surgery. When diet and exercise haven’t succeeded or you’re having major health problems as a result of your weight, a gastric bypass is performed.

Gastric bypass surgery, also known as Roux-en-Y (roo-en-wy) gastric bypass surgery, involves creating a tiny pouch from the stomach and connecting it straight to the small intestine. Food will be swallowed into this little pouch of stomach and then directly into the small intestine after gastric bypass, skipping the majority of your stomach and the first section of your small intestine.

Biliopancreatic Diversion Without Duodenal Switch (BPD)

The biliopancreatic diversion was primarily a malabsorptive procedure, with intestinal anatomy altered so that bile and pancreatic fluids did not meet ingested fluids until the ileum. As a result, food absorption will decrease and weight loss happens. A modification with a duodenal switch, biliopancreatic diversion with or without duodenal switch (BPD-DS), is now more commonly performed to minimize dumping syndrome, increase gastric restriction, and decrease ulceration.

Biliopancreatic diversion with duodenal switch (BPD-DS)

This surgery is very effective in weight loss management. It has the potential to lose more weight than a gastric bypass or a sleeve gastrectomy

BPD-DS (biliopancreatic diversion with duodenal switch) is a less-common weight-loss technique and is usually performed as a single procedure; but, in some cases, the procedure may be split into two phases:

The first phase is a sleeve gastrectomy, which involves removing around 80% of the stomach and replacing it with a smaller tube-shaped stomach that looks like a banana. The pyloric valve, which releases food into the small intestine, as well as a short piece of the small intestine that normally links to the stomach, remain intact (duodenum).
The second phase connects the end of the intestine to the duodenum near the stomach, bypassing the remainder of the intestine. BPD/DS restricts the amount of food you can eat while also reducing the absorption of nutrients such as proteins and fats.

Benefits of Bariatric Surgery

Bariatric surgery can result in sustainable weight loss in people who have not achieved long-term success with other weight loss attempts.
Portion size becomes smaller and you feel full sooner than normal.
Hunger hormone is reduced in some surgeries and you may not feel as hungry as before.
Massive weight loss resulting from bariatric surgery also reduces hormones such as insulin (that regulates sugar levels) and cortisol (stress hormone).
surgery can also improve fertility during childbearing years. One study reported that the risk of miscarriage may decline after bariatric surgery and can improve menstrual cycles in women who don’t ovulate.
For people with severe obesity, weight-loss surgery can extend years of life.

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Possible Health Risks of Bariatric Surgery:

Esophagitis and acid reflux
Septic shock can be caused by infections such as pneumonia, intra-abdominal abscesses, or C. diff colitis.
Where tissue is sewed or stapled together, there are leaks or blockages
More surgery is required to correct the concerns.
Continual vomiting
Diarrhea and cramps are symptoms of the dumping syndrome.
Failure of the kidneys
Mood swings or other emotional problems
Blood clots in the legs that have the potential to go to the lungs (pulmonary embolism)
Injury to the spleen may result in spleen removal, which might cause long-term immunity problems.
Hernia at an incision site or inside the abdomen
Anesthesia-related complications
Bowel obstruction (is the term for blockages in the intestines)
Bleeding may necessitate transfusions and other procedures, such as surgery.
Acute Coronary Syndrome
Problems with the heart’s beat (arrhythmias)
Stroke
Up to 18% of persons who have BPD/DS surgery also experience protein-energy deficiency. When severe, this condition is known as kwashiorkor, a severe and potentially life-threatening form of malnutrition.
Death

Conclusion

Weight-loss surgery is the final approach for individuals with morbid obesity. If you have not tried diet and exercise yet, or you may think surgery would be the answer, however, you must pass the assessments and be aware of possible risks that may result during and after surgery. In very overweight individuals, life expectancy and the quality of life is dramatically improved with bariatric surgery.