Bariatric surgery is suggested to patients with body mass indexes (BMI) of 40 and more or between 35 and 40 with obesity-related conditions that might improve after weight loss (such as type 2 diabetes or high blood pressure), who tried all other weight loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off. Patients who want to undergo bariatric surgery have to agree to long-term follow up such as making healthy lifestyle changes and attending regular check-ups.
Bariatric surgery depends on two principles: the decreasing of stomach volume, and/or ‘malabsorption,’ i.e. the prevention of food absorption in certain stages. The decision on the type of operation to perform is made following various examinations and observations done by specialists.
If the patient is a fertile woman, she should take into consideration that pregnancy is not recommended within the first 24 month following bariatric surgery.
Bariatric Surgery methods are performed with laparoscopy that use very small incisions so the patients return to daily lifestyle in a very short time. The methods are:
-Gastric Band
-Gastric Sleeve
-Gastric Bypass
-Gastric Balloon
Gastric Band:Commonly known as “stomach clamp”.The method involves inserting an adjustable silicone band around the stomach creating a small stomach pouch above the band and the rest of the stomach below it. In effect, the volume of the stomach reduces. The inner membrane of the band is like a balloon or bicycle tire, which connectswith a fine tubeto a port placed under the skin. This port provides the adjustment of stomach opening size by filling the band with sterile saline.The aim of gastric band is to feel full for the patientalthough he or she eats small amounts of food. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band.The absorption of food stays normal after the procedure. Hospital stay usually is less than 24 hours. Patient lose up to 40-50% of excess body weight within 18-24 months and unless there is a problem with the band patient does not have risk to regain weight. Adjustable Gastric Band has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures, has the lowest risk for vitamin/mineral deficiencies. However, weight loss is slower than in other bariatric procedures, there is a small risk of band slippage or erosion into the stomach, also if patient overeats it can result esophagus dilatation. Between bariatric surgeries, this method has the highest rate of reoperation.
Gastric Sleeve: Commonly known as “sleeve gastrectomy”. During the operation the stomach volume is reduced by removing its main part (approximately 80%) and leaving a small, tube shaped stomach. The removed part of stomach contains the segment that secretes the hunger hormone. This method is as effective as Gastric Bypass and Gastric Band in terms of weight loss and improvement or remission of type 2 diabetes, but the complications rates are much less. Gastric Sleeve restricts the amount of food the stomach can holdand causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety. Hospital stay is usually less than 2 days. In result average60-70% excess weight.
Gastric Bypass:Known as “Roux en-Y”. The procedure involves bypassing a large section of the stomach and creating a small stomach pouch for digestion before the small intestine is rearranged to connect to the both. This type of surgery reduces the volume of the stomach and aims to by-pass a part of the intestines so that a portion of the nutrients is discarded without being absorbed. In effect, patients feel full with smaller amounts of food and can only absorb a portion of their nutrient intake.In the result average of 60-80% excess weight loss. Patient should consider that this method of bariatric surgery is technically a more complex operation than the Gastric Band or Sleeve Gastrectomy so it potentially could result in greater complication rate and has a longer hospital stay than other methods. In addition, it can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium,folate and requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance.
Gastric Balloon:In this method, a deflated balloon is implanted in the stomach orally through the esophagus with the help of an endoscope. In the next stage, the balloon is inflatedwith air to give the patient a sense of being full. Unlike the three other methods mentioned above, the stomach balloon method is incision-free so it can be considered as a non-surgical method and is made with minor anesthesia. The balloon cannot remain in the stomach for more than 6 months so it is used for temporary treatment of obesity, it helps to lose weight and start maintaining a healthy lifestyle. Failing to follow specific diet and exercise program, patient can gain weight after removing the balloon. This method is also effective in helping obese patients lose some of their weight and reduce surgical risks prior to bariatric surgery.
