Bariatric surgery

What is Bariatric surgery

The prevalence of obesity has increased in recent decades, and obesity is now one of the leading public health concerns on a worldwide scale. There is accumulating agreement that bariatric surgery is currently the most efficacious and enduring treatment for clinically severe obesity, and as a result, the number of bariatric surgery procedures performed has risen dramatically in recent years.

When it comes to helping people with obesity weight loss surgery you may have heard the terms gastric sleeve, gastric bypass and gastric band these are types of bariatric or weight-loss surgery. People who have severe obesity often have related health problems such as type 2 diabetes, high blood pressure and sleep apnoea.

Bariatric surgery can help people lose weight and improve those problems by making changes to the digestive system. It can make the stomach smaller or change the small intestine so it absorbs fewer calories. People with severe obesity who have been unable to lose weight or keep weight off may be candidates. Bariatric surgery has risks and benefits so it's important to talk to your doctor first before taking up any treatment option. Your surgeon will perform bariatric surgery if your weight loss efforts through lifestyle changes and medications have been unsuccessful.

Two types of bariatric surgery

There are two types of bariatric surgery restrictive procedures decrease the size of the stomach so a person feels full quickly after surgery.

The stomach holds about one cup of food. A normal stomach holds four to six cups. Malabsorptive procedures decrease the absorption of calories in the small intestine. Before the procedure, an intravenous line will be started.  Bariatric surgery requires general anesthesia which puts you to sleep for the duration of the procedure a breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the operation.

There are four types of operations that are commonly offered to patients:

  • Adjustable gastric banding
  • Roux-en-Y gastric bypass
  • Biliopancreatic diversion with a duodenal switch
  • Vertical sleeve gastrectomy

Adjustable gastric banding bariatric surgery

Adjustable gastric band surgery is also known as lap band surgery is a minimally invasive procedure providing the advantages of reduced painless time in the hospital and a shorter recovery period than other bariatric procedures. It's ideal for people with a very good safety profile who are willing to commit to the band.

 It's not recommended for people with autoimmune disease as they can't put a foreign body in their body. This minimally invasive procedure can be done laparoscopically or with robotic assistance. The Lap-Band is a silicone elastomer ring that is placed laparoscopically around the upper part of the stomach. The ring is filled with saline on the inner surface the lap band is then connected to an access port that is placed beneath the skin during surgery.

The surgeon is able to adjust the lap band by adding or subtracting saline inside the inner balloon via the access port.

This ability to adjust the lap band helps drive the rate of weight loss if weight loss is inadequate as a result of a loose lap band the surgeon will add more saline to reduce the size of the opening and further restrict the amount of food that can move through it.

If the band is too tight the surgeon will loosen the band by removing some saline thus reducing the amount of restriction. Most patients can go home the same day and are back to work within 24 to 48 hours of the surgery.

The procedure is effective with patients typically losing about 40-50% of excess weight maintaining a diet high in protein and healthy fats are crucial to the success of the surgery.

Potential complications

There are risks of band erosion, leakage, migration/slippage, or displacement from the port. There could also be tubing-related complications, such as kinking of disconnection from the port. There is also the risk of port-site infection.

Sleeve Gastrectomy Producer

The sleeve gastrectomy is a restrictive procedure that limits the amount of food you can eat by reducing the size of your stomach. To gain access to the abdominal cavity small incisions are created on the abdomen trocars which serve as passageways for the surgical instruments are placed into the incisions. Surgical instruments are passed through the trocars to access the abdominal cavity.

The surgeon examines the abdomen using a laparoscope or video camera. The average human stomach can expand to hold around 1 to 1.5 liters of food while in the stomach food is combined with digestive enzymes to help break down the food into a simpler form so that it can be more easily digested and absorbed once in the small bowel

During sleeve gastrectomy bariatric surgery

During a sleeve gastrectomy, a thin vertical sleeve is created by using a stapling device. This sleeve will typically hold between 50 to 150 milliliters or is about the size of a banana.

The excised portion of the stomach is removed and the newly created gastric sleeve is able to hold approximately 1/10 of what the stomach was able to hold before. This smaller stomach sleeve restricts the amount of food you can eat before feeling full of bile and pancreatic fluids. from the liver and pancreas mix with the food and allow it to be completely digested and absorbed in the bowel. There is no rerouting of the small bowel or post-operative adjustments necessary for the sleeve gastrectomy as with all other weight loss procedures.

Behavior modification and dietary compliance play a critical part in determining the long-term success of the procedure.  All surgery presents risks weight, age, and medical history to determine your specific risks. Ask your doctor if bariatric surgery is right for you.

Potential complications

You may develop stomach ulcers. Stomach staples may cause complications such as leaks from staple lines or separation of tissue that were stapled or stitched together. Stomach-related discomfort may occur, such as heartburn, nausea, or belching. Irregular contractions of your esophagus may cause complications with swallowing (also known as esophageal dysmotility).

Roux-en-Y gastric bypass procedure bariatric surgery

Gastric bypass is technically referred to as roux and why gastric bypass is both a restrictive and malabsorptive procedure because it reduces the size of the stomach and decreases the absorption of calories in the small intestine.  During the gastric bypass procedure, your surgeon will use surgical staples to create a small compartment that will serve as your new stomach. This pouch will hold about one cup of food the lower portion of the stomach continues to secret digestive juices but does not receive food next.

During Roux-en-Y gastric bypass bariatric surgery

Your surgeon will cut the small intestine well beyond the stomach and bring one free end up and attach it to the pouch. The surgeon will then attach the other free end lower down on the small intestine creating a wide shape by bypassing the lower stomach and the first part of the small intestine. Fewer calories will be absorbed as food passes through this new pathway banding techniques are restrictive procedures.

They help decrease food intake in two ways by shrinking the stomach to a small pouch and by making a tiny opening from the pouch to the rest of the stomach, food moves slowly through this opening.  

For all methods of bariatric surgery, your surgeon will close your incisions with staples or stitches. After your procedure, your breathing tube will be removed and you will be taken to the recovery area for monitoring. You will be given pain relief medication and your diet will be gradually advanced over several days.

Biliopancreatic Diversion with a Duodenal Switch (BPD-DS)

Also called the duodenal switch, this three-stage procedure involves the removal of a large part of the stomach which makes the patient feel full after eating only a small meal, followed by re-routing of the small intestines to prevent food absorption. The third step involves changing how bile and other digestive juices affect the process of digesting and absorbing calories.

Potential complications

There is a period of intestinal adaptation when bowel movements can be very liquid and frequent. This condition may lessen over time but maybe a permanent condition. You may also experience bloating, gas, and malodorous stool. Lifelong vitamin supplementation is required, and close lifelong monitoring for protein malnutrition, anemia and bone disease is recommended. Changes to the intestinal structure can result in the increased risk of gallstone formation and the need for removal of the gallstone. You may experience “dumping syndrome” as food moves rapidly through your small intestine

Bariatric Surgeon team

The Bariatric Surgeon team will be there for you as you undertake this life-changing event. Your healthcare team includes not only your surgeon and nurses, but also other health professionals, such as a dietitian, psychologist or counselor, exercise physiologist, and your primary care physician. This team will help you prepare you for surgery, and guide you throughout your recovery and for the long term.

Benefits of Bariatric surgery

When you lose weight a lot of medical problems go away and the biggest medical problem is diabetes that's the one that's really been shown to go away in bariatric patients and about 80% of bariatric patients diabetes will go away 100%  and in the remaining patients it will be reduced but other things that bariatric surgery can help is asthma,  high blood pressure . If your cholesterol and  triglycerides are up then bariatric surgery can have certainly help make those things normalized.

 

Sleep apnea is another condition that bariatric surgery can treat as you start to lose weight. Patients often their CPAP pressures will go down. till the day that they can walk away from their CPAP machine and they can sleep you know free of snoring free of a mask.

bariatric surgery has been used to prevent the incidence of cancer.so it's things that maybe you have today that will go away with bariatric surgery.

Recovery After bariatric surgery

You will remain in the hospital for a few days, where you will consume a clear liquid diet and will be monitored for any immediate complications.

Upon discharge, you will be given strict dietary instructions. Depending on the type of surgery you have undergone, about 10 to 14 days after surgery, you will be allowed to add soft or pureed protein sources to your liquid diet and will then gradually build up to a solid food diet at 5 to 6 weeks after your surgery.

 In addition to the health benefits of bariatric surgery, keep in mind that you may experience some unwanted changes to your body after surgery, such as scarring or loose skin. Your scars can be of various sizes or shapes, depending on the type of surgery you have. Talk to your healthcare team if you are worried about scarring, and they may be able to recommend tips to limit scarring. Most patients who have bariatric surgery experience loose skin as they lose weight.

For some, this may be temporary. The amount of loose skin depends on many factors, including how much weight you lose, your genetics, age, smoking history, and whether you exercise. Clothing or compression garments can often hide loose skin. But, if the extra skin bothers you, discuss options with your healthcare team to see if plastic surgery may be an option for you.

 As you begin to lose weight and gain strength, members of your team will help you take the next steps to recover fully. They may refer you to support groups or exercise facilities in your community.

Studies have shown that patients who have frequent, face-to-face contact with their healthcare team are most successful in achieving and maintaining their goals.

You will most likely need to see your healthcare team for follow-up appointments every 3 to 6 months, and then every 1 to 2 years after that. It’s important to remember that the decision to have bariatric surgery is the first step in a lifelong commitment to your health, so follow-up care is recommended for life.

Conclusion

Bariatric surgery is a reasonably safe and effective method of weight loss for the treatment of morbid obesity and is more effective when combined with nutritional care, which is sometimes complex, always ongoing, and differs between surgical procedures. While bariatric procedures influence the volume of food consumed, none of the procedures necessarily improve the quality of food consumed or compliance with recommended supplement usage, leaving nutrition care and food choice important lifelong considerations. Ongoing coordinated care by the GP that links with the bariatric dietitian and others in the health management team maximizes the benefits and health outcomes for the patient through ongoing monitoring of nutritional status, prevention of nutrient deficiencies and maximizing long term weight loss.

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