Losing weight is believed to be everyone's cup of tea if some conditions like sincerity and commitment are fulfilled. But for some, sincerity and commitment may have to be combined with the "luck factor"! How can obese people risk their joints while trying to hop or jog around in a park? And how can they afford to remain obese forever risking their lives? For these people, bariatric surgeries or weight loss surgeries may seem to be a cure.
Some long term studies on bariatric surgeries have concluded that these kinds of surgeries help in cutting down the mortality risk by 23 to 40 percent while helping in treating diabetes and lowering the risk of cardiovascular diseases. These surgeries have been found to be effective for a long term weight loss.
Who Can Undergo a Bariatric Surgery?
According to the U.S. National Institute of Health, bariatric surgery is advisable for obese people with a BMI of at least 40 and for people who have a BMI of 35 and coexisting severe medical conditions like diabetes, hyperlipidemia and sleep apnea.
The Types of Bariatric Surgeries
1. Predominantly Malabsorptive Procedures
These procedures mainly induce malabsorption in a person and reduce the stomach size. It includes:
- Biliopancreatic Diversion (BPD): This procedure is performed very rarely. This procedure cause malabsorption and hence it is now replaced with Duodenal Switch (DS).
- Duodenal Switch (DS): A part of stomach is resected and the distal part of the small intestine is connected with the remaining stomach pouch, bypassing the duodenum (first part of the small intestine) and jejunum (middle section of the small intestine). Around 2 percent of patients face severe malabsorption and nutritional deficiency. The patient is often put on vitamin and mineral supplements, without which there is a risk of development of anemia and osteoporosis. Rapid weight loss might also lead to the formation of gall stones. Because of the malabsoptive nature of such surgeries they are barely performed now. Some other surgeries like jejunoileal surgery, which was of the same nature, is now banned and not performed anymore.
2. Predominantly Restrictive Procedures
These are restrictive type surgeries which intend to reduce the oral intake by limiting the gastric volume, bringing in early satiety and minimizing the metabolic complications.
- Vertical Banded Gastroplasty: This is commonly known as stomach stapling. A part of stomach is permanently stapled to create a smaller stomach pouch. This procedure involves no malabsorption or dumping syndrome. But one has to watch his food intake after this surgery. Vomiting and severe discomfort may result if food is eaten in a hurry or not chewed properly. And the reversible procedure of this surgery is even more difficult.
- Adjustable Gastric Band: Also known as gastric banding, it is one of the safest procedures performed with a mortality rate of 0.05 percent. Stomach restriction is created using a silicon band. The silicon band can be adjusted by adding or removing saline through a port placed just under the skin. This procedure can be performed laparoscopically. Weight loss occurs due to a restriction of nutrient intake created as an effect of the small gastric pouch. The weight loss is gradual and can take anywhere between 1 to 3.5 years for the results to show up. Being a non-invasive procedure, it can be reversed easily. But weight gain is common in such a case. A person is needed to closely observe the post operative guidelines to have a good weight loss effect. A person can lose around 47% of his extra weight with such a procedure and it does not involve any life threatening complication.
- Sleeve Gastrectomy: It is a non reversible, laparoscopic procedure. It involves surgical removal of a large portion of the stomach from the major curve. It reduces the stomach size to about 15 percent of the original size. The open edges are attached with surgical staples or sutures or both. The stomach assumes the shape of a sleeve or a banana. Most patients lose around 30 to 50 percent of excess weight in a period of about one year. Most food items can be eaten. There are no risks of dumping syndrome, ulcers risk, anemia or osteoporosis. People with existing anemia and various other health conditions can opt for this procedure.
- Intragastric Balloon: This procedure is not yet approved by the FDA, but approved in Australia, Mexico, Canada, India and several European and southern American countries. It involves the placement of a deflated balloon into the stomach and then filling it to decrease the available gastric space. This balloon can be left in the stomach for up to 6 months. This surgery may result in an average loss of 5 to 9 BMI over a period of 6 months.
- Gastric Plication: It is a version of the gastric sleeve surgery. A sleeve is created by suturing rather than removing the stomach tissue. This helps in preserving the natural nutrient absorption capability of the stomach as this does not involve any resection, cutting, staples and implants. The weight loss results are similar to that of a gastric bypass surgery. No major complication is found to be associated with this procedure.
3. Mixed Procedures
These procedures combine the above mentioned techniques. The subtypes are:
- Gastric Bypass Surgery: It is the most common bariatric surgery performed in the United States. The stomach is stapled in a way so as to create a small pouch which is connected with the distal small intestine and the upper part of the small intestine (duodenum and jejunum) is reattached in a Y shape. This surgery needs a strict post surgical adherence to a healthy diet pattern, as it can otherwise lead to various health related problems like ulcers, dumping syndrome and several other severe nutritional deficiencies in the body's requirement of iron , calcium , zinc, thiamine, B12 and vitamin A. It may also cause hyper parathyroidism.
- Sleeve Gastrectomy With Duodenal Switch: This is a variation of the biliopancreatic diversion. it is a irreversible surgery. A part of stomach along with its greater curve is resected, its residual volume is reduced to about 150 ml, which leads to serious food restriction. The stomach is disconnected from the duodenum and attached with the distal small intestine.
- Implantable Gastric Stimulation: This procedure is still under research. In this surgery, a device similar to the heart pacemaker is implanted with the electrical leads stimulating the external surface of the stomach. Electrical stimulation is thought to modify the activity of the enteric nervous system of the stomach. This is interpreted by the brain to give a feeling of satiety.
Facing scissors and scalpel is our last intention in life. Nature has gifted us with beautiful bodies which demand attention and awareness from our part! Eating healthy, controlling our "greed" and "moving and shaking" our bodies may help us to avoid the "sharp blades".
