Bariatric surgery – Types, Treatment, Procedure & Precautions
Have you been gaining weight even though you have been eating less? Has your weight loss been minimal even after dieting and exercising? If the answer to these questions is ‘Yes’, Bariatric Surgery is an option you should consider. Severe obesity is a condition that is often hard to treat with diet and exercise alone.
Bariatric surgery is a surgical option for losing weight in people who are extremely overweight and their weight poses a health hazard. The procedure involves the surgical removal of a part of the stomach to reduce its size or restricting the absorption of food from the intestine with a surgical procedure. There is an option that is a combination of these two methods.
Bariatric and metabolic surgeries not only help individuals lose up to 80% of their excess weight but also improve the chances of fighting diabetes, hypertension, cardiovascular disease and other diseases affecting normalcy of life. Surgical management at Apollo Spectra hospitals is an end-to-end program, customized and designed to meet the requirements of each individual. The center provides comprehensive facilities for the treatment of obesity that affects daily functioning. The treatment includes diet and psychological assessments, and extensive post-surgery follow-up plan. Spectra Institute of Bariatrics at Apollo Spectra Hospitals has a Comprehensive team of specialists including Bariatric Physician, Endocrinologist, Physiotherapist, Counsellor and Bariatric Surgeon. At Spectra Institute of Bariatrics, our experts will access your needs and suggest the right treatment plan for you ranging from Laparoscopic Gastric Banding, Endoscopic Intra-Gastric Balloon, Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux-en-Y-Gastric Bypass, Laparoscopic Mini Gastric Bypass & Laparoscopic Ileal Transposition.
Food eaten moves from the mouth to the stomach, where it is broken down and partially mixed with gastric juices. This food then passes on to the intestine where most of the absorption takes place. The amount of food that can be eaten is decreased if the size of the stomach is reduced by a surgical intervention. The number of calories absorbed in the body can be decreased if the portion of the small intestine from where most of the absorption takes place, is bypassed.
- Patients between the ages of 18-65 years
- If the patient has a body mass index (BMI) of over 37.5 kg.m2
- If the patient has a BMI of more than 32.5 kg/m2 who have associated serious weight-related problems such as diabetes, high blood pressure, arthritis or heart disease
Bariatric Surgery will not be done if the following exists:
- Absence of a period of identifiable medical management.
- Patient who is unable to participate in prolonged medical follow-up.
- Non-stabilized psychotic disorders, severe depression, personality and eating disorders, unless specifically advised by a psychiatrist experienced in obesity.
- Alcohol abuse and/or drug dependencies.
- Diseases threatening life in the short term.
- Patients who are unable to care for themselves and have no long-term family or social support that will warrant such care.
Restrictive weight loss surgery is of two types- Adjustable Gastric banding and Vertical Sleeve Gastrectomy. Both operations make less room in the stomach for food.
It is a completely reversible procedure performed laparoscopically. A silicone band is wrapped around the upper part of the stomach to create a small stomach. Small quantities of food can fill up the small stomach providing satiety. The narrow outlet of this small stomach delays progression of food into the intestine and the person feels full for longer periods.
This removes a part of the stomach, making the stomach smaller. This results in a stomach, which is roughly the size and shape of a banana or sleeve. Since this operation does not involve any “rerouting” or reconnecting of the intestines, it is a simpler operation than the gastric bypass or the duodenal switch.
There are several types of gastric bypass procedures, but they all involve bypassing part of the small intestine to varying degrees. For this reason, procedures of this type are referred to as malabsorptive procedures, because they involve bypassing a portion of the small intestine that absorbs nutrients.
Although a gastric bypass procedure is malabsorptive, it can also be restrictive because it reduces the size of the stomach so that the amount of food you can eat is restricted due to the smaller stomach.
A small pouch on the top of the stomach is created by using a special surgical stapler and the pouch is connected directly to a part of the small intestine. After this surgery, when you eat, food bypasses most of your stomach and the first part of your small intestines. That makes this surgery both restrictive and malabsorptive.
Biliopancreatic Diversion with Duodenal Switch surgery is very similar to gastric bypass. It involves two components. A small pouch is created by removing a portion of the stomach and later a portion of the small intestine is bypassed.
While malabsorptive procedures are more effective in contributing to weight loss than those that are solely restrictive, they also carry a greater risk of developing nutritional deficiencies.
Roux-en-Y gastric bypass, the most commonly performed bariatric procedure, is both malabsorptive and restrictive. The procedure involves stapling the stomach to create a small pouch that holds less food, and then shaping a portion of the small intestine into a “Y.” The “Y” portion of intestine is then connected to the stomach pouch so that when food is being digested it travels directly into the lower part of the small intestine, bypassing the first part of the small intestine (called the duodenum) and the first part of the second section of the small intestine (called the jejunum). Bypassing these sections of the intestine restricts the number of calories and nutrients that are absorbed into the body.
- You must have a dietitian evaluation.
- You must have a psychological evaluation.
- In addition to a complete medical history, your physician and anesthetist will perform a complete physical examination to ensure you’re in good health before undergoing the procedure. You will undergo blood tests or other diagnostic tests.
- You may be asked to begin exercising and alter your diet several weeks before surgery.
- If you’re a woman of child-bearing age, you may receive birth control counseling so that you do not become pregnant in your first year after surgery due to the risk to the fetus from rapid weight loss.
- Quit smoking and discontinue the use of all tobacco and nicotine products as it may lead to delayed wound healing after the surgery.
- Drink more water and limit other beverages.
- Stay mentally and physically fit by focusing on your health.
- Not to eat or drink anything for 10-12 hours before surgery and have a light dinner because the stomach must be empty before anaesthesia
- Ask a friend or family members to be at the hospital during the surgery for support.
After the Procedure
You will be encouraged to move around as much as you can while you are in bed, and then to get out of bed and walk around as your strength improves. This is your best defence against blood clots.
At first, you’ll receive fluids through an Intravenous Infusion. After a day or two, you’ll be given liquids, such as broth or clear juice, to drink.
Your physician will instruct you about how long to eat pureed foods after surgery. By one month after your procedure, you may be eating solid foods. You’ll meet with the dietician before going home and while you’re here, you’ll have a clear liquid diet that will be limited to a medicine cup every 15 minutes.
A nutritionist will instruct you about taking nutritional supplements to replace the nutrients lost due to the reconstruction of the digestive tract.
You will be discharged from the hospital after two to five days based on the type of surgery. Before you’re discharged from the hospital, we’ll schedule an appointment for a follow-up visit with your physician.
Visit your surgeon as scheduled as it is very important to keep him informed about the progress.
You should call your doctor immediately, in case of:
- fever of 100⁰F or above
- redness, swelling or increased pain or drainage from the wound
- chest pain or shortness of breath
- nausea or vomiting that may last for more than 12 hours
- pain or swelling in the legs
Continue the breathing exercises you began in the hospital, and gradually increase your physical activity as tolerated. It may take several weeks to return to your previous levels of stamina. You may be instructed to avoid lifting heavy items for several months in order to prevent strain on your abdominal muscles and the surgical incision.
Weight loss surgery can be emotionally difficult because you’ll be adjusting to new dietary habits and a body in the process of change. You may feel especially tired during the first month following surgery. But once your body adjusts, you’ll start to feel better. Exercise and attending a support group can be helpful at this time.
Returning to normal activities
You need to take complete rest for one or two weeks before performing daily activities like exercising and jogging.
You may return to normal activities within a week after laparoscopic adjustable gastric banding and two to three weeks after laparoscopic gastric bypass surgery. The surgeon may allow activities like walking and changing position in bed on the very first day after the surgery. Doing these activities promotes circulation, speeds up the recovery and minimizes complications.
The adjustable gastric banding operation allows you to lose 50% of your excess body weight at two years. It’s also effective in reversing obesity related co-morbidities.
The sleeve gastrectomy is between the gastric bypass and gastric banding in terms of weight loss with 60% excess weight loss at 1 year.
Special Dietary Requirement
Daily intake of protein with a multivitamin & mineral intake will prevent any possible nutritional deficiency. Iron & calcium supplements are required as well. Special dietary advice is provided to post-op patients & regular follow up is essential.
Physical Activity Recommendation
Patients are strongly advised to resume physical activity after surgery to ensure that body metabolism is maintained at high levels. All recommendations are in relation to time after surgery.
Long walks: 10 days later
Aerobic activities like swimming: 20 days later
Weight training etc.: 30 days later
Abdominal exercises: 3 months later
Do not lift heavy objects during the first six weeks after the surgery.