Weight-loss surgery, also known as bariatric surgery helps in reducing weight in those with morbid obesity and its associated health complications. Bariatric surgery is a relatively new field with lot of innovations and improvements in techniques being introduced to help manage weight problems.
With obesity rapidly becoming a global epidemic sometimes simple measures such as lifestyle changes including regular exercise and diet changes are simply not enough, and interventional surgeries become the norm of the day. It’s recommended for those with a BMI of 40 or with serious health issues like cardiovascular conditions, diabetes, high cholesterol or severe sleep apnea. Though surgery can be life-saving it comes with its own share of complications too, so do a thorough research before committing to surgery.
Bariatric surgery can be used to control weight through two different ways:
- Restriction surgery – this method limits the amount of food the stomach can physically hold, thereby limiting the number of calories consumed
- Malabsorption surgery – this method shortens or bypasses part of the small intestine from where food is absorbed, thus limiting the amount of calories absorbed.
There are four main classical types of weight-loss surgeries:
Gastric sleeve – In sleeve gastrectomy, the physical size of the stomach is reduced by surgically removing a small part of the stomach pouch from the body. What remains of the stomach is then made into a tubular form such that it cannot hold too much food at a time, hence reducing the intake. There is also a reduction in the appetite regulating hormone ghrelin which makes the person feel less hungry and feel full earlier. This procedure doesn’t interfere with the absorption of calories however.
Roux-en-Y gastric bypass – In this surgery, the stomach is divided into two pouches, with only the upper portion of the stomach receiving food; this means that only a limited amount of food or fluid can be consumed at a given time. The small intestine is then cut a little away from the lower portion of the stomach and rejoined directly to the new pouch that can receive food. This bypass allows for less absorption of calories and nutrition and eventual reduction in weight. The main portion of the stomach still produces gastric juices and the portion of the intestine still attached to it is then reattached at a point lower down to allow the juices flow into the small intestine.
Laparoscopic adjustable gastric banding – This procedure is also known as ‘Lap-Band’ and involves the tricky use of a band with an inflatable balloon attached to it. The band is fixed in place around the upper portion of the stomach pouch, thereby creating two sections with a very small opening from the upper portion of the stomach leading into the lower portion. The second part of the surgery involves the use of a port placed under the skin of the abdomen to control the size of the band. A tube connecting the band to the port allows for inflation or deflation of the balloon to control the size of the band. Lap-band helps the person to fill full sooner, but has no control over the absorption of calories. This method is also wrought with a high failure rate.
Duodenal Switch – This method is also known as biliopancreatic diversion with duodenal switch. In this procedure also, a large part of the stomach is removed; the middle section of the intestine is then closed off and the lower part reattached to the duodenum (hence, the duodenal switch). The closed-off portion of the intestine is then reattached to the lower end of the small intestine, thus allowing for bile and pancreatic juices to flow into it (biliopancreatic diversion). The end result is the stomach can take less food and the intestines absorb less calories and nutrition, both leading to weight loss.