Bariatric Surgery - The only long term weight loss solution

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Dr. Nandakishore Dukkipati

Posted By : Dr. Nandakishore Dukkipati - MBBS

Posted On : Aug 21, 2009 (Views : 3431)

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Lighter Side of Life, Series

1.Bariatric Surgery - The only long term weight loss solution

Surgical procedure performed to reduce weight (Baros), is called Bariatric surgery.

Bariatric (weight loss) surgery is known to be the most effective and long lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it may be among the most effective treatments for metabolic diseases and conditions including type-2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnea.

The consensus statement from world reknowned organizations such as National Institute of Health (NIH), American Society forMetabolic and Bariatric Surgery (ASMBS) is that,

“Surgery for severe obesity goes way beyond weight loss. This surgery results in the complete remission or significant improvement of type 2 diabetes and other life-threatening diseases in most patients”.

Surgical options for weight loss have been in existence for few decades. This field of science has evolved significantly in last decade due to obesity becoming a global epidemic and also in part due to availability of new technology and instrumentation that allowed for these procedures to be performed in a minimally invasive or laparoscopic approach. In this, the surgical procedures are performed with usage of very small skin incisions and camera guidance.

The available current surgical options for morbid obesity are

1. Intra-Gastric Balloon

A balloon is placed into the stomach under direct vision with an endoscope (camera through the mouth). Once the balloon is in place, it is inflated to 450 to 550 ml of fluid. The balloon occupies most of the space in the stomach and helps in reducing the food intake. One can feel full with very little food. This balloon needs to be removed within 6 months since the gastric acid will damage it. It can be replaced again.  This method can be utilized by peope who are 10 - 20 kgs overweight.

2. Laparoscopic adjustable Gastric band placement

In this operation, a silicone gastric band is placed around the upper part of the stomach,creating a small pouch. The small size of the pouch means that you feel full sooner. The band can be adjusted in size by inflating or deflating the band.

This allows the health professional to adjust the size of the opening between the pouch and the stomach and in turn can effectively control amount of food required to obtain early satiety. Gastric band procedure is the simplest and safest of all weight loss procedures and yields similar weight loss compared to all other procedures over a course of 2-3 years. In persons who are atleast 25kgs overweight, or BMI>32, these procedure are applicable.

As is the case with all weight-loss procedures, this also requires patient’s adherence to diet and lifestyle modification guidelines.

Laparoscopic Gastric Sleeve resection

Approximately 85% of stomach is removed during this surgery leaving a narrow tube like stomach. Due to very small capacity of the tubular stomach, less food can be consumed and early satiety achieved.

This procedure is irreversible and is relatively new with data of efficacy for past 3 years. This procedure, originally designed as an initial stage of another extensive surgery, has been shown to be effective for weight loss by itself. Good weight loss is seen with this procedure; however, concern exists regarding the possibility of re-enlargement of the stomach tube. This should not result if the appropriate diet guidelines are followed.(Applicble for BMI > 32)

Laparoscopic Roux-en-y Gastric Bypass

This procedure combines the restrictive factor by reducing the amount of food can be consumed and adds the component of mal-absorption by re-routing the small intestine. This procedure till date is considered as the ‘Gold standard’ among weight loss procedures.

It involves creation of gastric pouch which is completely separated from the remainder of stomach and is re-attached to small intestine. There is another additional attachment (Anastamosis) between to two loops of small intestine to facilitate the flow of food material (Applicable to BMI > 32).

Due to the component of mal-absorption, some may experience deficiency in vitamins, calcium, iron etc. These can be supplemented successfully to avoid such issues.

Emerging Surgical approaches

Intuitive surgical minds are constatnly exploring the possibilities of newer and innovative procedures that can surgically correct the health ailments such as diabetes and metabolic syndrome. Most of these procedures are still in the experimental stage with no significant long term information or large enough number of procedures performed yet to induct them into mainstream surgical procedures.

These approaches include procedures such as Duodeno- jejunal bypass, ileal transposition +/- Gastric sleeve resection, etc..

Regardless of the procedure performed, the efficacy of these surgical procedures is unquestionable.                                                                                                         

As the time moves forward with relentless fervor, start working towards the resolutions you made to improve the quality of life. Make every day count towards your success in achieving your personal goals.

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