Bariatric Surgery / Weight Loss Surgery
It refers to the various gastrointestinal surgical procedures available to help the severely obese patients lose weight. It is the most effective method to reduce weight and maintain weight loss in the severely obese.
Obesity related health disorders such as diabetes mellitus and high blood pressure may be improved or resolved with weight loss surgery.
Patients with a Body mass index (BMI) of > 37.5 kg/m2 and BMI > 32.5 kg/m2 (for Asians) with significant obesity related co-morbidities. They have failed non-surgical treatment (such as diet, exercise and drug treatment), are fit for surgery and agree to lifelong follow up and lifestyle changes.
The various surgical options can be classified into the following categories: restrictive procedures, malabsorptive procedures, and combined restrictive/malabsorptive procedures. Restrictive procedures limit the patient’s ability to take in food whereas malabsorptive procedures interrupt the digestive process.
Weight loss surgery is performed under general anaesthesia. They include adjustable gastric banding, sleeve gastrectomy and roux-en-Y gastric bypass.
Adjustable gastric banding (AGB) is one of the most frequently performed restrictive operation. A collar of silicone containing an inflatable bladder is placed around the upper stomach. Inflation is carried out by introducing saline via a special needle into a subcutaneous reservoir (port). It induces an early satiety and thereby decreases food intake. It also slows the passage of food from the upper pouch to the lower part of the stomach. Patients who undergo adjustable gastric banding can lose 50-60% of their excess body weight.
In sleeve gastrectomy, the stomach is reduced to about 15% of its original size. It is a purely restrictive operation and it eliminates the need of having to insert a foreign body. However, this procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur. It is also not reversible.
|3.||Gastric bypass is a combined restrictive-malabsorptive procedure. The operation includes forming a small stomach pouch and a small bowel bypass. It has excellent and durable results with low morbidity and mortality rates.|
Most of the bariatric procedures can be performed laparoscopically. The clinical advantages of laparoscopic procedures are the reduction in postoperative pain, lower rate of wound-related complications, and quicker recovery.
The bariatric surgeon will provide a detailed dietary plan. During the first 2 weeks, only liquid foods are allowed. Meals in puree form will be introduced in the subsequent 2 weeks and eventually solid meals. The amount of food that the patient can take is significantly reduced.
Pain medication will be given intravenously at the beginning and later converted to oral forms. The patient will also be encouraged to get out of bed and walk around soon after surgery.
Vitamin and mineral supplements will generally be recommended.
After discharge, the patient can perform light activity for the first 4 to 6 weeks.
The patient should also watch out for:
- Fever or chills
- Abdominal swelling
- Severe pain
- Nausea or vomiting
- Cough or shortness of breath
- Purulent drainage (pus) or from any incision
- Inability to eat or drink
Risks for any general anaesthesia are:
- Allergic reactions to medications
- Breathing problems
Risks for any major surgery are:
- Infection, including in the surgical wound, lungs (pneumonia) or bladder
- Blood clots in the legs that may travel to the lungs
- Heart attack
Risks for weight loss surgery are:
- Injury to the spleen, intestines, or other organs during operation
- Leakage of the contents of the stomach or intestines where they are joined together
- Excessive narrowing of the stomach or connection between the stomach and intestine
- Complications related to port or band for AGB
- Mineral and vitamin deficiency
- Weight regain