Bariatric Surgery

Bariatric surgery is a procedure to help people with obesity lose weight. This surgery involves reducing or bypassing either the stomach or small intestine.

Through this procedure, obese people can lose a significant amount of weight, often permanently.

Obesity is one of the leading causes of preventable death in the United States.

It is linked to the development of severe health issues such as:

• breathing problems
• depression
• high blood pressure
• type II diabetes
• stroke
• heart disease
• some cancers

Bariatric surgery is a radical way to address severe obesity by reducing the size of the stomach or small intestines, so the amount of food and nutrients that can be consumed is minimal.

Bariatric surgery is implemented on people who are morbidly obese—that is, more than 100 pounds over their ideal weight and with a body mass index (BMI) of 40 or above.

Individuals with obesity-associated diseases such as diabetes or high blood pressure are considered for bariatric surgery when they have a body mass index of 35 or above.

To be approved for bariatric surgery, patients must first attempt to lose weight through supervised weight loss and exercise programs.

Suppose multiple programs fail to result in weight loss. In that case, the patient becomes eligible for bariatric surgery as long as the need to lose weight is greater than the potential risks associated with the surgery.

Bariatric surgery is primarily performed on adults. Though an increasing number of teens over the age of 15 who are morbidly obese and have health conditions like type II diabetes have bariatric surgery, it is controversial.

Not all medical professionals believe that this is an appropriate surgery for adolescents and that their benefits outweigh the risks.

Because children and teens under the age of 15 are still growing, they are usually not considered candidates for bariatric surgery.

WHAT ARE THE TYPES OF BARIATRIC SURGERY?

There are three types of bariatric surgery. Restrictive bariatric surgery limits how much food can be held in the stomach.

Malabsorptive surgery limits the number of nutrients that can be absorbed in the body. The third type of surgery is a combination of these two types. Most malabsorptive surgeries involve restrictive bariatric surgery as well.

Restrictive Surgery

The most performed bariatric surgery procedure in the U.S, restrictive surgery, reduces the size of the stomach.

A normal stomach holds about 48 ounces (1.5 liters) of food. Restrictive surgery reduces the stomach’s capacity to about 1 to 3 ounces (30 to 90 milliliters).

The three types of restriction surgery available in the United States are:

• adjustable gastric band surgery (also known as gastric banding)
• vertical banded gastroplasty
• vertical sleeve gastrectomy

The most common restriction surgery in the United States is adjustable gastric band surgery. Also known as gastric banding, this type of bariatric surgery involves placing an elastic silicone band around the upper part of the stomach and pinching off part of it.

This leaves a small pouch of the stomach at the top. This stomach pouch has a narrow exit, slowing the rate at which it may be emptied.

4You can only consume about half a cup of food before feeling full or nauseous when you have this type of surgery.

Adjustable gastric band surgery is considered the safest weight-loss surgery, with a quick recovery time.

Those who have this surgery lose on average about half of their excess body weight in the first two years after the surgery.

Unlike other bariatric surgeries, gastric banding can be approved for people whose BMI is above 30 and have an additional health issue such as type II diabetes.

Also, unlike other bariatric surgeries, no parts of the digestive system are removed during the procedure, and the surgery is reversible. However, there are risks, including the slipping of the band.

Vertical banded gastroplasty (VBG) is commonly known as stomach stapling and is less common than gastric banding surgery.

The stomach is rendered smaller in this surgery by surgically stapling and banding part of the stomach shut.

Though the procedure can be done quickly and has few complications, it often results in less weight loss than other bariatric surgeries.

Risks include the staples pulling out, which can lead to leaks between the stomach and abdomen.

Vertical sleeve gastrectomy (VSG) involves the surgical removal of part of the stomach that produces an appetite-stimulating hormone called ghrelin.

What remains of the stomach is attached to the small intestine. The stomach’s capacity is reduced to about one ounce of food.

This surgery is usually performed on morbidly obese people who cannot undergo Roux-en-Y malabsorption surgery.

Though this surgery is not reversible, the remaining part of the stomach can stretch so food capacity and weight can increase.

Malabsorptive surgery

Also known as gastric bypass surgery, malabsorptive surgery is generally more drastic than restriction surgery.

It involves altering the digestive system to bypass part of the intestine, and fewer nutrients are absorbed.

Malabsorptive surgery is usually combined with restrictive surgery to ensure that less food reaches the digestive tract.

There are two types of malabsorptive surgery, Roux-en-Y gastric bypass and biliopancreatic diversion (BPD).

Roux-en-Y involves creating a small stomach pouch by stapling and banding the stomach and attaching part of the small intestine to the bag.

The duodenum—the first part of the small intestine where many calories and nutrients are absorbed—is bypassed. The rest of the digestive system is left intact.

Though the digestive system is permanently changed, Roux-en-Y allows people to lose between 60 and 70 percent of their excess weight.

However, the surgery is complex, comes with a longer recovery time, and means that patients must take nutritional supplements and eat a specialized diet for the rest of their lives.

There is a risk of tearing, bleeding, and infection at the cuts and reconnections of the stomach and small intestine.

BPD is more radical than Roux-en-Y. In this surgery, approximately two-thirds of the stomach is removed.

What is left is a pouch that can hold around three cups of food. Both the duodenum and jejunum (the second part of the small intestine) are bypassed so that the stomach pouch is connected directly to the last part of the small intestine, the ileum.

Even fewer nutrients and calories are absorbed than with Roux-en-Y, so lifelong proper nutritional support is vital. BPD generally results in more weight loss, up to 80 percent of excess weight.

Similar to Roux-en-Y, BPD comes with risks of tearing, bleeding, and infection.

WHAT HAPPENS WHEN YOU HAVE BARIATRIC SURGERY?

When you have bariatric surgery, the procedure is performed in a hospital or specialty surgical center.

The surgeon who operates should be experienced with obesity surgery. The surgery takes two to three hours. After the procedure, you may expect a hospital stay of about one week.

After the operation, most patients are on a liquid diet for up to three weeks, but sometimes up to three months.

After a month, most patients eat pureed food and solid food after about two or three months.

In addition to following a new diet and taking nutritional supplements, bariatric surgery patients usually must commit to an exercise plan.

You have to adjust to a new way of eating after bariatric surgery. You cannot eat too quickly or ingest too much food because this can cause nausea and vomiting.

It can also cause intestinal dumping in which undigested food reaches the small intestine too quickly. This causes pain, diarrhea, and dizziness.

Foods high in fat are hard to digest and can cause diarrhea if consumed, especially in excess, after bariatric surgery.

WHAT ELSE DO I NEED TO KNOW ABOUT BARIATRIC SURGERY?

Health-care insurers do not always cover bariatric surgery. Sometimes, it is considered elective surgery.

If such procedures are covered, documentation proving the necessity of the surgery is often required.

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