What is Bariatric Surgery and how does it work?

By: | Tags: , | Comments: 0 | March 5th, 2018

Obesity is spreading like a wild fire. The modernization in lifestyles on one hand has made our life easy, but on the other hand the widespread availability of junk foods and lack of physical exercises are pushing us towards obesity and its side effects. Obesity results from misbalance between the intake of calories and their proper utilization.

The most commonly used tool for quantifying obesity is Body Mass Index(BMI). It is the ratio between weight in kgs and height in meter2. Normal BMI of a person is 18.5 to 24.9. Once the BMI of a person crosses that level, he/she enters the arena of overweight/obesity. Obesity is the main causative factor for many ailments that can be detrimental for life e.g High blood pressure, Diabetes, Arthritis, Infertility to name a few. Lower level of obesity is mainly treated with non-surgical means like diet modifications, exercise etc. But after a certain level, the non-surgical means fail to result in adequate weight loss. The other name of surgery for obesity is Bariatric Surgery.

Indications of Bariatric Surgery:

Bariatric surgery is indicated in persons having BMI of 37.5 or greater. If an obese person has BMI of 32.5 along with two ailments resulting from morbidities(e.g blood pressure, diabetes, arthritis, sleep apnoea or day time somnolence, infertility etc), then also bariatric surgery is indicated.

Types of Bariatric Surgery:

Depending on the mechanism of weight loss, bariatric procedures can be divided broadly into the following groups-

  • Restrictive Procedures
  • Mal absorptive Procedures and
  • Combined procedures

 

Restrictive procedures-

The restrictive procedures reduce the capacity of stomach so that it can hold less food. So, they make you full sooner after taking food. In sleeve gastrectomy, approximately 70-80% vertical portion of stomach is removed surgically. More than 90% of a hormone, Ghrelin is normally secreted from the portion of the stomach that is supposed to be removed. Ghrelin controls our hunger. Hence, after surgery, people don’t feel hungry in spite of taking so less. Some examples of restrictive procedures are: Sleeve Gastrectomy, Gastric banding, Vertical banded gastroplasty etc.

 

 

Mal-absorptive procedures-

These surgeries rearrange or remove part of the digestive system, which then limit the portion of calories, minerals, and/or fat-soluble vitamins that body can absorb. Treatments with a large malabsorptive component result in the most weight loss but may have higher complication rates. Example of true mal-absorptive procedure is Bilio-Pancreatic diversion

 

Combined Procedures-

Some procedures involve restriction as well as malabsorptive components in causing weight loss. Some of the combined procedures are Roux-en-Y gastric bypass, One-anastomosis(Mini) gastric bypass etc.

Every procedure is not suitable for every patient. The success of Bariatric surgery involves proper individualization of the procedures and advising a procedure very cautiously to the respective patients. Advantages should always outweigh side effects of the procedures. If the procedures are not carefully chosen after detail counseling with experienced bariatric surgeon, then possibility of the reverse relation is a high probability.

 

Schematic representation:

 

  1. Sleeve Gastrectomy

2. One anastomosis(Mini) Gastric Bypass

 

3.  Roux-en Y Gastric bypass:

 

 

 

 

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