Weight-loss Surgery for Obesity

Weight-loss surgery is also known as bariatric surgery. It is offered in some instances of morbid obesity (BMI is 40 kg/m2 or above) or people with a BMI between 35-39.9 kg/m2 and obesity-related complications, following conventional medical treatments have failed. Bariatric surgery helps lose the most weight, but it may lead to some severe complications. A number of gastrointestinal surgical procedures belong to bariatric surgery. They help lose body weight, mainly in three ways. Bariatric surgery restricts the quantity of food the patient can comfortably eat (restrictive procedures) or lowers the absorption of calories (malabsorptive procedures), or both. Bariatric surgical procedures cause a significant weight loss with improvement in quality of life and the risk of complications. Sometimes, they help lose 50 % or more of the excessive weight. However, they do not guarantee that the patient will lose all the excessive weight or that him or her will keep up it for a long period. After bariatric surgery, the patient needs to follow exercise, a healthy diet, and lifestyle changes as usual.


Roux-en-Y gastric bypass

This procedure results in fairly good long-lasting results. Gastric bypass includes both restrictive and malabsorptive components. In Roux-en-Y gastric bypass, the surgeon makes a small pouch (appropriately the size of an egg) towards the top of the stomach. The small pouch is joined straight to the middle part of the small bowel (jejunum). This process is known as gastro-jejunostomy. It helps your meals to bypass the rest of the stomach as well as the upper part of the small bowel (duodenum). This surgery can be carried out through a large incision (opening) in the abdomen (as an open procedure) or through tiny incisions and using a laparoscopy (small surgical instruments with a camera). Roux-en-Y gastric bypass can lead to some nutrient deficiencies, requiring careful long-term follow up.


Bilio-pancreatic diversion including the duodenal switch

The bilio-pancreatic diversion is indicated for people, who have a BMI of 50 kg/m2 or above. This surgery has both malabsorptive and restrictive components. It involves removing roughly 70 % of the stomach. The rest of the stomach and a small part of the duodenum are connected to the upper part of the ileum. Then, the second part of the small bowel (jejunum) is joined to the lower portion of the ileum. This bariatric surgery provides sustained body weight loss. However, it can lead to vitamin deficiencies and malnutrition. The patient needs close supervision for complications.


Laparoscopic adjustable gastric banding (LAGB)

The stomach is divided into an upper small pouch and a lower large pouch by an inflatable band. Tightening the band, just like a belt, a small channel is made between the pouches. The band remains in place forever. It connects with a small access port, positioned under the skin. By injecting normal saline through the access port, the band can be adjusted. This is a restrictive procedure, which is less invasive. It can be done as a laparoscopic procedure. LAGB leads to slow, constant weight loss (about 60 % of the excessive weight after three years). However, results of gastric banding may not be good as with other bariatric procedures. It has a lower risk of death, which is less than 0.5 %. Usually, gastric banding doesn’t cause nutritional deficiencies, although it limits the food intake. It produces fewer adverse effects such as vomiting. This procedure is usually recommended to people with a BMI of 40 kg/m2 or above. It is also indicated for individuals with a BMI between 35-39.9 kg/m2 and obesity-related complications.


Sleeve gastrectomy

In sleeve gastrectomy, about 75 % of the stomach is removed as a laparoscopic surgery, resulting in a tube or sleeve like structure. This procedure is a restrictive bariatric surgery. Sleeve gastrectomy is as successful as gastric bypass.


Liposuction

In liposuction, a large amount of fat is removed by suction. Usually, this procedure does not lower the risk of cardiovascular disease (CVD). However, weight regain occurs frequently.



Related Links:

What Is Obesity?
Complications of Obesity
Obesity and Dietary Control
Tips for Diet in Obesity
Pharmacological Management of Obesity
Medications for Obesity