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Weight Loss Surgery

  • Surgery on the stomach and intestines to help a person with extreme obesity lose weight. Bariatric surgery is an option for people who have a body mass index (BMI) above 40. Surgery is also an option for people with a body mass index between 35 and 40 who have health problems like type 2 diabetes or heart disease.
  • There are two basic types of bariatric surgery - restrictive surgeries and malabsorptive/restrictive surgeries. Restrictive surgeries work by physically restricting the size of the stomach and slowing down digestion. Malabsorptive/restrictive surgeries are more invasive surgeries that, in addition to restricting the size of the stomach, physically remove parts of the digestive tract, interfering with the absorption of calories.
  • An example of restrictive surgery is adjustable gastric banding also called lap band surgery. Stomach banding is the process of placing a synthetic band around the upper portion of the stomach. It works by creating a small "pouch" at the top of the stomach just below the oesophagus, thus dramatically reducing the amount of food that can be eaten.
  • The size of the opening to the stomach determines the amount of food that can be eaten. The size of the opening can be controlled by the surgeon by inflating or deflating the band through a port that is implanted beneath the skin on the abdomen. The band can be removed at any time.

Causes

Obesity or excessive weight could be due to various reasons including:
1. Lifestyle habits- Excessive intake of junk and aerated drinks without exercising is one of the leading reasons for obesity today.

2. Alcohol: Drinking too much of alcohol can either lead to excessive weight loss or weight gain depending on your body type.

3. Genetics: A history of over-weight family members can also result in obesity for other family members. One’s genetic disposition determines how and where you store fat in your body.

4. Lack of physical exercise: A sedentary life with little physical activity is the germinating bed of obesity and the host of problems that it brings along. The first thing any weight loss specialist will talk about with a patient is how much physical activity does he/she involve in daily.

5. Medical reasons: While the main reason for the weight issues is the lifestyle changes that we are undergoing including the ever-increasing intake of junk food without much physical activity, there are certain cases wherein the obesity is due to a medical condition.

The weight loss specialist looks into all these factors and then prescribe which treatment is best for you. Some disorders that are directly related to excessive bodyweight include coronary heart disease, high blood pressure, type 2 diabetes, abnormal blood fats, stroke, metabolic disorder, cancer, osteoarthritis, extreme sleep apnea, and infertility in women.


Treatment

In most cases, body weight could be brought under control through a combination of healthy dieting and physical exercises. However, for some people, this is not a possibility due to various factors like genetics or dome other medical problem that inhibits weight loss. In such a scenario, a weight loss specialist in India prescribes weight loss surgery also known as bariatric surgery for the patient. Many research studies have recently reported decrease in mortality and also an improvement in medical conditions after bariatric surgery


A weight loss specialist suggest for a weight loss surgery in the case of:

  • BMI> 30
  • Gynaecological disorders
  • Hypertension and excessive mental stress
  • Reduced physical stamina and endurance
  • Acute Sleep disorders

Obesity can manifest itself in many forms including minor heart-attacks. So, a person must first consult a Bariatric Surgeon and know about various available options and then take an informed decision.

There are many types of Bariatric surgeries depending upon the two mechanisms of either restriction i.e. reduced capacity to eat at one particular point of time or malabsorption. Your weight loss specialist combine one or both of these mechanisms in a variable manner to achieve desired results.

Various types of bariatric surgeries include:

1. Gastric Banding – Gastric banding is considered to be the safest weight loss surgery that brings down weight using an adjustable silicone band. The Best Bariatric surgeons use laparoscopy to insert the band around the upper part of the stomach, which lets stomach to hold only a little food. Adjustable gastric banding can result in nearly 40 per cent weight shedding post-surgery. However, the results differ with the patient.

One should always consult their weight loss specialist about the precautions that need to be taken post-surgery and the follow-up that is required. In case if gastric banding, special dietary advice like mandatory intake of protein with a multivitamin & mineral is always given.

2. Laparoscopic sleeve gastrectomy – Sleeve Gastrectomy is one of the most commonly used surgical procedures by weight loss specialist. Through this surgery, nearly 85 per cent of the stomach is surgically removed. The tummy is then reshaped into a sleeve-like structure. The gastrointestinal tract otherwise remains intact. This surgery reduces hunger by lowering down the secretion of hunger-stimulating hormones.

3. Gastric bypass surgery – Another popular bariatric technique is gastric bypass surgery that involves the creation of a thumb-sized pouch from the upper stomach, accompanied by a bypass of the remaining stomach. The lower part does not receive any food but continues to secrete the digestive juices. Since the food now bypasses a section of the small intestine, fewer calories are now absorbed. This is considered a safe procedure by weight loss specialist as by avoiding the intestinal bypass, the chance of intestinal blockage, anaemia, osteoporosis, protein deficiency and vitamin deficiency are significantly reduced.

4. Biliopancreatic diversion – This surgery, also known as the Scopinaro procedure induce weight loss by altering the digestive system. Part of the stomach is resected, creating a smaller stomach. This gives the body lesser time to absorb fats and calories resulting in weight loss.

This is quite a complex surgery with longer recovery time. Your weight loss specialist can brief you about all the risks and complications involved in this surgery. But despite this, Biliopancreatic Diversion is considered super-helpful for clinical or morbid obesity where other standard weight loss options don’t work.

5. Duodenal switch surgery – This procedure is a modification of biliopancreatic diversion comprising of a malabsorptive and restrictive component.


Procedures

There are four types of bariatric surgery procedures offered at Virtua, as well as revisional surgery to modify a previous bariatric procedure. 

Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy is a restrictive bariatric surgery procedure where about 80% of the stomach is removed; the intestines are kept intact. The remaining stomach is formed into a vertical sleeve, which restricts the amount of food that can be comfortably consumed. It also limits the production of the appetite-regulating hormone ghrelin, which makes you feel less hungry. It doesn't affect the absorption of calories and nutrients in the intestines.

Roux-en-Y Gastric Bypass (Gastric Bypass)
Roux-en-Y gastric bypass involves a combination of restriction and malabsorption techniques. The stomach is reduced to a small pouch, the size of an egg. This greatly limits the amount of food and beverages that can be comfortably consumed at one time. The new pouch is connected to the intestines, bypassing a portion of the small intestines. This limits the absorption of calories and nutrients.

Duodenal Switch
Duodenal switch uses both restriction and malabsorption techniques. As in sleeve gastrectomy, about 60-70% of the stomach is removed leaving a "sleeve," which restricts the amount of food that can be eaten. Then, like gastric bypass, this sleeve is connected to the intestines, bypassing a portion of the small intestines. This limits the absorption of calories and nutrients.  

Adjustable Gastric Band (Lap-Band)
Laparoscopic adjustable gastric band, often called a Lap-band, is a silicone band that is placed around the stomach through three small incisions. The band is tightened over time to reduce the size of the stomach. The tightness of the band is adjusted through a small port in the abdomen. Gastric banding restricts the amount of food that can be comfortably consumed. It doesn't reduce the absorption of calories and nutrients.




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