Bariatric Surgery for Weight Loss

Bariatric surgery encompasses several different types of surgical procedures performed on obese patients to aid in significant long-term weight loss. The newest of these procedures is sleeve gastrectomy. This procedure achieves weight loss by removing the larger, rounded part of the stomach.  The remaining stomach is shaped like a sleeve and will hold less content than that of the original stomach reducing the amount of calories your body is able to absorb.

Long-Term Studies Show Bariatric Procedures Support:

1. Significant long-term weight loss.
2. Recovery from diabetes.
3. Improvement in cardiovascular risk factors.
4. Reduction in mortality of 23% from 40%.

The U.S. National Institutes of Health Recommends Bariatric Surgery For Obese People With:

1. A body mass index (BMI) of at least 40.
2. Serious health problems related to weight such as diabetes.
3. BMI of 30 to 35 in combination with significant comorbidities.

Indication

Surgery is a treatment option for patients who failed an adequate exercise and diet program (with or without drug therapy) and who present with obesity-related co morbid conditions, for example hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea.

A doctor–patient discussion of surgical options includes the long-term side effects, such as the need for reoperation, gallbladder disease, and malabsorption.

It is extremely critical patients undergo psychiatric evaluation to determine their mental health. Half of bariatric surgery candidates are depressed and it is important for these issues to be discussed with your health care provider.

Sleeve Gastrectomy Is A Two Stage Process

Stage One

The large portion of the stomach is removed. The open edges are then attached together (typically with surgical staples, sutures, or both) to leave the stomach shaped more like a tube, or a sleeve, with a banana shape.

This step of the procedure permanently reduces the size of the stomach and removes the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).

This surgical method is performed laparoscopically and is not reversible. Most patients can expect to lose 30 to 50% of their excess body weight over a 6–12 month period with the sleeve gastrectomy alone.

Stage Two

The second stage of the procedure is performed several months later. The timing of the second procedure will vary according to the degree of weight loss, typically 6 – 18 months.

The reduced stomach is converted into a formal gastric bypass or duodenal switch. This step will provide additional and permanent weight lost that cannot be achieved with the sleeve gastrectomy alone.

This combined approach has tremendously decreased the risk of weight loss surgery for specific groups of patients.

Stomach volume is reduced and continues to functional normally so most food items can be consumed in small amounts.

Dumping syndrome is less likely due to the preservation of the pylorus. This procedure minimizes the chance of an ulcer occurring.

By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are significantly reduced.
Bariatric Surgery is exceedingly effective as a first stage procedure for high BMI patients.

Limited results appear promising as a single stage procedure for low BMI patients (BMI 35–45) appealing option for people with existing anemia, Crohn’s disease, irritable bowel syndrome, and numerous other conditions that make them too high risk for intestinal bypass procedures.

Post Surgery

Immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or sugar-free gelatin desserts. This diet is continued until the gastrointestinal tract has recovered from the surgery. The next stage provides a blended or pureed sugar-free diet for at least two weeks. This may consist of skimmed milk, cream of wheat, a small amount of margarine, protein drinks, cream soup, pureed fruit and mashed potatoes with gravy.
Post-surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting.

Many patients will need to take a daily multivitamin pill for life to compensate for reduced absorption of essential nutrients.

Because patients cannot eat a large quantity of food, physicians typically recommend a diet that is relatively high in protein and low in fats and alcohol.
It is very common, within the first month post-surgery, for a patient to undergo volume depletion and dehydration. Patients have difficulty drinking the appropriate amount of fluids as they adapt to their new gastric volume. Limitations on oral fluid intake, reduced calorie intake, and a higher incidence of vomiting and diarrhea are all factors that have a significant contribution to dehydration. In order to prevent fluid volume depletion and dehydration, a minimum of 48–64 fl oz should be consumed by repetitive small sips all day.

Reduced Mortality And Morbidity

Several recent studies report decreases in mortality and severity of medical conditions after bariatric surgery. Bariatric surgery not only reduces obesity but manipulates the metabolism of patients; refer to “metabolic syndrome”. Improvements in blood chemistry and chemical conditions such as diabetes, high cholesterol, and hypertension are noted after surgery.

Three essential branched-chain amino acids: leucine, isoleucine, and valine, found in foods like fish, eggs, and legumes, decrease dramatically after gastric bypass surgery. The surgery delivers structural and hormonal changes which can potentially cure diabetes. Given the remarkable rate of diabetes remission with bariatric surgery, there is considerable interest in offering this intervention to type 2 diabetes patients with a BMI of <35 kg/m2.

Laparoscopic bariatric surgery requires a hospital stay of only one or two days.

Rapid weight loss after obesity surgery can contribute to the development of gallstones.

Nutritional derangements due to deficiencies of micronutrients like iron, vitamin B12, fat soluble vitamins, thiamine, and folate are especially common.

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