People with extreme and excessive obesity are frequently unsuccessfully treated with diet and exercise alone. An operation called bariatric surgery is done to help people like these lose weight. Patients with severe obesity may live longer if they undergo bariatric surgery and make changes to their diet and lifestyle after the procedure.
Principles of bariatric surgery The fundamental goal of bariatric surgery is to reduce food absorption in the stomach and intestines by restricting food intake.
When food is chewed and mixed with saliva and other secretions that contain enzymes, the digestion process begins. After that, the food travels to the stomach, where it is broken down along with the juices of the digestive tract in order to absorb nutrients and calories. Food enters the duodenum, the first part of the small intestine, where it is mixed with bile and pancreatic juice, accelerating digestion.
The goal of bariatric surgery is to change or stop this digestion process so that food is not broken down and absorbed the way it normally would. Patients can lose weight and lower their risk of obesity-related health risks or disorders by reducing the amount of nutrients and calories they absorb.
The body mass index (BMI), which is a measure of height and weight, is used to define obesity levels and determine whether bariatric surgery is necessary. A BMI of more than 40 kg/m2 or more than 35 kg/m2 combined with severe health issues is clinically severe obesity.
Type 2 diabetes, arthritis, heart disease, and severe obstructive sleep apnea are among the health issues linked to obesity. Patients with a BMI of 30 kg/m2 or more who also have at least one of these conditions are eligible for the use of adjustable gastric banding, which is approved by the Food and Drug Administration (FDA).
Bariatric Surgery Types There are many different kinds of bariatric surgeries that can be done. Laparoscopy, in which instruments are guided into the abdomen through tiny half-inch incisions, or an "open" approach, which involves cutting open the abdomen, can be used to perform surgery. The majority of bariatric surgery performed today is laparoscopic because, as opposed to open surgery, it requires fewer incisions, damages less tissue, causes fewer post-operative complications, and allows for earlier hospital discharge.
There are four different kinds of procedures available:
Surgical options include: vertical sleeve gastrectomy (VSG), biliopancreatic diversion with a duodenal switch (BPD-DS), adjustable gastric banding (AGB), and Roux-en-Y gastric bypass (RYGB). Image source: Dr. Walter Pories, FACS
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The metabolic links between NASH and gut changes caused by diet Each type of surgery has advantages and disadvantages, and various patient factors, such as BMI, eating habits, health issues related to obesity, and the number of previous stomach surgeries, influence which procedure is chosen. The benefits and risks of each type of surgery should be taken into consideration when the patient and provider discuss the best option.
Risks during and after surgery People who have had bariatric surgery must follow a strict diet and exercise plan for the rest of their lives to avoid complications and gain weight. Additionally, patients may develop excess skin that is folded and loose, necessitating additional surgery to tighten and remove.
