Bariatric Surgery

Are you weary from constantly fighting the battle of the bulge? Are you fed up with your repeated attempts to diet and exercise? Most experts agree that a balanced diet along with regular exercise is the best way to lose weight, but the traditional path to weight loss doesn’t work for everyone. With the rate of obesity on the rise throughout the world, obesity-related complications and mortality rates are also increasing. That’s why it’s so important to control and treat obesity in people who have tried the conventional, non-surgical methods and failed to lose weight.

So what are your other choices? This is where bariatric surgery comes in.

What is Bariatric Surgery?

Bariatric surgery is weight loss surgery for people with a Body Mass Index (BMI) over 40. If your BMI is 35, but you also have serious weight-related medical conditions such as type 2 diabetes or cardiovascular disease, bariatric surgery could also be an option. Gastric bypass and diabetes treatments are often used in combination to reduce the severity of this condition. The decision to have weight loss surgery should always be discussed with a bariatric surgeon, who can tell you about the pros and cons, and the changes you’ll need to make.
 

What is the Need for Bariatric Surgery?

Since bariatric surgery is a last step for morbidly obese people, let’s first understand the “obesity epidemic.” It is a well-known fact that obesity rates are soaring all over the world. More than half of American adults are overweight or obese, and this trend is also being passed on to the next generation, as evidenced by the alarming rise of obesity in children. Obesity is linked to a sedentary lifestyle; the more obese someone is, the less able they are to engage in physical activity, and the more obese they become. This cycle leads to a plethora of diseases and health problems like cancer, diabetes, infertility, and heart disease, among others.

Bariatric Surgery Before and After

Obesity treatments include weight loss programs, various weight loss diets, specific exercise programs and obesity surgery. Fad diets may guarantee fast weight loss, but they invariably pose serious health risks. In many cases, people who lose weight on hard-to-follow fad diets find that they regain the weight as soon as they resume their regular lifestyle.  This period of significant weight loss followed by weight gain is often referred to as the “yo-yo” effect and it’s even more dangerous than obesity alone.

Does this mean the battle against weight loss is hopeless? No! Obesity surgeries can definitely help people who struggle with yo-yo dieting. Studies have shown that there are significant long-term benefits of bariatric surgery, such as weight loss, improvement in cardiovascular factors and a possible reversal of type 2 diabetes. Moreover, bariatric surgery has been shown to reduce the rate of mortality from 40 percent to 23 percent.
 
Do keep in mind however, that after bariatric surgery you will need to follow a bariatric surgery diet and get regular exercise to maximize results! Some bariatric surgery patients opt for body contouring surgeries like liposuction, which removes excess fat from particular areas of the body. Newer techniques such as laser liposuction employ thermal energy to break down fat cells. Another method of liposuction is ultrasonic liposuction, which uses high-pitched sound waves to break down the walls of fat cells. In both these procedures, liquefied fat is then extracted from the particular area. Though hugely popular, liposuction has its own side effects and limitations. Only small amounts of fat can be safely removed at a time in order to reduce the risk of complications and negative reactions. Also, liposuction is expensive, and insurance only covers procedures deemed medically necessary. It would be wise to look at liposuction before and after images to decide whether this type of treatment would suit your requirements.

What Does Bariatric Surgery Cost?

Weight loss surgery can cost anywhere from $13,000 to $35,000, depending on the kind of procedure you have. More invasive surgeries like gastric bypass cost more than gastric banding surgeries. Remember to account not only for the cost of surgery, but also for hospital expenses, after-care, and assistance required at home and time it will take to recuperate. If you decide to opt for liposuction, you’ll need to discuss liposuction insurance/costs, as well as other bariatric surgery costs, like gastric banding cost /insurance, with your insurance company. Also, make sure that the surgeon is a true Bariatric specialist and the healthcare institution of choice has a high rate of successful bariatric surgeries.

What other factors should you consider?

• Age – Bariatric surgery is usually performed on adults between the ages of 18 to 65 (although it’s becoming more commonplace for adolescents to have bariatric surgery)
• Existing diseases – Heart disease, type 2 diabetes, Crohn’s disease, osteoporosis, and hypertension increase the risk of complications. These conditions can also influence the kind of surgery you can have.
• Smoking status – Smoking greatly increases the risks of complications from surgery by constricting blood vessels and reducing blood flow. Most surgeons will perform surgeries on people who have been non-smokers for at least a few months prior to surgery. Also, a history of drug or alcohol abuse can increase the risk for complications
• Risks and side effects – Possible risks include formation of blood clots, pneumonia, hernia, infections at the site of incision, anemia, osteoporosis, dumping syndrome, and others.
• Need for further surgeries – if your weight loss is not as expected, additional procedures may be required,  such as the second part of the duodenal switch surgery (versus just the gastric sleeve surgery alone). Also, many patients opt for cosmetic surgery to take care of the sagging skin and fat deposits after profound weight loss.  

 

What are my options for surgery?

Your bariatric surgeon will advise you as to which type of surgery you qualify for (and which will benefit you the most). Bariatric surgery is typically classified into 3 kinds:

• Mainly restrictive procedures
• Mainly malabsorptive procedures
• Mixed procedures

What are my options for surgery?

Your bariatric physician and surgeon will be able to guide you as to which type of surgery will benefit you the most. Bariatric surgery is typically classified into 3 kinds:

• Mainly restrictive procedures
• Mainly malabsorptive procedures
• Mixed procedures

Gastric Banding: This is a laparoscopic procedure, also called “keyhole surgery,” in which a restrictive silicone band is put around the upper part of the stomach. A small pouch of the stomach remains above the band, and the rest of the stomach stays as is. When you eat, the food fills up the small pouch first. Thus, you feel full after eating very little. The band then allows food to very slowly pass through to the larger stomach area for digestion. Because you’re eating less, weight loss of 50-55 percent of your total body weight is not uncommon.  If you struggle with binging and severe overeating concerns, gastric banding surgery may be a good option since it will help you to control your food intake. Since this surgery is less invasive, it carries less risks and complications. The band is periodically adjusted by the doctor (making it tighter or more loose) and may even be removed once you have lost a substantial amount of weight.

Gastric Sleeve Surgery: This procedure is also done laparoscopically, but is not reversible like gastric banding. The surgeon removes a large part of the stomach (about 80 percent) along the main curve, and then stitches up the ends, forming a tubular or sleeve-like stomach. The digestive and absorptive processes are not affected, and your diet after gastric sleeve surgery generally includes most mild foods in small amounts. Gastric sleeve also prevents dumping syndrome, a condition where food passes through the body too quickly and leads to malabsorption and diarrhea. With gastric sleeve, weight loss after surgery happens because you get full faster and therefore eat less. Gastric sleeve surgery may be a good option for patients who are unable to visit the surgeon very often (as is required in gastric banding). This type of surgery is also ideal for people with existing stomach-related conditions, such as Crohn’s disease.

Duodenal Switch Surgery: The duodenal switch procedure is an example of a mixed type of procedure. The surgeon first partially resects the stomach, reducing its capacity to about 20 percent. Then, the bottom part of the small intestine is connected to the remaining stomach pouch. The food you eat only passes through a section of about 20 inches of the small intestine; that way, it’s not completely digested or absorbed before going into the colon. This process causes malabsorption, which results in rapid weight loss. Even though the duodenal switch diet may not be as restrictive as the gastric band diet, the degree of malabsorption is so high, that you’ll need to take vitamin and mineral supplements and fluids to prevent anemia, osteoporosis and dehydration. If you choose to have this type of surgery, your dietician will counsel you on how to avoid foods that may cause abdominal discomfort like gas, heartburn and unpleasant bowel changes.
 
Gastric Bypass Surgery: Roux-en-y gastric bypass is one of the most widely performed weight loss surgeries. It and works on the principle of malabsorption to bring about weight loss. First the upper part of the stomach is stapled to create a small pouch. Then, this new smaller pouch is attached to the lower part of the small intestine. The remaining part of the stomach and upper part of the small intestine are then re-attached to the continuing small intestine, forming a “Y.” This procedure can also be done laparoscopically and is less complicated because it does not remove part of the stomach. Food passes through the small stomach directly into the last part of the small intestine, and leaves the body largely undigested. Massive weight loss happens in the 6 - 12 months after surgery. Although having diabetes before gastric bypass is a risk factor for surgery, the ensuing weight loss after surgery often leads of a remission of diabetes. In the days after gastric bypass surgery, your diet is limited to clear liquids, followed by thicker liquids and purees. Soft cooked and mashed foods are then added, and eventually, solid food is re-introduced.

Mini Gastric Bypass: Though the mini gastric bypass surgery is not as widely used, this is another method of bypassing digestion in the stomach. Here, a part of the stomach is divided and connected with a loop of the lower small intestine. The remaining portion of the stomach is also connected to the intestine. The major disadvantage of this procedure is that the digestive juices from the intestine may pass upwards into the stomach, often causing corrosion and ulcers. More studies and clinical trials are required to perfect this procedure before it’s used to any extent.

Bariatric surgery can prove to be a boon in helping you to finally lose weight and improve your quality of life and overall well-being. If you have spent many years battling weight related health problems, bariatric surgery might be the answer you’ve been searching for.