What is a Bariatric Surgery?
Metabolic and bariatric surgery (MBS), simply known as weight loss surgery, is the most effective and durable treatment option for severe obesity and the number of complex diseases it gives rise to. Far from being a cosmetic quick-fix surgery, metabolic and bariatric surgery is a life-changing medical technique for patients who have struggled unsuccessfully to achieve weight loss through traditional methods.
Bariatric surgery is primarily used to treat severe obesity (Class III obesity, typically a body mass index or BMI of 40 or greater) or patients with a body mass index of 35 or higher who are suffering from other serious weight-related health conditions (co-morbidities).
As bariatric surgery is considered to be the most effective and durable treatment option for severe obesity, it is also useful in achieving either improved or complete respite from associated diseases with obesity, like type 2 diabetes mellitus, hypertension, high cholesterol, obstructive sleep apnea, Non-alcoholic fatty liver disease, osteoarthritis, reduced risk of cancer, and heart diseases.
What are the different types of bariatric surgery?
Modern metabolic and bariatric surgery (MBS) is mainly performed using minimally invasive techniques, which involve smaller incisions, reducing the pain after the operation, shorter hospital stays, and a quicker recovery time. The two most common techniques most widely used are :
- Sleeve Gastrectomy (SG): This procedure involves permanently removing about 80% of the stomach, creating a long, tube-like pouch. It is highly effective due to the metabolic effect caused by removing the fundus. The fundus is the area of the body that produces the hunger hormone known as Ghrelin the most.
- Roux-en-Y Gastric Bypass (RYGB): This is considered to be the gold standard technique for decades. This operation involves creating a small stomach pouch and rerouting a section of small intestine to connect to it. It combines restriction and malabsorption, offering exceptional results, especially in patients with severe uncontrolled type 2 diabetes.
| Procedure Name | Bariatric (Weight Loss) |
|---|---|
| Type of Surgery | Major procedure conducted using a minimally invasive technique |
| Type of Anesthesia | General Anesthesia |
| Procedure Duration | Sleeve gastrectomy (SG) 60 to 90 minutes, 90-150 minutes for Roux-en-Y gastric bypass (RYGB) |
| Recovery Duration | For sleeve gastrectomy, 1 week for return to light activity, complete recovery is in 4-6 weeks. For Roux-en-Y gastric bypass (RYGB) return to light activity in 2 weeks. |
Bariatric (Weight Loss): Pre-Op & Post-Op Care
Bariatric surgery is a major multi-step procedure that requires extensive pre-operative examination, specialized intra-operative techniques, and lifelong post-operative care. The specific types are a bit varied based on the procedure being performed, but overall, the process is designed to ensure patient safety and long-term success.
Bariatric Surgery Pre-operative care
The pre-operative care can take months and involves a multi-disciplinary team to make sure that the patient is a suitable candidate and fully prepared for the lifestyle changes that are going to happen ahead.
Examination and screening involve an initial consultation that involves discussing surgical options and reviewing medical history. The patient then undergoes a complete physical evaluation, blood work, cardiac and pulmonary testing, and metabolic evaluation to identify any pre-existing conditions like diabetes, hypertension, or sleep apnea.
The next step involves meeting with a dietitian to review the diet history and eating habits of the patient. The patient is then instructed on the necessary diet procedure to follow post the operation, which includes a high-protein, low-carbohydrate, and low-fat diet.
A mental health examination is then conducted to check that the patient is mentally ready for the procedure.
The patient should quit smoking and avoid any kind of nicotine products for months before the surgery.
The patient should shift to a low-calorie liquid diet 2-3 weeks before the procedure to shrink the liver, making surgery safer.
Bariatric Surgery Intra-operative care
The intra-operative phase differs based on the type of surgery. Two of the most common bariatric surgery techniques include Sleeve gastrectomy (SG) and Roux-en-Ygastric Bypass (RYGB).
For the preparation of sleeve gastrectomy, the patient is placed under general anesthesia, followed by making several small incisions in the abdomen using laparoscopic tools.
Resection involves the surgeon using a stapling device to vertically divide and remove approximately 80% of the stomach region. The remaining portion is a narrow, banana-shaped gastric sleeve.
The staple line is sealed, instruments are removed, and the incisions are then closed with sutures.
Roux-en-Y gastric Bypass involves performing surgery laparoscopically under the influence of general anesthesia.
The procedure involves stapling the upper part of the stomach to create a small pouch, about the size of an egg. The rest of the stomach is then sealed off but not removed.
The small intestine is divided into two sections. The upper section is attached to the new stomach pouch, and the lower section is reconnected further down to allow the mixing of digestive juices and food.
The surgeon then checks for any leakage or bleeding and closes the incisions.
After the procedure
Post-operative care is a long-term commitment that begins immediately after the bariatric surgery procedure and usually involves care for the rest of the patient’s life.
Immediate recovery for the first few days typically involves 1 to 4 days; medications are provided to control pain and decrease the need for strong narcotics.
The patient is then encouraged to walk as soon as possible after the surgery to promote blood circulation and prevent the formation of clots.
The doctor instructs the patient to follow a clear liquid diet, with small and frequent sips to prevent dehydration and stomach discomfort.
Recovery at home for the first few months involves diet progression over several weeks. The patient will gradually advance from clear liquids to full liquids, pureed foods, soft solids, and then a natural, balanced diet.
Physically strenuous activity is advised to be started after full recovery, which takes about 6 weeks, after consultation with the surgeon.
Lifelong multivitamin and mineral supplementation is required to prevent any nutritional deficiencies, which are very common after the malabsorptive procedures.
Long-term follow-up involves regular visits with the bariatric team that includes surgeons, a dietitian, and a therapist. Laboratory checkups are done to monitor for vitamin or mineral deficiencies and to monitor metabolic conditions.
Lifestyle modifications for patients involve changes in dietary habits and exercise habits.
Benefits of Bariatric (Weight Loss) at Yashoda Hospitals
- Improves or resolves type 2 diabetes
- Reduces the risk of heart disease and stroke
- Provides relief from joint pain
- Resolves Obstructive sleep apnea
- Reduces the risk of some cancers
- Resolves non-alcoholic fatty liver disease
- Extends life expectancy
- Improves fertility
- Boosts mental health
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