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To lose weight is not an easy task, especially when patients get diagnosed with morbid obesity, as per their Body Mass Index. After going through some unsuccessful attempts at losing weight through control of one’s diet, regular exercises or pharmacotherapy, which happen to be some of the most common methods that have been medically supervised for weight loss, surgery might represent the only source. Laparoscopic Sleeve Gastrectomy happens to be one of the methods of surgery, directed towards weight loss and it belongs to the category of bariatric surgery.
Who all can undergo this surgery of laparoscopic sleeve gastrectomy?
This particular surgery is mainly intended for those people, who have extremely high Body Mass Index or BMI, ones who suffer from comorbidities or even for those, who have a complex history of surgery. As it is an invasive procedure, physicians tend to only consider this in situations where there is high risk involved medically for bypass or for those patients who prefer to undergo a more permanent surgery. This does not involve any kind of device to get placed inside the patient’s body as it happens during the case of procedures of gastric band.
The procedure of laparoscopic sleeve gastrectomy
- The surgeon removes close to 90% of the stomach, thus reducing its size and capacity to increase one’s ability to lose weight.
- The stomach gets divided vertically into two portions, hence creating a small pouch.
- Then, after stapling the stomach, the surgeon removes the excess portion.
- It is a kind of restrictive operation as it puts a limit on the intake of food but does not bring in any change to the normal functioning of the digestive system.
- The process is known as laparoscopic as it does not require open surgery.
- The surgeon just makes 5-6 small cuts in the abdomen, through which he gets through his surgical instruments, which include a laparoscopic camera.
- This helps to increase the visibility of the surgeon, while the method helps to carry out the surgery in painless manner, with less of scarring and minimum recovery time.
- There is no risk of any kind of infections and adhesions.
Efficacy of Laparoscopic Sleeve Gastrectomy
This particular bariatric surgery of Laparoscopic Sleeve Gastrectomy is an effective method through which one can lose weight due to some reasons that include:
- As it is a laparoscopic surgery, the normal functioning of stomach, nerves and digestive system do not get affected.
- There is less likelihood of developing the dumping syndrome.
- There is also low risk of ulcers and patients need not visit hospitals from time to time.
The surgery procedure of Roux-en-Y Gastric Bypass has two parts:
- Making a Small Pouch inside the Stomach
- The surgeon divides the stomach of an individual into two portions, a large portion and a much smaller one.
- After this, a process known as stomach stapling is carried out, where the smaller part of the stomach gets stapled together in order to make a pouch, which would be able to hold only a cup of food and that is obviously a very small amount.
- Now, with such a small portion of the stomach, obviously people would feel as if it has become full really quickly and hence lead to less eating. This particular strategy is called restrictive as the new size of the stomach restricts the amount of food that it can hold.
- The second part is where the bypass surgery actually takes place.
- Here, the surgeon would disconnect the new, small pouch of stomach from the major portion of the stomach and the first half of the small intestine, which is known as the duodenum.
- Then he connects that to a portion of the small intestine little farther down. This particular surgical technique is known as a “Roux-en-Y.”
After a Roux-en-Y gets conducted, food could directly pass on from the stomach and get into the jejunum, hence avoiding the duodenum. This helps to curb down a person’s ability to absorb calories as well as all other nutrients. This particular method of weight loss is known as malabsorptive.
Stapling of the stomach along with Roux-en-Y typically is done during the time of conducting the same surgery and altogether are called a Roux-en-Y gastric bypass. Normally surgeons conduct the process by way of laparoscopy but when laparoscopy is not possible, they may also conduct a laparotomy.
Recovery process and potential risks
- Once the gastric bypass surgery is conducted, people usually stay back in the hospital for a maximum of 3 days and then go back to their usual activities within 3 weeks.
- Around 10% of people come across complications but they are minor and include:
- Infections in the wound
- Problems related to digestion.
- Just about 5% of people tend to have serious complications that could turn out to be life threatening in nature. Those include:
- Blood clot
- Heart attack
- Serious infection
The risk of complications is minimal at centres that conduct more than 100 bariatric surgeries every year.
Weight loss can be achieved through certain surgical procedures when all others methods seem to fail. These procedures called bariatric surgery,the most commonly performed are-
a) Laparoscopic Sleeve Gastrectomy
Where the stomach is converted into a thin tube of 100 ml capacity.
b) Gastric bypass surgery
This process involves dividing the stomach into 2 portions and connecting the top end directly to the middle portion of small intestine with the food you eat going directly from the top part of the stomach to the intestine.
This class of surgery works in two ways to bring about weight loss – firstly, through surgical changes made to your digestive system, it strives to limit your food intake; and secondly, it also controls your nutrient absorption capability.
There are certain conditions that you need to meet before you can opt for weight loss surgery and these are:
1. Diet and exercise have failed to help you lose significant amount of weight
2. You’re extremely obese and have a body mass index (BMI) of 37.5 kg/m2 or more. (BMI or body mass index is a ratio of your weight (kg) / height (m2) ).
3. Your BMI is above 32.5 kg/m2 along with associated health problems like Type 2 diabetes, sleep apnoea (a common sleep disorder wherein you snore excessively and experience pauses in breathing or shallow breathing instances while sleeping), high blood pressure, high cholesterol levels, osteoarthritis or joint pains.
You will need to be evaluated thoroughly by a Bariatric Surgeon who would advise you some tests to do a whole body evaluation before surgery. He might ask you to meet the different specialists as per your co-morbid conditions in order to optimize your clinical condition. This ensures a safer surgery.
Weight loss through surgery shouldn’t be looked upon as a shortcut to losing weight. It is a powerful tool to aid you to become healthier, but remember.... "With Great Power comes Greater Responsibility", because after the surgery you’ll be required to make some changes to your eating and lifestyle habits to ensure a long, healthy and satisfying life.
Bariatric surgery refers to the procedure by which excessive fat is removed gradually within few months from an individual’s body after modification in size of stomach and modification in gut pathway and length by laproscopically (key hole surgery).
The diet that must succeed a bariatric surgery changes with time. A post bariatric surgery diet will tentatively look like:
- Initial stages: At the initial stage, eating solid food should be strictly avoided. A liquid diet with added protein can is a feasible option as long as it does not have any solid particles. The doctor may also prescribe regular and intermittent consumption at the beginning.
- Intermediary stages: The diet must be changed post second till the sixth week as the meal is made thicker. However, solid food must still be expelled. Due to the surgery, it is only normal that you would feel full after small consumption thereby, necessitating regular intake of food within short span of time.
- Final stages: Post sixth week, incorporating solid food in the diet is generally allowed by the doctors. With the introduction of fuller meals, regular intake of food should be reduced and four meals a day should be the norm.
Along with a fixed diet chart, you may also practice certain exercises to expedite the process of recovery. Some of them are:
- Light exercise: Depending on the condition, few patients may be prescribed exercises every week for an hour.
- Multiple exercises: Few, on the other hand, may be prescribed by the surgeons to exercise twice every week, generally for an hour.
A biliopancreatic diversion with duodenal switch is a less common kind of weight-loss procedure. The procedure is conducted in two steps. The first step involves sleeve gastrectomy, where about 80 percent of the stomach gets removed, hence leaving behind a small stomach, in the shape of a tube. Though the valve, which releases food to the small intestine remains intact along with a small portion of the small intestine that normally stays connected to the stomach. The second step ensures that the major part of the intestine gets bypassed through connecting the end portion of the intestine to the duodenum close to the stomach. A Biliopancreatic Diversion (BPD) puts a limit on how much one can eat and thus reduces the nutrients from getting absorbed, which includes fats and proteins.
BPD is usually conducted as a single procedure but in some selective situations, the procedure might get performed as two separate operations, sleeve gastrectomy and that is followed by intestinal bypass once the process of losing weight has begun.
Why the surgery is conducted?
A Duodenal Switch with Biliopancreatic Diversion is done in order to assist a person in losing excess weight and thus reduce the risk of developing potential life-threatening health problems related to health, which includes:
- High blood pressure
- Heart disease
- High level of cholesterol
- Severe kind of sleep apnea
- Type 2 Diabetes
Eligible candidates for the surgery
- This surgery is mostly done only when people have tried to lose weight by making improvements in their diet and exercise habits.
- Still, this surgery is not for every individual who is overweight. People would have to go through an extensive process of screening to determine if they qualify.
- Patients, who become eligible, have to be willing to make permanent changes so as to lead a healthy lifestyle both before as well as after the surgery.
- This might include long-term plans where they follow-up by monitoring if they are maintaining their nutrition, lifestyle, behaviour and also their medical conditions.
Risks associated with the surgery
This particular surgery, as with any other surgery, carries some potential risks. They are both in the short-term and in the long-term.
Risks associated with BPD/DS are similar to any abdominal surgery and include:
- Excess amount of bleeding
- Adverse reactions to anesthesia
- Blood clots
- Shortness of breath due to breathing problems
- Leaks might arise in the gastrointestinal system.
- Long-term risks and complications from this surgery might include:
- Obstruction in the bowel movements
- Dummping syndrome leading to diarrhoea, nausea and vomiting tendencies.
- Gallbladder stones
- Hernias might arise
- Blood sugar level might come down
- People might even suffer from malnutrition
- There could be perforation in the stomach
Bariatric surgery is advised only in cases of morbid obesity, which has various severe health effects. Undergoing bariatric or weight loss surgery requires effort not just prior to surgery, but also after surgery to ensure its success. This includes significant diet and lifestyle changes, which often involves moving from one end of the spectrum to another end. However, for a person who is willing to do this, the long-term benefits are multiple.
- Weight loss: Bariatric surgery is advised only for people who are obese. One of the first benefits they would see is weight loss. The tendency to eat less is one of the important ways to reduce eating. Nutrition planning should be meticulously done to achieve two things – avoid weight gain and promote weight loss.
- Emotional gains: For a person who is used to seeing an obese image in the mirror, it is a great morale booster to see that image changing to a slender version. This is a big boost to continue the effort towards diet and exercise, which will only improve the confidence and esteem levels.
- Overall health: Morbid obesity is not an isolated condition. It brings with it a host of medical issues including sleep apnoea, diabetes, hypercholesterolemia, etc. With obesity under control, these conditions also begin to improve and the person’s overall quality of life begins to improve. This in turn provides a big boost for the person to continue working at weight loss.
- Reduced healthcare expenses: Obese people often need to eat various medications to manage overall health. There could also be emotional health management issues. With this controlled, the patient spends less on overall health and feels good again.
- Social connect: Morbid obesity isboth a physical and an emotional blockage for a person to engage socially. Once it is controlled, the person is more confident in meeting people and participating in social activities. This further leads to increased overall happiness.
- Active life: With reduced weight, the person’s level of activity improves. What seemed difficult earlier is suddenly doable. A person who could not walk some steps is able to, and this is a big booster.
People who undergo bariatric surgery require quite a bit of effort to change their overall lifestyle. However, the benefits are for them to see for themselves, and that is the biggest motivator to continue working towards their goal. Support is definitely required both medically and socially to ensure that it works. The benefits are there for all to reap.
The Mini-Gastric Bypass or in other words, Single Anatomosis Gastric Bypass is an extremely effective and a well-established procedure that combines some of the properties of two other bariatric surgeries:
- A Gastric Sleeve
- A Standard Gastric Bypass
The upper half of the stomach gets divided into a tube, quite similar to the top three quarters of a sleeve and then it gets joined to a loop of intestine. This Mini-Gastric Bypass can be made use of as one of the most primary procedures through which one can lose weight and get themselves back to normal.
- Whoever suffers from excess body weight cannot undergo this weight-loss surgery. only certain people who fall under the following category
- Patients who have had previously undergone either gastric banding surgery or gastric sleeve surgery but have not been successful in attaining weight loss.
- Those individuals who had started to develop complications related to the gastric band and have taken decision to go for revision surgery.
- The surgery is not really suited for those patients, who seem to have symptoms of reflux disease.
How does the surgery take place?
Now let us take a look at exactly how does this surgery takes place.
- The first thing with this operation is that the upper part of the stomach gets stapled to give the form of a thin tube, around 30ml to 50ml size.
- The thin tube hence becomes the brand new stomach, which is lot smaller in size and remains completely separate from the rest of the stomach.
- After this, the stomach gets sewn to a loop of the small intestine, hence getting the duodenum, which is the first part of the intestine, bypassed and along with it, around 150-200cm of bowel.
- The remaining stomach and the upper half of the small intestine stays in the body but is not used for digestion of food any longer.
Ways through which mini-gastric bypass procedure helps people to lose weight:
- It helps reduce the feeling of hunger in people through alteration in the signalling process of gut to brain.
- It enables a feeling of satiety as well as fullness to creep in, a lot earlier than usual, while people have their meal, thereby resulting in healthy portion size.
- Leading to the absorption of a decreased amount of calories from the food due to the bypassing of 150-200cm of the upper portion of the small intestine.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Bariatric surgery is unlike other surgeries, the success is defined after 6-18months later. It is not without its complications. But complications managed well by Bariatric surgeons and the introduction of Laproscopy, it gives advantages of reduced post-op pain to less incisional hernias and less post-operative hospital stay.
Sometime problems may happen like-
- Post-operative bleeding: Managed well by the surgeon.
- Dehydration: Chances of dehydration, therefore, one of the main post-op instructions, would be to increase water intake significantly, after the first week of course, when water is included in the diet. For someone who is not used to drinking lots of water, this can be difficult.
- Indigestion: Difficulty digesting food after the surgery is very common. There could be a burning sensation in the stomach. This is often managed by dietary changes like avoiding fatty foods, eating small frequent meals, avoiding too much sugary food items, etc. Too much fruits and vegetables should not be introduced early on, as fibre can be difficult to digest. Avoid fruits like nuts, seeds, fried foods, processed foods, etc. Gradually moving from water to pureed diet to semi-solids to solids can help in getting the stomach used to it.
- Vitamin and mineral deficiency: With the drastic cut in the amount of food consumption, there could be multiple problems including skin rashes, weak bones, dental issues, hair loss, gallstones, kidney stones, etc. All these are due to deficiency of various essential minerals like calcium, potassium, etc. This can be managed through minor diet modifications to ensure the body gets the required minerals and vitamins, even if they are in the form of supplements.
- Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. Therefore, the sugar levels increase rapidly, producing various symptoms like bloating, diarrhoea, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day. Five to six small meals are preferred over 2 to 3 large meals. Some people also get relief from lying down after eating.
- Hernias: Less after laproscopic surgery but sometime it may happen.
- Diet changes: Whether it is medications or foods, some substances have to be knocked off your list. A detailed diet plan should be made with the doctor, as some can affect the stomach in an adverse manner.
- Altered bowel habits: Some people may have diarrhoea, others have constipation. Looking into one’s diet and making suitable changes will help. Therefore, it is very important that you must keep regular follow-up and consultation with your surgeon, in order to avoid complications.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Diabetes is a gnawing problem that affects millions throughout the world. It is a disorder that if overlooked can lead to serious diseases; cardiovascular ailments, problems related to vision, kidney problems and many more. While medication tries to regulate your blood sugar levels, it is not always unfailing. Medication along with changes in your diet and lifestyle can still not improve your condition in certain cases. At times it is hard to increase the insulin production in a person's body even after administering medicines solely known for their efficacy. Such kind of diabetic patients can therefore benefit from a Bariatric surgery.
What is a Bariatric surgery?
Bariatric surgery doesn't refer to a single operative method. It involves a host of surgical procedures conducted on a person to rid him or her of obesity. Obesity in combination with diabetes can make a person's life miserable. The treatment of one can come in the way of curing the other. A diabetic patient who also suffers from obesity usually finds it hard to lose weight in spite of exercising or being on diet. Surgery comes to their rescue. This kind of surgery should be fallen back upon as the lender of last resort that is to say when other solutions have not helped. Bariatric surgery is always performed under skilled supervision. It might include reduction of the size of your stomach, removal of a portion of the stomach, or even gastric bypass surgery.
How does Bariatric surgery help reduce Diabetes?
Diabetes can be of three basic kinds;
Type 1 diabetes in which the body produces no amount of insulin.
Type 2 diabetes in which the body produces an insufficient amount of insulin or Gestational diabetes that pregnant women tend to contract.
Bariatric surgery proves to be very advantageous for patients of Type 2 diabetes:
1. Surgery lowers blood sugar levels considerably. Research shows people with acute diabetes made huge improvements after having undergone a Bariatric surgery. Their blood sugar levels dropped by a noticeable percentage and they felt healthier. Reduced blood sugar is an almost immediate effect in some while for others it does take some time.
2. Bariatric surgery exercises a control over cholesterol, blood pressure and triglyceride levels.
3. The impressive benefits of this operation for a Type 2 diabetes patient are not superficial or temporary. If the patient adheres to the lifestyle prescribed by a doctor, takes medication regularly and follows the basics of post- operative care he or she is likely to remain beyond the ambit of this metabolic disorder.
4. It successfully takes care of ailments resulting from diabetes.
5. Bariatric surgery can eliminate the need for medication or it can reduce the dosage of medicines you take.
In case you have a concern or query you can always consult an expert & get answers to your questions!
When dieting and exercising fail to help an obese person manage their weight, bariatric surgery may be suggested. One of the most popular types of bariatric surgery is a gastric sleeve surgery or sleeve gastrectomy. The main aim of this surgery is to reduce the amount of food that can be consumed in one sitting. It does not affect the amount of nutrients and fats absorbed from the food that has been eaten. A majority of the weight loss resulting from this surgery happens within 18 months.
A gastric sleeve surgery is a relatively safe, straightforward and short surgery. Prior to the day of the surgery, you would have been given a special diet to be followed for two weeks. It is essential to follow this diet strictly. This surgery may be performed laparoscopically or via a large incision made in the abdomen. More than half the outer side of the stomach is removed. The remaining part of the stomach takes the form of a tube. This surgery is not reversible.
Recovery from a gastric sleeve surgery varies from person to person. A certain amount of pain and discomfort is normal for the first week following the surgery. Soft foods may be introduced in week 4 and you can get back to small amounts of your normal food in week 5. You will notice that you feel fuller much faster and are able to consume a very limited portion of your normal food intake. In some cases, your food may also be emptied into the small intestines at a very fast rate. This is known as dumping syndrome. This may cause diarrhea and nausea and leave you feeling weak. It is essential to drink plenty of water to allow for smooth bowel movements and to prevent constipation.
On an average, this surgery can help people lose up to 60% of their excess body weight. However, this depends largely on your control over your diet and the amount of exercise you do. At some point in time, your weight loss may plateau. This is normal to overcome this, you must make a change to your diet or exercise schedule. A dietician can also help you address the right number of meals needed by your body. A gastric sleeve surgery does not require any maintenance post the surgery but it is important not to fall back to your earlier unhealthy lifestyle and to maintain a positive attitude.