What are Different Types of Bariatric Surgeries? 

Bariatric Surgery is one of the most popular options for obese people looking for a way to control their weight. To get bariatric surgery, one has to qualify for certain criteria like BMI (Body Mass Index), associated comorbidities like Diabetes, Hypertension, sleep apnea, infertility, hypercholesterolemia etc. There are many kinds of bariatric surgeries or weight loss surgeries, different surgeries work differently in order to give the desired effect, which is why it is important to understand these surgeries thoroughly. 

Weight loss surgeries are divided into different categories like - 

  Restrictive surgeries: Some bariatric surgeries are focused on limiting the amount of food that can be stored in the stomach. This allows a person to eat less than they used to, because of the limited capacity of the stomach. Sleeve gastrectomy, Adjustable gastric banding, Gastric imbrication, Gastric balloon surgery are examples of restrictive procedures. In sleeve gastrectomy, the stomach is divided into two halves first, then one half of the stomach is completely removed. The remaining part of the stomach is formed into a tube-like structure. This tube-like structure cannot hold enough food and restricts excessive food intake. It also limits the secretion of an appetite hormone called Ghrelin which limits the desire of a person to eat. 

  Malabsorptive procedures: In this procedure, a large segment of the small intestine is bypassed i.e the food is not allowed to enter a large segment of the small intestine and hence malabsorption will be there. Duodenal switch is a malabsorbtive surgery. 

To Summarize: The weight loss procedures that suit our Indian population are the Roux en Y gastric bypass and the sleeve gastrectomy. We do not come across any sign of malnutrition in patients who have undergone these procedures. For successful outcomes, vitamin, calcium and protein supplements are required. 

There are certain myths about bariatric surgery --- life will never be normal after the surgery, pregnancy is a problem after this surgery, one will never be able to eat after this surgery, marriage is a problem after this surgery etc. All these are incorrect as one live a better life after the surgery as one has shed the extra kilos, one is cured of existing problems like diabetes, high cholesterol, hypertension, obesity induced infertility and sleep apnea extra. IN FACT, the quality of life is phenomenal after this surgery. CHOICE of surgery depends on the existing BMI, existing associated problems and results of the investigations that are done prior to the surgery. Your surgeon is the best to decide the right procedure for you. As the procedure which your friend has undergone might not be good for you. Choice of procedure and proper follow up are the key points for a successful surgical outcome. 

  Combination of restrictive and Malabsorptive surgeries: In these procedures, the surgery is done on the stomach as well as the small intestine. It involves creating a small stomach pouch which is attached to the small intestine, thus bypassing a small segment of the small intestine to get the desired effect if the person has diabetes associated. The rest of the stomach produces important digestive juices and is also connected to the intestine so that it can transfer these digestive juices in it. As a part of the stomach and few centimetres of the small intestine are bypassed i.e food does not enter this part, the surgery is called the gastric bypass. The Roux en Y gastric bypass and the Mini Gastric bypass surgeries are examples of these combination procedures.

Bariatric Surgeries - Know Forms Of Them!

Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.

As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.

The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.

Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.

Sometimes, problems that may be faced are:- 

Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.

Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.

Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.

Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.  

Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.

Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.

Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.

Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to  2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.

Bariatric Surgery - Know Problems Of It!

Obesity can shorten your lifespan by decades and also limit and reduce the quality of your life. Obesity cannot always be controlled by dieting and exercise and thus more complicated means such as bariatric surgery has to be employed.

Types of bariatric surgery
Most bariatric surgeries either limit your ability to consume food and thus make you feel fuller quickly or limit the absorption of nutrients from the food you eat. Certain surgeries use a combination of the two in varying degrees. Mentioned below are the most commonly employed forms of bariatric surgery  

Gastric Balloon   This is a form of surgery wherein a specially made balloon is inserted into the stomach. In certain cases even two balloons are inserted into the stomach to reduce the room left for food. This causes you to have less food resulting in weight loss over a period of time.
Gastric Sleeve   This is a form of surgery wherein a major portion of the stomach is removed through the procedure. Also known as Vertical Sleeve Gastrectomy, the surgeon creates a pouch within the stomach which essentially becomes a connecting tube between the esophagus and the large intestine. The reduced stomach size causes fewer hunger related enzymes and hormones to be secreted, causing less hunger and also reducing your food intake capability. This results in weight loss over a period of time.
Gastric Bypass   Gastric bypass uses the combination of two techniques, lesser absorption of minerals as well as reduced intake capacity. In this method, a part of the stomach is rearranged akin to the gastric sleeve. However the leftover portion of the stomach is not removed as it can continue to secrete stomach acids. Because of the reduced size of the stomach, you would eat less and if you happen to over eat, it would cause dumping syndrome (quick and repeated bowel evacuation) which would deter you from eating more.
Lap band surgery   This is one form of surgery where the stomach is not reduced or cut but rather limited by a band that is put around it. This band constricts the stomach and causes the upper part to become smaller. Hence you would feel fuller from eating less, thus resulting in weight loss.
V-bloc therapy   This is a very modern approach to bariatric procedures which works in a very similar way to a pacemaker. A device is placed just under your skin and two leads or wires are connected to the vagal nerve. This nerve is responsible for sending the hunger signals to the brain from the stomach. This device acts as a block to the nerve signals and thus ensures you eat less.
Duodenal switch   This surgery is also known as a Biliopancreatic Diversion wherein the surgeons cut out the part of the stomach similar to a gastric sleeve surgery but also make adjustments to the pancreatic chain and the small intestine to reduce the absorption of minerals.

6 Types Of Bariatric Surgery You Can Think of!

Laproscopic Bariatric Surgery allows Surgeons to perform minimally-invasive treatments to obese patients who have had repeated failure in losing weight through diet change and exercise. Bariatric Surgery is a procedure that does not require any incisions. Patients can return home within 2-3days without much discomfort. In this procedure, inserting operative instruments through multiple holes along with a camera which displays video images on monitor without making a single incision. The camera allows the Surgeons to witness the internal condition and perform the procedure safely. The three most well-known Laproscopic bariatric surgery procedures include gastric bypass, gastric sleeve, and mini-gastric bypass. 

Most common types of Laparoscopic bariatric surgery: 

Gastric sleeve: This is a more drastic mode of surgery and is a new addition to the bariatric endoscopic surgery procedures. Through this procedure, 90 percent of a patient s stomach is removed to facilitate the loss of hunger. This also helps in portion control of food. 
Gastric bypass: This is the most widely used bariatric procedure to cut down fats and control hunger across the globe. The digestive system is re-routed to suppress the hunger of the patient in this procedure. It also contains minimal risk to a healthy individual. 
Mini-Gastric bypass: Similar to Gastric bypass but shorter procedure with approximately equal results in comparison to gastric bypass. 
Other procedures for weight loss are: EndoBarrier therapy and Intra-gastric balloon The procedure is decided by the Surgeons and depending on which types of the procedure will suit you the most. 
Bariatric Surgery allows doctors to perform minimally-invasive treatments to obese patients who have had repeated failure in losing weight through diet change and exercise. Bariatric Surgery is a procedure that does not require any incisions. Patients can return home within the few day without much discomfort. A keyhole procedure involves inserting camera and instructions within abdominal cavity and operations performed by viewing over the monitor. The camera allows the doctor to witness the internal condition and perform the procedure safely. 

Benefits of Laparoscopic Bariatric Surgery: 

Being a minimally-invasive procedure, laparoscopic bariatric surgery has its own advantages. Since minimal incisions are made, the risk of operative complications is easily mitigated. Bariatric surgery is also a long-term solution.

Most Common Types Of Laparoscopic Bariatric Surgery!

Are your regular exercises and the strict diet proving futile on your quest for a tighter and a flatter tummy? You can consider getting an 'abdominoplasty' or 'tummy tuck' done. This cosmetic surgery helps in flattening your abdomen by taking off the extra skin and fat and tightening up the muscles in the walls of your abdomen.

The procedure
1. The first step involves choosing a surgeon for consultation.
2. There are two types of  tummy tuck  surgery, both carried out under general anesthesia.  Complete abdominoplasty  whereby, your surgeon would dissect your abdomen from one hipbone to the other and then give an outline to your muscle, tissue and skin.  Mini or partial abdominoplasty  are recommended for people whose fat deposits are underneath their naval region.

Complete Abdominoplasty
 Complete Abdominoplasty  involves making a big incision around the lower part of the tummy from one hip to another, making a second cut in order to free the belly of the tissue that surrounds that region, separating the skin from the walls around the abdomen, re-aligning the muscles in the abdomen, removing the supplementary skin and fat and then pulling forth the skin remains and stitching them too.

Partial Abdominoplasty
Partial Abdominoplasty requires making a large cut on the lower belly, separating the skin from your abdominal wall, cutting out the excess fat, removing the additional skin and holding the remaining part of the skin together and finally stitching it in place.

Time taken for the surgery
The surgery may stretch from one to about five hours.

Pre-requisites

You will have to cut down on the consumption of alcohol and especially smoking; smoking leads to more complication and slows down the healing process.
It is recommended to have a well-balanced meal before the surgery.
After-care

You may suffer from swelling and pain in the days after the surgery, for which your doctor would prescribe pain-killers.
Regardless of the type of surgery conducted, the portion that was operated on would be stitched and bandaged. Therefore, it is very important to abide by the surgeon s instructions about how you should take care of the dressing in the days to follow.

Tummy Fat - Can Surgery Be Considered to Reduce it?

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 12-18 months.

A gastric sleeve surgery is a relatively safe, straightforward and short surgery. Prior to surgery, few patients would have been given a special diet.  This surgery is always  performed laparoscopically popularly known as keyhole route. More than half the outer side of the stomach is removed. The remaining part of the stomach takes the form of a tube. 

Though recovery from any surgery varies from person to person, most patients are able to walk and allowed sips of water by evening. Though certain amount of pain and discomfort is expected, this remains in bearable range with pain killers. Usually liquid diet is advised for 2 weeks followed by soft foods for 4 weeks.

You will notice that you feel fuller much faster and are able to consume a very limited portion of your normal food intake. It is essential to drink plenty of water to remain adequately hydrated and to prevent constipation.

On an average, this surgery can help people lose up to 70% - 100%% of their excess body weight. However, this depends largely on your understanding and compliance of post operative dietary changes. A dietician can also help you make right food choices, decide meal portions and address the right number of meals needed by your body. For long term weight maintenance it is important not to fall back to your earlier lifestyle and to maintain a positive attitude.

Gastric Sleeve Surgery - What Is The Process Of It?

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