Question

Laparoscopic Bariatric Surgery!

Dr.Nimisha S Kantharia · Accepted Answer

Laparoscopic Bariatric Surgery Bariatric surgery is a group of surgical procedures that bariatric surgeons resort to in order to treat obesity. Bariatric surgery is not a form of cosmetic or plastic surgery. Surgery is done on the digestive tract, particularly the stomach and/or intestine, and basically follows the principle of restricting the amount of food that the stomach can hold to reduce the amount of body fat and excess weight.

Bariatric surgery may also help to shed weight by decreasing the absorption of certain nutrients by the body. Sometimes, there may be an interplay of both these processes to put a brake on obesity. Bariatric surgery also gives rise to favourable hormonal changes, suching as decreasing ghrelin - the appetite hormone, and increasing anti-diabetic hormone

The most common bariatric surgery procedures are Sleeve Gastrectomy and Gastric Bypass surgeries. These procedures are conducted by laparoscopic technique, through four to five tiny incisions or cuts. Let s discuss some of the laparoscopic bariatric surgery briefly:

1) Laparoscopic Gastric Bypass

A small stomach pouch is created and joined to the small intestine, around 100-150 cm away from its beginning. This results in two pathways, one for the food which passes from esophagus/food-pipe into the stomach pouch and then to the small intestine (it is called 'bypass as the food does not enter and hence 'bypasses' the remaining large portion of stomach and first 100-150 cm of small intestine).

The acid produced by larger remnant stomach, bile produced by liver and the other digestive juices travels along the bypassed route, and mixes with the food at a later point than normal digestive pathway.

2) Laparoscopic Sleeve Gastrectomy

This procedure achieves its weight-loss objective by removing about 70 per cent of the stomach. The remaining portion of stomach resembles a tube-like structure about the size and shape of a banana.

The surgery is done by laparoscopically. The surgeon uses a laparoscope to visualize the stomach and surgical instruments to maneuver inside in order to remove majority of the stomach. There is no intestinal component to this surgery. Sleeve gastrectomy helps to achieve weight loss objective by reducing food intake as well as by its effect on a number of hormones that control hunger, blood sugar etc.

Studies suggest that it can be as effective as the gastric bypass method for weight loss. Laparoscopic Bariatric Surgery is done for obesity after thorough clinical evaluation of the candidate, including assessment of other obesity associated illness like diabetes, high blood pressure, sleep apnea, high cholesterol levels, fatty liver disease, among others.

Certain blood tests, vitamin levels and x-rays, ECG, etc will be done before surgery. After surgery a step-wise, tailored nutrition program will be advised. In the initial few months after surgery, frequent follow up is recommended. Later half-yearly and then annual follow up is a must for optimal results.

Laparoscopic Bariatric Surgery is very effective in treating obesity, as well as the complications due to obesity such as diabetes, high blood pressure, sleep apnea, etc. These are some of the different types of surgeries that can help fight obesity. Doctors guide their patients about the type of surgery that is most suitable for them.

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