Obesity Surgery Procedures
Obesity Surgery, Oftentimes, when a person is overweight, it brings about certain kinds of secondary health problems. It is a complex disease, often including secondary conditions. Moreover, these secondary conditions worsen the outcome for obesity patients too. Secondary problems caused by obesity put the patient’s life at peril if not addressed.. These problems include:
- Diabetes type 2
- High blood pressure
- Some types of cancer
- Sleep apnea
- Fatty liver disease
- Heart disease
- Kidney Disease
However, these problems are not impossible to solve. Thanks to today’s technological advancement in the medical industry, we can get rid of our extra weight. As a result, we can gain the look and health that we have always desired.
What Is Obesity Surgery?
People with weight problems seeking to find an ailment often try many different kinds of approaches. Some resort to dieting, some try weight loss pills, thinning teas, exercise etc. When all else fails, modern medicine offers a solution for these people. Surgical interventions are highly effective against treating obesity and in turn, its secondary complications.
In surgical interventions to help lose weight, doctors lower limit the amount of food the stomach can hold. Sometimes these procedures aim to create a malfunction in food absorption, and some operations combine both of them.
In today’s world, there are certain obesity surgery types in practice.
- Gastric bypass
- Adjustable gastric band
- Sleeve gastrectomy
- Biliopancreatic diversion with duodenal switch
Each of these operations has its own advantages and disadvantages. In this article, we will go over each of these options for surgery for obesity. And help you determine which one to go with. Let’s begin with the gastric bypass operation.
Gastric bypass is sometimes also referred to as “Roux-en-Y Gastric Bypass”. This kind of operation is the most popular obesity surgery type today. Let’s delve into the details of the procedure.
This surgery for obesity consists of two parts. In the first part, doctor dissects most of the stomach away from the gastric pathway. This way, the majority of the stomach gets detached from the GI tract. After, the physician makes a tiny incision on a small fraction of the small intestine. Then, this dissected small intestine gets connected to the new, smaller stomach. Majority of the stomach gets left out from the pathway of the food. Though, this bigger part of the stomach still stays attached to the small intestine. This way stomach keeps producing stomach acid and enzymes for digestion. These enzymes just interact with the ingested food a bit later on.
Taking away most of the stomach from the pathway of food means that the patient cannot eat as much volume as before. In turn, this leads to less calorie consumption and thus, weight loss. On top of this, most of the stomach does not interact with the food directly.
Another thing that this operation cause is the body to derive fewer nutrients and fewer calories from food intake. All the while, we also bypass a small amount of the small intestine in this operation too. This segment of the small intestine that we usually bypass absorbs food too, but not anymore. Let’s move on to the advantages and disadvantages of gastric bypass obesity surgery.
Advantages of Gastric Bypass
- Patients lose 60% to 80% of their excessive weight in the end result.
- Limits the amount of food patients can eat in one sitting.
- It can indirectly cause the body to spend more energy overall.
- Makes changes in the gut microbiome and hormones; this translates to less appetite. In other words, patients feel less hungry.
- Over 50% of the weight loss stays lost in this type of operation.
Disadvantages of Gastric Bypass
- This operation is a rather complex one, getting this operation from an inexperienced doctor increases certain risks of unwanted complications.
- Since the body cannot absorb nutrients as efficiently as before, certain nutrient deficiencies may occur. Usually, patients experience one or more of the following micronutrients: calcium, folate, iron or vitamin B12 deficiency.
- Patients have to stay in hospital for longer compared to other types of gastric surgery.
- This operation requires life-long aftercare. Patients need to stick to individual dietary restrictions. Some may need continuous vitamin or mineral supplementation. Furthermore, periodic check-ups are necessary.
This kind of operation is sometimes also called Laparoscopic Sleeve Gastrectomy. In this kind of surgery for weight loss obesity, doctors take away around 80% of the patient’s stomach. The remaining 20% of the stomach resembles a banana in shape.
There are a number of different aspects of sleeve surgery that facilitate weight loss. First and foremost, this operation drastically reduces the volume of the stomach. This way stomach cannot hold much food at the same time. In other words, the patient cannot take as many calories as before.
However, the majority of help comes from the effects on the gut biome. The reduction of stomach volume affects hormones found in guts. These hormones manage certain factors such as hunger, fullness and blood glucose regulation.
Research indicates that sleeve gastrectomy operation is just as effective as roux-en-y gastric bypass. These studies show that it does its job at facilitating weight loss just as good as gastric bypass. On top of that, sleeve obesity surgery works at improving type 2 diabetes symptoms as good as gastric bypass too. Also, some research suggests that sleeve obesity surgery improves symptoms of type 2 diabetes regardless of weight loss.
When it comes to the risk of complications after the operation, obesity sleeve surgery falls somewhere in the middle. This kind of surgery for weight loss has a slightly higher complication risk than adjustable gastric band. While compared to gastric bypass surgery, it poses slightly less risk. Let’s have a look at the advantages and disadvantages this weight-loss operation offers.
- Limits the patient’s food intake drastically
- Gives significant results very quickly
- Shows a similar graph to gastric bypass surgery in terms of weight loss speed and weight loss maintenance
- During the operation, doctors do not have to insert any foreign bodies inside the patient. The procedure contains no bypassing of any sort. Nothing about the gastrointestinal tract gets rearranged.
- Patients do not have to spend a long time in the hospital compared to other weight loss operation types. Usually, doctors allow patients to leave after two days.
- This operation causes gut hormones to behave differently. This difference in behaviour leads to less experienced hunger, less appetite throughout the day and better satiety all around.
- We are not able to revert this procedure and restore the volume of the patient’s stomach. Patients undergoing this operation are under the risk of vitamin deficiencies. Less stomach volume means food absorption is not as good.
- When compared to adjustable gastric band obesity surgery, this operation has a higher early complication rate.
Adjustable Gastric Band
Another popular name for this surgery in the industry is the band. In this operation, surgeons attach a special type of band around the top part of the stomach. This band creates an isolated pouch over the stomach.
When the stomach gets constricted, patients start feeling full after eating small amounts of food. Patients do not feel like eating a lot when they have a gastric band, and this reduces the number of calories they take.
The amount of hunger patients feel depends on how tight the band is set over their stomach. If the doctor leaves the gap below the pouch more open, the patient gets to eat more. The tightness of the band is adjustable. Doctors can set the opening again and again. They do this by injecting a sterile solution inside the band or extracting if they want to make the gap bigger. To enable this, doctors leave an access point to the band under the patient’s skin.
Usually, doctors leave the gap relatively wide in the beginning. The patient visits the doctor regularly, and the doctor tightens the band when he or she sees fit. This is often called “filling”.
A while ago, experts thought this procedure worked by restricting the passage of food through the gap. Thus, a restricted passage made the patient become full sooner. New researches challenge this idea. They demonstrate that the food ingested by the patient passes through the gap rather quickly. So this means, we cannot link the slowed passage of food through the gap with becoming full faster when eating.
On the other hand, the other two previous obesity surgery options cause a degree of loss in the absorption of nutrients, whereas restriction with the band does not cause such a thing to happen. Since there is no removed tissue, the patient’s digestive system runs just as efficient as before. And digestion occurs just like before the operation after gastric band operation. Let’s discuss the main advantages and disadvantages of this type of weight loss surgery.
- The stomach cannot hold as much food as before. Though the stomach stays intact.
- Patients lose approximately 40% to 50% of their excessive weight after the operation.
- Gastric band operation does not involve any incisions on the gastrointestinal tract. The stomach is not cut in this operation at all. Also, there is no bypassing in this operation towards the small intestine.
- This operation requires a very short stay at the hospital. Patients are able to leave the hospital in the first 24 hours. Some hospitals even discharge patients the same day, depending on their time of operation.
- This obesity treatment offers the most flexibility. Not only it is fully adjustable, but it is also completely revertible too.
- This weight-loss operation type has the lowest rate of death among the main methods in practice today. Also, the adjustable gastric band has the lowest early-onset complication rate among these operations.
- Patient’s do not have a high risk of developing any kind of malnutrition problems with this operation. Actually, this one has the lowest rate among the main types of obesity surgery.
- During the early phase after the operation, this one offers the slowest weight loss. All other obesity surgeries offer a more and faster weight loss.
- When we compare it to other types of obesity operations, this kind has fewer patients losing 50% of their excessive weight.
- This procedure includes the insertion of a foreign object inside the body.
- In rare cases, we have seen that the band can slip into places it should not. Sometimes the band may experience wear and tear too.
- If the patient persists in overeating, this may result in dilation of the oesophagus.
- Postoperative care is strict. Therefore, patients need to obey the guidelines. Also, patients have to make regular visits to their doctor for a check-up.
Biliopancreatic Diversion with Duodenal Switch Gastric Bypass
This method often goes by its abbreviation BPD/DS. This kind of obesity surgery also happens in two parts too, like gastric bypass. In this procedure, the first step is pretty similar to sleeve gastrectomy. The doctor takes away most of the stomach and leaves a small part from it, resembling a banana shape. And, in the second part, doctor bypasses the majority of the patient’s small intestine.
During the operation, doctors split the duodenum from the stomach right around where the stomach connects to it. Duodenum is the first part of the small intestine. Then, the doctor connects the split stomach line towards the end of the small intestine. This way, when the patient consumes food, food passes through the shrunken stomach into the end of the small intestine. As a result, most of the digestion and nutrient absorption gets bypassed. In this weight loss surgery, we bypass around three-quarters of the small intestine.
The small intestine carries necessary enzymes and bile, which originate from the pancreas. We need these components to be able to digest fats and proteins. That’s why doctors still connect the rest of the small intestine to the newly formed tract. This obesity surgery works the same way as the other surgeries at first glance.
The patient cannot eat much food due to reduced digestive organ volume. The difference between BDP/DS and the other weight-loss surgeries is simple. In this operation, we also bypass a huge part of small intestine too. This causes BDP/DS to have a higher risk profile in every aspect than other types of operations. Patients lose weight fastest in this type of weight-loss process. But they also have a higher risk of developing problems related to malnutrition and malabsorption. They have to stay longer at the hospital. And they have the highest risk of complications and death among these four operation types.