What is Bariatric Surgery?
Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients or by a combination of both gastric restriction and malabsorption. Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).
The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.
In this procedure , Stapling creates a small (15 to 20 cc) stomach pouch. The reminder of the stomach is not removed, but is completely stapled cut and divided from the lower stomach pouch. The outlet from this newly formed pouch empties directly in to the lower portion of the jejunum, thus bypassing calorie absorption and the duodenum. To achieve this, the small intestine is divided just beyond the duodenum and a connection with the new, smaller stomach pouch is constructed. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.
The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch.
A sleeve gastrectomy is a restrictive that limits the amount of food you can eat by reducing the size of your stomach.During this procedure a thin vertical sleeve of stomach is created using a stapling device. This sleeve will typically hold between 50 to 70 ml of food and liquid and is about the size of a banana. The excised portion of the stomach is removed.
Gastric Band –is an an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.
The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.Reducing the size of the opening is done gradually over time with repeated adjustments. The upper pouch holds about 4 ounces (1/2 cup)of food. This helps a person feel full sooner and longer than usual. The idea behind the band is to reduces hunger and thereby decrease the amount of calories that are consumed.
Intragastric balloon involves placing a deflated balloon into the stomach, and then filling it to decrease the amount of gastric space.
The balloon is introduced into the stomach through the mouth without the need for surgery. The doctor inserts an endoscopic camera (gastroscope) into the stomach. If no abnormalities are observed, the balloon is placed through the mouth and down the oesophagus into the stomach. Once inside the stomach, it is then filled with a sterile saline solution, through a small filling tube attached to the balloon. Once filled, the doctor removes the tube by gently pulling on the external end, leaving the balloon inside the stomach.This procedure is performed by a qualified specialist gastroenterologist alongside an anaesthetist and trained nursing staff
Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass
The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.
The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream. The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream. Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients). Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.