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 most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch. Each surgery has its own advantages and disadvantages.
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The laparoscopic sleeve gastrectomy is a bariatric (Metabolic) procedure in which approximately 85% of the stomach has been removed and the remaining stomach has been shaped like a tube or “sleeve”. Initially this procedure was considered as first stage procedure for the super obese. However over a period of time it was realized that the results of this procedure were very encouraging. Hence now as days it has been accepted worldwide standalone bariatric procedure.
As with all other bariatric operations, Sleeve gastrectomy Surgery is also performed laparoscopically (keyhole surgery). Small incisions are created in the abdominal wall to allow small instruments to be passed into the abdominal cavity, guided by a special surgical telescope with a video camera, in order to perform the operation. Sleeve gastrectomy involves converting the stomach into a long thin tube. This is done by stapling the stomach along its entire length and then removing of approximately 80% of it.
This operation reduces the capacity of the stomach and thus restricting the amount of food that can be eaten. It also significantly lowers the level of the hunger hormone, ghrelin (a hormone produced by the parietal cells in the stomach) with the added benefit of reduction in hunger sensation and excellent weight loss.
Bariatric surgery is not only cosmetic surgery. Weight reduction after surgery is an gradual phenomenon. Patient tends to lose almost 70% excess body weight in the span of 1-1.5 year. Simultaneously patient get relief in their associated disease like DM, hypertension, OSA, Osteoarthritis, cardiac risk, infertility and many more.
Most people are discharged home 2 days after surgery. Some will stay an additional night or perhaps two depending on their health issues, especially their mobility, and availability of support at home.
The sleeve gastrectomy is a suitable option for most bariatric patients( BMI >32.5kg/m2) seeking weight loss. it is preferred over the gastric bypass in some special scenarios such as in those who have had multiple abdominal operations and/or complex abdominal hernia surgery with the placement of a mesh that could have resulted in extensive adhesions within the abdomen involving the intestine and rendering the gastric bypass rather hazardous due to risk of injury to the bowel and the likelihood for a considerable prolongation of the operating time with its added risk. It is also a good choice for people who suffer with inflammation of the bowel such as ulcerative colitis and those who have coeliac disease (gluten allergy).
Laparoscopic Roux-en-Y (pronounced "roo-on-why") gastric bypass is one of the weight-loss options UT Southwestern Medical Center offers to treat obesity and related health complications.
The gastric bypass is the most reliable operation for long-lasting weight loss because of its multiple mechanisms. With a realistic diet and exercise plan, a patient can reasonably expect to lose about one-third of their total body weight within a year of the operation and 65 percent to 75 percent of excess weight in one to one-and-a-half years.
Roux-en-Y Gastric Bypass Highlights:
The most extensively studied bariatric operation
The most effective operation for weight loss
Helps to reduce the perception of hunger
Reduces the effective stomach size from the size of a football to the size of a golf ball and skips about three feet of small intestine to train you to eat less and, in turn, absorb less fat
The most effective treatment for diabetes, often resulting in immediate improvement
The most effective treatment for heartburn/acid reflux in morbidly obese patients.
There are two parts to a gastric bypass: The first part involves the creation of a small gastric pouch about the size of a golf ball. The second part involves rerouting the small intestine so that the first 75 centimeters to 100 centimeters of small intestine are skipped or bypassed. The remaining 10-plus feet of small bowel are left undisturbed.
This procedure combines a restrictive operation that makes you eat less with a minimally malabsorptive operation that decreases the amount of fat absorption. There is plenty of small intestine left. Gastric bypass surgery also dramatically lowers ghrelin levels, which is the hormone that makes you feel hungry.
This operation is considered malabsorptive because most vitamins get absorbed in the first portion of the small intestine, which is bypassed. Because some vitamin deficiencies may cause permanent, irreversible damage, it is very important for patients to make a lifelong commitment to taking vitamins.
By skipping or bypassing the first several centimeters of small intestine, the body also becomes more sensitive to insulin and helps to control blood sugars in most diabetics even before any weight has been lost at all. In many instances, blood sugars levels are much easier to control immediately after gastric bypass surgery.
In addition to effective diabetes control, the Roux-en-Y gastric bypass is arguably the best operation for patients with acid reflux. Mechanically, the acid stream is diverted so that the acid-secreting part of the stomach is separated, ensuring there can no longer be backsplash of acid on the esophagus.
Attend one of our free, no-obligation bariatric surgery seminars to meet our team and learn about the procedures we offer. Our bariatric surgeons, dieticians, and other team members will explain each procedure, what you’ll need to do before and after surgery, and answer any questions you may have.
The mini gastric bypass surgery is what its name suggests: a scaled-down, miniature version of the traditional gastric bypass surgery. The difference in the actual surgery is that with mini gastric bypass, the procedure is laparoscopic and reversible. Instead of a small pouch that is created with Roux-en-Y gastric bypass, the mini gastric bypass procedure creates a narrow tube that is attached to the small intestine, approximately six feet from its starting point, a placement that bypasses the highly absorptive section of the intestine.
Mini gastric bypass (MGBP) works both by restricting the amount of food that can be eaten at any one time, and by altering the gut hormones involved in appetite control. In the first part of the mini gastric bypass surgery, the stomach is divided by creating a small tube of stomach, which becomes the pouch. This is the restrictive part of the procedure, which means that only a very small amount of food can be eaten at any one time. Next, the surgeon brings up a loop of bowel (about 200cm long) and joins this to the lower part of the stomach pouch. The food passes from the small pouch into the small bowel, where it meets the digestive juices, which have moved downwards from the main part of the stomach. In other words, about 2m of small bowel has been bypassed before the absorption of food, and calories, take place.
Efforts to lose weight with diet and exercise have been unsuccessful
Your body mass index (or BMI) is 40 or higher
Your BMI is 35 to 39.9, and you have a serious weight-related health problem, such as: Type 2 Diabetes, hypertension, or severe sleep apnea.
Mini gastric bypass surgery is a simplified form of gastric bypass surgery, which is becoming popular now. This procedure is shorter, more easily performed, and has a lower risk of complications compared to the standard gastric bypass surgery—which is one of the commonly performed weight loss surgeries.