Have you been gaining weight even though you have been eating less? Has your weight loss been minimal even after dieting and exercising? If the answer to these questions is ‘Yes’, Bariatric Surgery is an option you should consider. Severe obesity is a condition that is often hard to treat with diet and exercise alone.
Bariatric surgery is a surgical option for losing weight in people who are extremely overweight and their weight poses a health hazard. The procedure involves the surgical removal of a part of the stomach to reduce its size or restricting the absorption of food from the intestine with a surgical procedure. There is an option that is a combination of these two methods.
Food eaten moves from the mouth to the stomach, where it is broken down and partially mixed with gastric juices. This food then passes on to the intestine where most of the absorption takes place. The amount of food that can be eaten is decreased if the size of the stomach is reduced by a surgical intervention. The number of calories absorbed in the body can be decreased if the portion of the small intestine from where most of the absorption takes place, is bypassed.
- Patients between the ages of 18-65 years
- If the patient has a body mass index (BMI) of over 37.5 kg.m2
- If the patient has a BMI of more than 32.5 kg/m2 who have associated serious weight-related problems such as diabetes, high blood pressure, arthritis or heart disease
Bariatric Surgery will not be done if the following exists:
- Absence of a period of identifiable medical management.
- Patient who is unable to participate in prolonged medical follow-up.
- Non-stabilized psychotic disorders, severe depression, personality and eating disorders, unless specifically advised by a psychiatrist experienced in obesity.
- Alcohol abuse and/or drug dependencies.
- Diseases threatening life in the short term.
- Patients who are unable to care for themselves and have no long-term family or social support that will warrant such care.
Restrictive weight loss surgery is of two types- Adjustable Gastric banding and Vertical Sleeve Gastrectomy. Both operations make less room in the stomach for food.
Although a gastric bypass procedure is malabsorptive, it can also be restrictive because it reduces the size of the stomach so that the amount of food you can eat is restricted due to the smaller stomach.
A small pouch on the top of the stomach is created by using a special surgical stapler and the pouch is connected directly to a part of the small intestine. After this surgery, when you eat, food bypasses most of your stomach and the first part of your small intestines. That makes this surgery both restrictive and malabsorptive.
Bilopancreatric Diversion with Duodenal Switch surgery is very similar to gastric bypass. It involves two components. A small pouch is created by removing a portion of the stomach and later a portion of the small intestine is bypassed.
While malabsorptive procedures are more effective in contributing to weight loss than those that are solely restrictive, they also carry a greater risk of developing nutritional deficiencies.
- You must have a dietician evaluation.
- You must have a psychological evaluation.
- In addition to a complete medical history, your physician and anaesthetist will perform a complete physical examination to ensure you’re in good health before undergoing the procedure. You will undergo blood tests or other diagnostic tests.
- You may be asked to begin exercising and alter your diet several weeks before surgery.
- If you’re a woman of child-bearing age, you may receive birth control counselling so that you do not become pregnant in your first year after surgery due to the risk to the foetus from rapid weight loss.
- Quit smoking and discontinue the use of all tobacco and nicotine products as it may lead to delayed wound healing after the surgery.
- Drink more water and limit other beverages.
- Stay mentally and physically fit by focusing on your health.
- Not to eat or drink anything for 10-12 hours before surgery and have a light dinner because the stomach must be empty before anaesthesia
- Ask a friend or family members to be at the hospital during the surgery for support.
- risk from general anesthesia
- blood clot in the legs or lungs
- hernias (internally or externally)
- blockage or obstruction
- injury to liver and/or spleen
- pulmonary and/or cardiac and/or renal failure
There’s a risk of needing another operation or conversion to an open operation with a bigger incision. One of the most serious complications of gastric bypass is a stomach leak that can cause peritonitis to develop. Peritonitis is an inflammation of the peritoneum, the smooth membrane that lines the cavity of the abdomen.
There may be other risks depending upon your specific medical condition.
With the gastric band, there’s a risk that the band can either slip or erode.
There’s a risk that you will not lose weight if you don’t follow the diet and exercise program.
With the gastric bypass procedure, malabsorptive symptoms may be more serious, with an increased risk of anaemia. Your body may not absorb adequate amounts of iron, calcium and vitamin B12, leading to the risk of metabolic bone disease and osteoporosis.
Stomal stenosis occurs when there is a stricture (tightening) of the opening between the stomach and intestine after a Roux-en-Y procedure. When this occurs, vomiting after eating and sometimes after drinking may occur. Stomal stenosis can be treated easily but should be treated immediately.
“Dumping syndrome” is likely to occur with these procedures because the food in the stomach moves to the intestines quickly. Symptoms include nausea, sweating, fainting, weakness and diarrhoea.
Be sure to discuss any concerns with your physician prior to the procedure.
What can you expect post-surgery?
At first you’ll receive fluids through an Intravenous infusion. After a day or two you’ll be given liquids, such as broth or clear juice, to drink.
Your physician will instruct you about how long to eat pureed foods after surgery. By one month after your procedure, you may be eating solid foods. You’ll meet with the dietician before going home and while you’re here, you’ll have a clear liquid diet that will be limited to a medicine cup every 15 minutes.
A nutritionist will instruct you about taking nutritional supplements to replace the nutrients lost due to the reconstruction of the digestive tract.
You will be discharged from the hospital after two to five days based on the type of surgery. Before you’re discharged from the hospital, we’ll schedule an appointment for a follow-up visit with your physician.
Visit your surgeon as scheduled as it is very important to keep him informed about the progress.
You should call your doctor immediately, in case of:
- fever of 100⁰F or above
- redness, swelling or increased pain or drainage from the wound
- chest pain or shortness of breath
- nausea or vomiting that may last for more than 12 hours
- pain or swelling in the legs
Weight loss surgery can be emotionally difficult because you’ll be adjusting to new dietary habits and a body in the process of change. You may feel especially tired during the first month following surgery. But once your body adjusts, you’ll start to feel better. Exercise and attending a support group can be helpful at this time.
You may return to normal activities within a week after laparoscopic adjustable gastric banding and two to three weeks after laparoscopic gastric bypass surgery. The surgeon may allow activities like walking and changing position in bed on the very first day after the surgery. Doing these activities promotes circulation, speeds up the recovery and minimizes complications.
The adjustable gastric banding operation allows you to lose 50% of your excess body weight at two years. It’s also effective in reversing obesity related co-morbidities.
The sleeve gastrectomy is between the gastric bypass and gastric banding in terms of weight loss with 60% excess weight loss at 1 year.
Long walks: 10 days later
Aerobic activities like swimming: 20 days later
Weight training etc.: 30 days later
Abdominal exercises: 3 months later
Do not lift heavy objects during the first six weeks after the surgery.