Bariatric or Weight Loss Surgery

BARIATRIC OR WEIGHT LOSS SURGERY

OBESITY

Obesity is defined as having a body mass index (BMI) of 30 or more.

BMI is a measure of your weight in relation to your height. Metric BMI Formula = Weight (kg)/ Height (m2)

BMI table

BARIATRIC SURGERY/ WEIGHT LOSS SURGERY

Bariatric surgery is an operation that helps you lose weight by making changes to your digestive system.

  • Restrictive: It makes your stomach smaller, allowing you to eat and drink less at one time and making you feel full sooner.
  • Malabsorption: It changes your small intestine, which is the part of your body that absorbs calories and nutrients from foods and beverages.

WHO IS IT FOR?

Bariatric surgery could be an option for you if…

  • Your BMI is greater than 37 (extremely obese).
  • Your BMI is greater than 32 (obese) and you have 1 or more comorbidities (health problems) such as type 2 diabetes, high blood pressure, severe sleep apnea, heart disease, high blood pressure, back or joint pain, hypercholesterolemia, etc.
  • You failed to lose weight even with exercise and diet.
  • You feel mentally prepared to commit to a lifetime of healthy lifestyle habits to prevent regaining weight after surgery.

WHY IS IT DONE?

Bariatric surgery is performed to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

  • Heart disease and stroke
  • High blood pressure
  • Non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH)
  • Sleep apnea
  • Type 2 diabetes

TYPES OF BARIATRIC SURGERIES

More than 1.3 million people underwent bariatric surgery from 2011 through 2017.

There are three types of bariatric surgery that are commonly done:

  • Gastric banding
  • Sleeve gastrectomy
  • Gastric bypass

Surgeons also perform a fourth operation known as biliopancreatic diversion with duodenal switch, but this is not performed often.

Type of Surgery

Image

GASTRIC BANDING

A ring with an inner inflatable band is placed around the top of your stomach to create a small stomach pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled with salt solution. The surgeon can adjust the size of the stomach pouch’s opening to the rest of your stomach by injecting or removing the solution in the balloon through a small device called a port, which will be placed under your skin.

After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose enough weight, the surgeon may remove it in another surgery.

Gastric Banding

SLEEVE GASTRECTOMY

Surgeons will remove 80 - 90 per cent of your stomach and join the remaining portions together to make a new "sleeve" pouch. Patients will feel full a lot quicker, thus limiting their food intake and drastically cutting down their intake of calories (restrictive weight loss surgery). It is now the most commonly performed bariatric procedure in the United States and worldwide. Besides aiding with weight loss, it also helps to improve obesity-related problems and conditions such as diabetes mellitus type II, hypertension, sleep apnea, fatty liver disease, joint pain, and hyperlipidemia.

Gastric Banding

GASTRIC BYPASS SURGERY (Roux-en-Y bypass Surgery)

Roux-en-Y bypass is one of the most common gastric bypass surgeries, accounting for 47 per cent of all weight loss surgeries. With this surgery, surgeons will reduce the upper stomach to the size of a small pouch (about the size of an egg), disconnecting it from the larger part of the stomach and the upper part of the small intestine (duodenum) and rerouting it to the farther part of intestines (jejunum). Food bypasses most of the stomach and a part of the intestines, which reduces food intake and the amount of fat and calories absorbed. This is a combined restrictive and malabsorption weight loss surgery.

Sleeve gastrectomy and Roux-en-Y gastric bypass are two of the most common bariatric surgeries. According to a study of 164,247 patients one year after surgery, patients who underwent a sleeve gastrectomy lost an average of 29.5 per cent of their total body weight, while those who had Roux-en-Y gastric bypass lost an average of 34.2 per cent.

gastric-bypass
Gastric Banding

GASTRIC BANDING

A ring with an inner inflatable band is placed around the top of your stomach to create a small stomach pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled with salt solution. The surgeon can adjust the size of the stomach pouch’s opening to the rest of your stomach by injecting or removing the solution in the balloon through a small device called a port, which will be placed under your skin.

After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose enough weight, the surgeon may remove it in another surgery.

Gastric Banding

SLEEVE GASTRECTOMY

Surgeons will remove 80 - 90 per cent of your stomach and join the remaining portions together to make a new "sleeve" pouch. Patients will feel full a lot quicker, thus limiting their food intake and drastically cutting down their intake of calories (restrictive weight loss surgery). It is now the most commonly performed bariatric procedure in the United States and worldwide. Besides aiding with weight loss, it also helps to improve obesity-related problems and conditions such as diabetes mellitus type II, hypertension, sleep apnea, fatty liver disease, joint pain, and hyperlipidemia.

gastric-bypass

GASTRIC BYPASS SURGERY (Roux-en-Y bypass Surgery)

Roux-en-Y bypass is one of the most common gastric bypass surgeries, accounting for 47 per cent of all weight loss surgeries. With this surgery, surgeons will reduce the upper stomach to the size of a small pouch (about the size of an egg), disconnecting it from the larger part of the stomach and the upper part of the small intestine (duodenum) and rerouting it to the farther part of intestines (jejunum). Food bypasses most of the stomach and a part of the intestines, which reduces food intake and the amount of fat and calories absorbed. This is a combined restrictive and malabsorption weight loss surgery.

Sleeve gastrectomy and Roux-en-Y gastric bypass are two of the most common bariatric surgeries. According to a study of 164,247 patients one year after surgery, patients who underwent a sleeve gastrectomy lost an average of 29.5 per cent of their total body weight, while those who had Roux-en-Y gastric bypass lost an average of 34.2 per cent.

SURGERY OPTIONS

LAPAROSCOPIC BARIATRIC SURGERY

Bariatric surgery is often performed using minimally invasive surgery. Laparoscopic is the most common minimally invasive surgery done through a few small incisions using long, thin surgical instruments and a tiny camera. The camera takes images inside your body, which will be sent to the video monitor in the Operating Room, guiding surgeons as they operate.

ROBOTIC-ASSISTED LAPAROSCOPIC BARIATRIC SURGERY/ DA VINCI BARIATRIC SURGERY

da Vinci Surgery is another minimally invasive surgical option for patients considering bariatric surgery. The da Vinci system features a magnified 3D high-definition vision system, allowing the surgeon’s hand movements to be scaled, filtered and translated into precise movements by the special wristed instruments, which can bend and rotate far greater than the human wrist. The da Vinci System is able to enhance surgical capabilities by making it possible for complex surgeries to be performed through a tiny surgical opening.

Intuitive motion, wristed instruments and 3D visualization enable the suturing of serosal and mucosal layers for excellent Gastro-Jejunal (GJ) anastomosis, thus reducing gastrointestinal leak and stricture rates. Besides, da Vinci technology helps to facilitate gastric revisions such as fistulae or band-to-bypass conversions for patients who have previously sought weight-loss surgery but did not achieve desired outcomes.

POTENTIAL BENEFITS COMPARED TO LAPAROSCOPIC BARIATRIC SURGERY

  • Patients experience post-surgery complications at rates similar, or sometimes lower, rate than those who had a laparoscopic procedure.
  • Patients experience complications during surgery at rates similar to those who had a laparoscopic procedure.
  • The duration of hospital stay is similar, or sometimes shorter than those who had laparoscopic surgery.

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific.

CANDIDATES FOR ROBOTIC-ASSISTED LAPAROSCOPIC BARIATRIC SURGERY

Not all patients are suitable candidates for robotic bariatric surgery. It is important to discuss all options with your doctor, as only you and your doctor can determine whether surgery with da Vinci is appropriate for your condition. Morbidly obese patients are typically not candidates for da Vinci surgery. You should always ask your surgeon about his or her training, experience, and patient outcomes.

POSSIBLE RISK OF BARIATRIC SURGERY

The risks of any form of bariatric surgery, including robotic bariatric surgery, are leaking/ or narrowing (stricture) at the connective part of the bowel, malnutrition, dumping syndrome (food moves too quickly into the small intestine), dehydration, need for supplementation of vitamins, protein and minerals, abdominal pain, nausea and vomiting.

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