Also called “BARIATRIC SURGERY”. The term Bariatric Surgery is derived from Greek Words. “BAROS” meaning Weight, and “IATREIA” meaning Medical treatment. Bariatric Surgery encompasses all of the various surgeries which have been designed to cause a significant and long lasting weight loss in obese persons. Surgery for the treatment of obesity is only appropriate for those individuals who are considered Morbidly Obese. Because possible risks and complications of surgery, it’s not appropriate for all individuals.
Surgery is not advisable for the following individuals.
History of substance and eating disorder.
Major psychiatric illness which is untreated and / or unresolved
Patient who are ill and risk for any type of surgery.
Patients with endocrine causes for their severe obesity.
According to National Institute of Health, patient who have been unsuccessful at losing weight using medical treatments such as Diet, Exercise, and medication, surgery is the treatment of choice and the only treatment that has been proven to be successful in the long term
Normal digestive system Food ingested is chewed and swallowed for which stomach (gastric pouch) acts as reservoir. Food from stomach is passed into duodenum where its mixes with digestive juices (pancreatic, hepatic & small intestine secretions) and goes into small intestine which absorbs food into body which is stored mainly inform of liver glycogen and mainly as fat. Variety of hormones are secreted from stomach, pancrease and other parts which acts on brain which induces hunger or produces satiety.
Principle of Obesity surgery (bariatric surgery) Unlike liposuction or lipolysis where fat is sucked out or removed which can reaccumulate in no time. Obesity surgery is done to restrict amount of food taken, reduce hunger, restrict amount of food absorbed into body, and changes in hormones responsible for diabetes, hypertension, infertility and other beneficial effects
Type of obesity surgery:
Purely Restrictive
Gastric adjustable banding
Sleeve gastrectomy
Restrictive > Malabsorptive
Short-limb/Roux-en-Y gastric bypass
Malabsorptive > Restrictive
Biliopancreatic diversion (BPD)
BPD with duodenal switch
Very long limb Roux-en-Y gastric bypass
Purely Malabsorptive
Jejunoilieal bypass
Jejunocolonic bypass
Laparoscopic bariatric surgery (obesity surgery) Unlike open surgery where long cut is made in abdomen laparoscopic (keyhole) surgery is done with small ports of 5 – 15 cm cuts thru which 10 mm telescope introduced which transmits image of structures inside abdomen onto monitor and surgeon operates with slender instruments of 5 – 10 mm looking at monitor. Laparoscopy reduces pain, hospitalization, early recovery, less complications and better results and laparoscopy has become method of choice for many hospitals.
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Laparoscopic gastric banding: Silicone band is placed around proximal stomach producing small pouch of 20 – 30 cc which restricts amount of food intake
Adjustable Lap Band
1 hr procedure
1 day in-house
1 wk – Return to work
40-45% EBW loss @ 2 yrs
<0.1% life risk
Self-sabotage easier
Laparoscopic sleeve gastrectomy: Great part of stomach excised keeping sleeve of stomach which reduces amount of food intake and also reduces gherlin production which in turn minimizes hunger.
Modified after vertical branded gastroplasty
Small sleeve of stomach along lesser curvature preserved
3 – 4 days hospitals stay
Mostly restrictive but now hormonal role
Initially used as primary procedure before bypass
Expected weight loss 50 – 60%
< 0.5% life risk
Laparoscopic gastric bypass: Small pouch of stomach is created to reduce intake of food and small bowel is bypassed to lessen absorption of food and hormonal changes which help to cure many medical problems
2-4 hour procedure
3 – 5 days in-house
2-3 weeks – Return to work
60-80% EBW loss @ 2yrs
0.5-1.0% Risk of Death
Dumping Syndrome
Laparoscopic biliopancreatic diversion: Small stomach pouch is created and small bowel is transposed resulting in severe malabsorpton. It is done for super obese patients
