Weight loss surgery or ‘bariatric surgery’ are procedures which change the manner in which the digestive system functions, helping to limit the food consumed and in this way lower the weight of the individual along with lowering the risk of associated medical problems (NIDDK 2009).
In certain cases, bariatric surgery also interferes with the manner in which nutrition is absorbed into the body. Individuals who undergo bariatric surgery may also have to ensure certain changes in their lifestyle such as regular exercise, dietary changes and avoiding certain other risks.
One of the most frequently performed bariatric surgeries is gastric bypass in the US. Compared to other bariatric surgeries, gastric bypass is much safer, has lesser complications and can provide long-term results. However, there are also certain risks associated with the procedure, along with changes in diet, lifestyle and behavior. A lot depends on the patient for the success of the treatment (Mayo Clinic Staff 2009).
Indication Gastric bypass surgery is required in obese and overweight individuals who are unable to reduce their weight through diet and physical activities.
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As the BMI ratio is between 35 and 39 (obesity) and above 40 (severe obesity), the health related risks are higher and the individual can be affected with diabetes, hypertension, heart disorders, etc. However, gastric bypass surgery may not only be required alone, but along with it, exercise, dietary changes and lifestyle changes to ensure that the results of the gastric bypass are satisfactory (Mayo Clinic Staff 2009).
Bariatric surgery can also be performed if other methods of conservative treatment fail for obesity.
The patient has to be properly informed about the details of the procedure, along with the benefits, risks and alternatives, so that an informed decision can be made (Medline Plus, 2010).
The patient would have to give an informed consent for the procedure. The patient should also be committed to lifelong changes with diet, physical activity, behavior, medical monitoring and medication therapy. Insurance would be applicable for Bariatric surgery only if it has been medically indicated due to an obesity related cause, rather than cosmetic.
Bariatric surgery may be indicated for adolescents only if other conventional methods have failed for about 6 months. Newer studies have demonstrated that gastric bypass may actually be ideal for adolescent obesity (NIDDK 2010).
Procedure The entire procedure is done under general anesthesia, and the patient would require preparing for tests, dietary changes, X-rays (for planning the surgery), medications and hospitalization (Mayo Clinic Staff 2009).
In the US, 4 types gastric bypass are performed. These include biliopancreatic diversion with a duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), and vertical sleeve gastrectomy (VSG).
AGB involves placing a band around the top portion of the stomach to reduce the size of the stomach pouch to ensure that the food intake is reduced. In RGYB, involves placing a gastric band and also by bypassing the food directly from the pouch to the small intestine.
In BPD-DS, a large portion of the stomach is removed, bypassing the food from the stomach to the small intestine and re-routing the bile and digestive tract juices, so that food is not absorbed and digested properly. In VSG, a portion of the stomach is reduced to ensure that the quantity of food consumed is reduced (NIDDK 2009).
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After the procedure, the individual should not consume anything for the next 24 hours. Following this, a special diet needs to be consumed, which includes liquids, soft foods and slow progress towards solid food.
Following this, the indvidiaul needs to consume reduced quantity of food. There may be certain side-effects of the procedure (Mayo Clinic Staff 2009).
Results Weight loss surgeries basically work by reducing the amount of food being consumed or the amount of food being digested. Some surgeries bypass a majority of the food consumed resulting in reduced amount of absorption of nutrients. Along with dietary and lifestyle changes, loss of body weight can be achieved.
However, there are also a few risks associated with weight loss surgeries. The individual may lose about 50 to 60 % of the excess body weight within 2 years of the surgery. However, exercises, lifestyle changes and diet need to be included in the plan (Mayo Clinic Staff 2009).
The risk of several health disorders such as diabetes, hypertension, sleep apnea, heart disease, infections, and cancer can be reduced (Daniel Jones, 2010).
Complications In recent years with improvement in the surgical technique, there has been a reduction in the rate of complications from the year 2006, by about 21%. The rate of readmissions has also been under a decrease (NIDDK 2009).
Some of the early complications related to gastric bypass include bleeding, infection, leakage of intestine, damage to the intestines, heart attacks, blood clots in the legs, emboli, etc.
The other complications that can develop include malnutrition, (such as beri beri, pellagra, etc), strictures, hernias (includes internal hernias and intestinal hernias), pneumonia, nausea, vomiting, hypoglycemia, gallstones, kidney stones, dehydration, etc. If the contents from the stomach move very quickly, it can result in dumping syndrome causing nausea, vomiting and diarrhea. In patients with poor general health and with serious medical conditions, fatal outcomes may be a risk, but very rare (Mayo Clinic Staff 2009).
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In some patients further surgery may be required (Daniel Jones, 2010).
