The percentage of morbidly obesely individuals is increasing at an alarming rate. Bariatric surgery offers an effective and safe option in individuals unable to notice disorders, a sedentary lifestyle, a high carb diet or due to intake of certain medicines. Bariatric surgery has proven advantageous and aptly indicated as a preferred line of treatment to reduce weight loss in people suffering from lifestyle diseases affecting heart, kidneys and the circulatory system (1).
INDICATIONS FOR BARIATRIC SURGERY –
- CRITERIA FOR OBESITY-A shocking statistics mentions that more than three in four African American adults are overweight or obese. The obesity can defined as body mass index (BMI) is of 30 or greater or by waist size; in women the size is above 35 inches and for men, the size is above 40 inches (2).
Obesity associated with one or more morbid diseases that are recalcitrant to weight loss programmes. People suffering from obesity are at high risk for developing various health disorders as compared to people with normal weight. They are listed below (3) –
- Increased rate of mortality.
- High blood pressure (Hypertension) and hypertension related serious ailments like renal failure and stroke.
- Deranged lipid profile adding to development of atherosclerosis or hardening of the blood vessels.
- Type 2 diabetes or diabetes which is resistant to Insulin or insulin independent Diabetes.
- Gallbladder disease- like cholelithiasis or gall bladder stones.
- Early degeneration of the joints termed as osteoarthritis of knees, back and neck causing various pain and restriction of movement.
- Sleep apnea and breathing problems
- Certain types of cancers (endometrial, breast, colon, kidney, gallbladder, and liver)
- Psychiatric ailments like Low self-esteem, proneness to depression, lack of motivation to pursue their goals and anxiety.
There are different types of bariatric surgery that are selected on the basis of the morbid diseases associated, the severity of obesity and also the skill of the surgeon. They are (4)-
- Laparoscopic adjustable gastric band
- Gastric sleeve surgery, also called sleeve gastrectomy
- Gastric bypass
- Biliopancreatic diversion with duodenal switch, less often performed.
Laparoscopic Adjustable Gastric Band
This surgery involves a ring with an inner inflatable band fixed at the top of your stomach in order to reduce the capacity of the stomach to retain food. This leads to easy satiety following smaller meals. with salt solution. The size of the band can be readjusted in the subsequent follow ups. The U.S. Food and Drug Administration (FDA) has passed the use of the gastric band for people with a BMI of 30 or associated with at least one health problem related to obesity.
Gastric Sleeve – Gastric sleeve surgery, also termed as vertical sleeve gastrectomy consists of resection of major portion of the stomach leaving behind a small portion of the stomach. The disadvantage of performing this surgery is that it is permanent and may result in disruption of the gut hormones or other factors such as gut bacteria that may affect appetite and metabolism. The goal of weight loss is achieved by reducing the food intake due to easy satiety felt by reducing the stomach size.
Gastric Bypass – it is also known as Roux-en-Y gastric bypass. It is done in two parts. Firstly, to staple the stomach in order to reduce the stomach capacity. Secondly, anastomosing or joining a resected small intestine and attaching the lower part of it directly to the small stomach pouch. This method assures fewer absorption of calories.
Duodenal Switch – it involves 2 different surgeries wherein the first part consists of gastric sleeve surgery and the second surgery attempts to redirect food to bypass most of your small intestine. This surgery causes rapid weight reduction. But less performed due to malabsorption of nutrients (4).
The most common side effects of bariatric surgery are (5)-
· Heart burn due to acid reflux
· Stomach obstruction
· Infection due to surgery
· Frequent episodes of nausea and vomiting
· Dilation of esophagus due to rapid filling of stomach.
· Type of food restriction.
· Long term complications are –Dumping syndrome, hypoglycemia, malnutrition due to limited absorption of nutrients, ulcers, intestinal obstruction.
Surgery related complications-
· Band slippage or deflation of the band, erosion
· Gall stones, in case of rap
· Rapid weight loss
· Blood clots
· Bleeding at the surgery site
· Perforation of the stomach or intestines
· Damage to organs in proximity
· Stricture formation leading to adhesions.