What is bariatric surgery?
Bariatric surgery is a set of surgical techniques that can be used to treat morbid obesity, that is, those patients who have a Body Mass Index greater than 35. It is used when other methods have not given results, especially in case of diets. However, bariatric surgery will be used and will be complemented by diets and patient education, so that the patient learns to lead a healthy life and eating habits.
There are different types of bariatric surgery, depending on the objective to be achieved and the type of technique used.
Bariatric surgery techniques are used to treat morbid obesity.
Restrictive techniques include those procedures that reduce the volume of the gastric cavity and lead to weight loss by reducing gastric capacity and limiting food intake. These techniques include:
- GVB vertical banded gastroplasty. What it does is to create a small gastric reserve in the upper part of the stomach, on the lesser curvature, creating a gastric window. Subsequently, the rest of the stomach is excluded with the application of 4 lines of staples from this window, or by sectioning the stomach with a cutting linear stapler.
- Adjustable gastric banding. In this technique a band is placed around the esophago-gastric junction. It is specially designed to leave a small gastric reservoir of about 25 cm, with an outlet that can be regulated by insufflation of the internal part of the band, adjusting it to the patient’s needs.
- Gastric sleeve or vertical gastrectomy. It is performed from 6 to 8cm from the pylorus to the angle of His with continuous shots of linear mechanical suture, specific for the gastric wall. The resected part of the stomach is removed.
- Vertical banded gastroplasty. A small gastric reservoir is created with a staple that separates the reservoir from the remaining fundus and a band or prosthetic ring, which connects it to the rest of the digestive tract.
- Intragastric or gastric balloon. It consists of a balloon made of silicone with a capacity of 400-900cc. Its purpose is to occupy part of the stomach, creating a feeling of satiety and decreased appetite in the patient. It is inserted into the stomach through endoscopy.
- Gastric plicture. It consists of reducing the size of the stomach with a fold made with staples. It is a less invasive technique, since it is not necessary to make cuts in the stomach.
Malabsorptive techniques are rarely used, since they entail problems over time. They consist of introducing changes in the intestines so that they absorb less nutrients from the food ingested. This can cause certain vitamins and minerals to be poorly absorbed, so some patients have to take food supplements. Hence, they are rarely used. Among them is the duodenal switch, which causes the patient to lose passage by rendering a large part of the small intestine useless. This reduces the absorption of calories ingested. There is a radical weight loss but vitamin complexes are needed as a supplement.
Mixed techniques combine restrictive-malabsorptive procedures but also reduce gastric capacity and interrupt the absorption of food and nutrients that the patient ingests. Among them are:
- Gastric bypass. This is the most commonly used technique. The capacity of the stomach is reduced to 20-50cc and connected to a more advanced section of the small intestine. In this way only 60% of the small intestine is used to absorb food.
- Biliopancreatic diversion. Combines gastric restriction, performing a subtotal gastrectomy with a 200-400cc gastric reservoir. Together with the gastrectomy, a biliopancreatic diversion is performed, with a long segment of the small intestine, removing the function of the so-called biliopancreatic loop.
Why is it performed?
This surgery is used when other treatments based on diets have failed. In this way, the patient’s appetite and the amount of food ingested is reduced by reducing the volume of the stomach. It is recommended for patients who are
- Between 18 and 60 years old.
- BMI > 35 kg/m2.
- Morbid obesity for more than 5 years.
- Continued failure of conservative treatments.
- Ability to understand the mechanisms by which weight is lost in surgery and how to maintain it over time.
- Gastroesophageal reflux.
- Cardiac diseases.
- High blood pressure.
- Type 2 diabetes.
- Strokes.
- Sleep apneas.
What does it consist of?
Bariatric surgery techniques are usually performed laparoscopically to cause minimal discomfort to the patient. However, they are still invasive procedures. It is necessary a multidisciplinary team that can recommend the best technique and make the best follow-up to the patient.
Basically, it consists of reducing energy intake and the formation of body fat with two basic principles: reducing food intake and modifying its absorption. In this way, the caloric intake will be adequate to reduce weight without affecting the metabolism.
Preparation for bariatric surgery
Before any bariatric surgery it is important that the patient undergoes a comprehensive review to assess the patient’s health status. This will include a psychological and psychiatric evaluation. The patient will also be trained so that he/she learns and agrees to make the relevant changes and that these are healthy.
Post-procedure care
It is important that the patient follows the indications of the specialist in General Surgery to the letter, in order to avoid certain complications that may occur. Bariatric surgery interventions are important and invasive, so a good postoperative period is essential.
Some of the complications that the patient may suffer are:
- Vomiting (when the patient eats excessively after the intervention).
- Rupture of the staple lines
- Ulcers
- Difficulty in swallowing
- Gastric pouch distention and abdominal distention.
- Nutritional deficiencies that can lead to other related problems, such as osteoporosis or anemia.
- Opening of the sutures
Alternatives to this treatment
The alternatives to bariatric surgery are other more invasive techniques. In this text some of the most advanced techniques are cited and all the available alternatives for obesity surgery are mentioned.