Bariatric Surgery: Types and Advances

Obesity is a disease with a lot of incision in Spain and there are several surgeries to treat it. The technique that most experts are betting on lately is the gastric sleeve, since it is useful when it comes to treating diseases associated with obesity.

Indications for bariatric surgeries

Whenever a body mass index of 40 or more is reached, surgery is the only treatment that has confirmed its benefit. This BMI is obtained by dividing weight in kilograms by height in meters squared.

In addition, patients with a BMI of 35 or higher, with a disease associated with obesity such as type 2 diabetes, arterial hypertension, cholesterol and triglyceride disorders or sleep disturbances (sleep apnea syndrome) also benefit from bariatric and metabolic surgery.

Gastric bypass

This is a mixed technique (restrictive and derivative) in which the size of the stomach is significantly reduced and an intestinal short-circuit is made so that the food does not pass through the entire small intestine, mainly through the duodenum and proximal jejunum. Its effects are, therefore, those of a restrictive technique that causes early satiety and those of a derivative technique in which food absorption is reduced.

Sleeve gastrectomy

This is a restrictive surgery in which the size of the stomach is reduced according to a calibration used with special probes during the operation. There is no intestinal short circuit (bypass) and, therefore, food passes through all segments of the intestine and its absorption is normal. It causes early satiety with a small amount of food, which is typical of restrictive techniques.

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Adjustable gastric banding

A band or ring is inserted at the entrance of the stomach and therefore decreases the passage of food. Patients feel satiety with a small amount of food. This band or ring is more or less adjusted with a subcutaneous device, which is left under the skin in a very accessible place, to be filled or emptied with physiological saline solution that more or less opens or closes the passage through the band. This seeks a balance between the intake so that it is as little as possible, but also sufficient for the entry of food, avoiding vomiting.

Endobarrier

It is a technique that is done by endoscopy and in which a prosthesis is placed inside the stomach and duodenum that makes the food pass through it in the diameter of the prosthesis and also causes an early satiety by controlling the passage of nutrients.

Intragastric balloon

It is also placed by endoscopy and consists of leaving inside the stomach an inflated device that makes the patient feel a sensation of fullness or continuous filling, thus causing an absence of hunger sensation. This balloon is left in place for a certain period of time, about six months, during which, thanks to this sensation of fullness and an adequate diet, weight loss is achieved.

This weight loss must be maintained after the removal of the balloon with changes in dietary habits, lifestyle, etc. that the patient may have learned while the balloon was in place.

Gastric sleeve in obesity with comorbidities

The main comorbidity we observe in patients with obesity is type II diabetes. After the gastric sleeve operation, 75% of the operated patients no longer require medication, so we consider this pathology cured; in the rest of the cases, patients can control their glucose levels only by means of oral drugs without the need to inject insulin.

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Other associated pathologies that also improve or even disappear are sleep apnea, arterial hypertension, and of course they obtain an indescribable improvement in their quality of life.

Choosing the right bariatric surgery

Any obesity surgery has its advantages and disadvantages, but we must significantly improve the problems of our patients, assuring them a clear weight reduction and an improvement in the associated diseases, if any, and without adding other problems such as alterations in the absorption of proteins, vitamins, iron and other minerals, etc.

That is why today, vertical gastrectomy, commonly called gastric sleeve, is the technique that is gradually being performed more and more and whose long-term results are already defined as spectacular.

3D technology in bariatric surgery

The benefits are mainly related to patient safety. The surgical team has a much more complete field of vision and the maneuvers are much simpler, especially stomach dissection and suturing. The three-dimensional screens allow us to visualize the inside of the abdominal cavity in the same way as if the operation were open.

All this means that the surgeon has much more control, the operations are shorter and safer. Being able to perform operations in 3D is a real revolution; it is the closest system that exists to robotic surgery, but without the high investment required by the latter.

Prognosis

The change is radical and relatively fast, since within 12 months after the operation the patient can obtain a reduction in excess weight of up to 80%. We have found that 12 months after the operation, the average weight of the patients was 88 kg. But the improvements can be seen in everything: the average hospital stay is 1.3 to 2 days and the operation usually lasts only 45 minutes, much shorter than before implanting the three-dimensional surgery.