Gastric Sleeve, Gastric Bypass, LAP-BAND Surgery
Bariatric Treatment in Iran
What is Bariatric Surgery?
Bariatric surgery, referred to as weight loss surgery, is the procedure for weight loss for people who are severely obese. When fat reduction methods such as diet management and physical exercise, are not effective, bariatric surgery is the best substitute to lose and manage weight in a planned manner.
Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing a combination of both gastric restriction and malabsorption. Bariatric procedures often result in hormonal changes. The most common bariatric surgery procedures are a gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch. Each surgery has its advantages and disadvantages. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).
Who should consider Bariatric Surgery?
Candidates for bariatric surgery should qualify the following conditions:
- A candidate should have a BMI (Body Mass Index) in between 35-40. The candidate should also possess an obesity-related condition of diabetes mellitus, severe sleep apnea, cardiovascular disease, and hypertension. The calculation of BMI is done by dividing the weight of a person in kilograms by height in meters squared.
Apart from these, a Bariatric surgery candidate should also be:
- Willing to exercise for at least ninety minutes each week.
- Overweight for more than five years.
- Is able and willing to make lifestyle and eating habit changes.
- Have had short-term success with earlier serious attempts for weight loss.
- Free from an auto-immune disease.
Types of Bariatric Surgery
Gastric Sleeve (Sleeve Gastrectomy)
Gastric Sleeve surgery, also referred to as Sleeve Gastrectomy, is primarily performed to remove about 85% of the stomach. The rest 15% of the original capacity of the stomach is left for shaping in the form of a sleeve. By restricting the amount of food, the stomach can hold. No foreign objects are required. Therefore a patient recovers in a relatively short hospital stay.
Gastric Bypass Surgery
The purpose of this procedure is to separate the stomach into two unequal sections. Only 5 percent of the stomach area is left for food consumption. The food gets emptied from this small stomach pocket in the upper intestine at the time of digestion. This procedure creates 60 to 80 percent excess weight loss.
Just like gastric bypass surgery, Biliopancreatic diversion also creates a smaller stomach. In this, ingested food is not fully absorbed in the intestine. This surgery is specifically for people who are more than severely obese. Super obesity means that BMI (body mass index) is 50 or higher.
After surgery, the patient will feel full more quickly than when the stomach was its original size. This reduces the amount of food the patient will want to eat. Bypassing part of the intestine also means that fewer calories are absorbed. This leads to weight loss. Most surgeons will not perform the surgery except in super obesity.
This surgery is an easily recovering short procedure. Around the stomach’s upper part, an inflatable band is used that divides the stomach into two unequal parts. The stomach’s upper part is treated as a new stomach, and the food intake is restricted and promotes the weight loss.
A laparoscopic adjustable gastric band, commonly called a lap-band, is an inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to slow consumption of food and thus reduce the amount of food consumed.
Minimal Access Techniques
SILS (Single Incision Laparpscopic Surgery)
SILS is the next generation of laparoscopy, where the access is only through a single port instead of multiple ports. This utilizes new specialized port and roticulator instruments thus making the procedure scarless as it will be buried inside the belly button. This procedure though consumes more time, gives early to
st-operative recovery with less
pain than in conventional laparoscopy thus making it a treatment of choice for patients.
Endoscopic Bariatric Surgery
There is numerous endoscopic treatment for obese patients. Endoluminal bariatric weight loss surgery is gaining popularity as well, with up to 40% reduction in excess weight loss and around 60 % resolution of co-morbidities. Few of the available procedures include an intragastric balloon, primary gastroplasty, and outlet reduction for failed gastric bypass, pouch creation, and endo-barrier bypass sleeve.
Bariatric Surgery Procedure
Restrictive Procedure – The Lap Gastric Band
The surgery is primarily performed for decreasing the amount of food consumption at a time. The purpose is to create restriction so that a person feels satisfied with little amounts of food. Due to the smaller outlet, the food remains in the stomach for a long time. The idea is to decrease daily calorie intake without a feeling of deprivation.
The benefits of the gastric band include –
- The stomach returns to its original form even if the band is removed.
- The recovery period is also slightly shorter.
- No cutting, removal or stapling of the stomach tissue is done.
- The surgeon can easily control the size of the pouch outlet as the band is adjustable.
Malabsorptive procedures-Roux -En- Y Gastric Bypass
This procedure helps in altering the digestion. The length of the intestine is reduced by using Malabsorptive techniques. When the food comes in contact with the intestine, fewer calories are absorbed. Roux-en-Y is regarded as the gold standard procedure for weight loss surgery.
The benefits of Roux-En-Y include
- Medical conditions like High cholesterol, high blood pressure, sleep apnea and acid reflux are some of the medical conditions associated with obesity. These are either improved or removed after the surgery.
- About 70-80% of the excess body weight is reduced.
- The surgery increases the insulin sensitivity and alters the metabolism of carbohydrates. The surgery sometimes eliminates the need for diabetes medications.
- The average weight loss is much greater than the average achieved through gastric band surgery and sleeve gastrectomy.
Aftercare for Bariatric Surgery
To maintain weight loss after the surgery, you have to continue to eat less, change your dietary habits and increase physical activity. Weight reduction surgery helps you in changing your food behavior by giving early satiety after a small meal and providing a prolonged feeling of fullness so that you can adhere to the dietary control.