A to Z Disease

What Is Weight Loss, or Bariatric, Surgery?

"Bariatric" medicine refers to the medical field associated with the prevention and treatment of obesity. Bariatric surgery involves altering your digestive system to redirect or restrict the amount of food your body can process, which then leads to weight loss.

How Does Bariatric Surgery Work?

Our digestive system allows food to move from the mouth, down the esophagus to the stomach. The normal stomach is designed to hold about three pints of food and will release food particles to the small intestine. In the small intestine, the useful nutrients and calories are absorbed. The food particles that can't be digested are stored in the large intestine until they are eliminated. What bariatric surgery does is change the process or speed of digestion. The changes depend on the type of bariatric surgery that is performed.

Types of Bariatric Surgery

The two major types of bariatric surgery are restrictive and gastric bypass.

Restrictive Surgeries

Restrictive surgeries decrease the size of the stomach. The two most common techniques are called Laparoscopic Gastric Banding, and Vertical Banded Gastroplasty, or VBG.

Laparoscopic Gastric Banding

"Laparoscopic" means the doctor uses a video camera attached to thin tubes that are inserted into the body through small incisions. Because this is considered a minimally invasive procedure, it typically means a quicker recovery, less time in the hospital and less scarring than an open procedure.

During this procedure an inflatable silicone band, is placed around the upper part of the stomach like a belt or wristwatch. This gastric band divides the stomach into a small and large portion, leaving a narrow opening between the two. This controls the amount of food that can be consumed and slows the food as it is moves from the esophagus into the stomach, resulting in a quicker sensation of fullness. Unlike many of the other bariatric surgery options, the gastric band procedure is reversible and once the band is removed, the stomach will return to its original shape. This band is adjustable and allows your doctor to inflate or deflate it using a saline solution that's administered through a thin needle.

Vertical Banded Gastroplasty, or VBG

The second type of restrictive surgery, VBG, is more commonly known as "stomach stapling." In this procedure, a band and staples are used to create the small pouch at the top of your stomach. The effect is similar to the gastric band; the patient will likely eat less food and feel full sooner.

Gastric Bypass Surgeries

"Gastric bypass" surgeries are a combination of both restrictive and malabsorptive procedures. Malabsorptive means the digestive system is changed so that food doesn't travel through part of the small intestine where nutrients and calories are usually absorbed.

The most common gastric bypass surgery involves stapling part of the stomach to create a small pouch about the size of a walnut. This is the "restrictive" part of this procedure and is similar to gastric banding and VBG. Next, part of the small intestine is cut and re-shaped into a "Y" and then reconnected directly to the stomach pouch. This way, when food is digested, it bypasses most of the stomach and parts of the small intestine responsible for absorbing nutrients and calories. Since food doesn't pass through these portions of the small intestine, rapid weight loss can occur.

Gastric bypass can be performed through open surgery or laproscopically. Once gastric bypass surgery has been performed, it can't be reversed.

Who Can Have Bariatric Surgery?

Bariatric surgery is not an option for everyone. It is also something that should be considered after you've tried to lose weight through healthy diet and exercise for an extended period. If traditional methods for losing weight fail, here are some criteria for determining if bariatric surgery is an option:

• BMI Is 40 or Higher. BMI is a number that represents your body fat content relative to your height. You can determine your BMI by knowing your height and weight and using a BMI chart.
• Number of Pounds Overweight. You are at least 100 pounds overweight if you are a man, and 80 pounds overweight if you are a woman.
• Obesity-Related Medical Conditions. These can include conditions like high blood pressure, sleep apnea or diabetes.
• Obesity Interfering with Daily Life. This can include difficulty fulfilling needs for your job or family, or simply walking from one place to another.
• Commitment and Determination. You do not see bariatric surgery as a one-time quick fix. You are dedicated to sustaining the weight loss you achieve through surgery through diet and exercise. You are also aware of potential side effects, complications and necessary lifestyle changes, and will work with your doctor to keep your health on track.

Benefits and Risks of Bariatric Surgery

If you and your doctor decide this type of surgery is right for you, you'll want to know the benefits and risks involved.

• With the restrictive surgeries, like banding, you may lose up to 60 percent of your excess weight over the course of 2 to 3 years. About 80 percent of patients experience some degree of weight loss. With gastric bypass, the majority of the weight loss, as much as 70 percent, will occur in the first 1 to 2 years. Both of these surgeries will likely result in improvements in medical problems, like cholesterol levels, sleep apnea, high blood pressure, and Type 2 diabetes.
• Overall, gastric bypass surgery leads to more weight loss than restrictive surgeries, but can be more invasive and cannot be reversed.
• It isn't uncommon for people who have had these surgeries to see their weight loss plateau and even gain some weight back after a few years. That is why a drastically different lifestyle, especially your diet, is such a critical part of the treatment.
• These surgeries do come with risks. There are potentially serious side effects and complications that you could experience as a result of these procedures.
• You may need to have follow-up operations to correct any complications or abdominal hernias. While you are losing weight, you are advised not to become pregnant.
• For patients who undergo restrictive surgeries, there is the risk of band erosion or the breakdown of the staple line, which will then need to be surgically corrected. In addition, there is a small chance of death with any bariatric procedure.
• After the surgery is performed, your daily lifestyle will change and you should consult your doctor. He or she can help you stay on track with your recovery and weight loss.