Bariatric is the study of obesity and Bariatric surgery is a surgery for obesity or weight loss. People who are overweight and can not loose weight by exercising or lessening their diet have to go through a series of clinical procedures to loose weight. Gastric banding, which is an implanted medical device, is used to decrease the size of the stomach; or sleeve gastrectomy or biliopancreatic diversion with duodenal switch assists in removing a portion of the stomach; or the small intestines are resected to a small stomach pouch known as gastric bypass surgery.
Indications
According to U.S National Institutes of health, a person with a body mass index (BMI) of at least 40 is recommended to receive a bariatric surgery.
According to the medical guidelines provided by the American College of Physicians, it was concluded that obesity surgery is recommended for patients of 40kg/m2 as advised by the U.S National Institute of health. As exercising is not showing any positive results, these individuals are suffering from many diseases due to obesity. These patients suffer co morbid conditions including impaired glucose tolerance, hyperlipedemia, hypertension, obstructive sleep apnea and diabetes mellitus. Also, patients should be treated in high-volume centers with expert surgeons in obesity surgery.
Obesity surgery is classified into the following procedures:
- Predominantly mal absorptive procedures
- Predominantly restrictive procedures
- Mixed procedures
Predominantly mal absorptive procedures
Predominantly mal absorptive procedures create mal absorption and lessen the size of the stomach. Predominantly mal absorptive procedures are further divided into:
o Biliopancreatic diversion- It is also known as Scopinaro procedure. Problems of malnourishment are a part of Biliopancreatic diversion due to which its original form is not performed much. 2% of the patients going through the procedure of Biliopancreatic diversion suffer severe nutritional deficiency and mal absorption, and hence require reestablishment of the normal absorption. Patients who go through this surgery must have a diet consisting of dietary minerals and vitamins than what normal people take. If these nutrients are not taken in the diet, serious deficiency disorders like osteoporosis and anemia can occur.
o Jejunoileal bypass- The procedure of Jejunoileal bypass is no longer in existence. It was performed in the 1950s to 1970s in which the small bowel was detached from the body.
o End luminal sleeve- A study was carried out in Chile to examine the effects of End luminal sleeve on human beings by blocking absorption of food in the upper jejunum and duodenum. However, it was not successful and did not yield any optimistic results.
Predominantly restrictive procedures
Predominantly restrictive procedures are used to reduce ingestion of food by lessening the gastric volume and leaving the alimentary canal to work with the same way as before. They also reduce the risk of complications of metabolism. Predominantly restrictive procedures are divided into:
o Vertical banded gastroplasty- This procedure of predominantly restrictive procedures is also called stomach stapling. A small stomach pouch is produced by the use of staples and bands. There is roughly a one-centimeter hole which helps to push the contents of pouch in the remaining area of the stomach and then into the gastrointestinal tract.
o Adjustable gastric band- This procedure involves restricting the stomach through the use of silicone band, which can be attuned by the adding or removing of saline via a port which is placed right under the skin. Adjustable gastric band is also called lap band because it can be performed laparoscopically.
o Sleeve gastrectomy- Gastric sleeve or Sleeve gastrectomy is a procedure of obesity surgery in which size of the stomach is lessened to 15% of its initial size. This is also done laparoscopically by removing a huge portion of stomach and also the major curve through a surgery. The open edges of the stomach are further attached together either by use of surgical sutures, staples or both, in order to make stomach look like a sleeve, or a tube which is banana shaped.
o Intragastric balloon (Gastric balloon) – The procedure of Intragastric balloon or Gastric balloon places a deflated balloon in the stomach; and then the balloon is filled to reduce the amount of gastric space. This balloon is set to stay in the stomach for six month maximum, and is very helpful in weight loss, resulting in loss of 5-9BMI in half a year.
o Gastric Plication- In the process of gastric sleeve or gastric placation, a sleeve is made by suturing only. This prevents the mal absorption.
Mixed procedures
Mixed procedures of obesity surgery are subdivided into:
o Gastric bypass surgery- Common method of Gastric Bypass surgery is Roux-en-Y gastric bypass in which a small pouch is created which is further attached to the distal small intestine. This pouch is created by a stapler device. Subsequently, upper region of the small intestine is attached again in a Y-shaped configuration.
o Sleeve gastrectomy with duodenal switch- In Sleeve gastrectomy with duodenal switch, some part of the stomach and the great curve of the stomach is resected.
o Implantable gastric stimulation- The procedure of Implantable gastric stimulation is studied in the United States. In this procedure, a device is implanted into the external area of the stomach (surface) which works with the brain by sending electrical signals, and gives a feeling of fullness.