Bariatric Surgery and Metabolism
‘Each Day, Approximately 100 Bariatric Surgery Procedures Are Being Carried Out In India Alone’
This statement itself is sufficient to depict the role of bariatric surgery in today’s healthcare industry. Bariatric surgery is becoming a crucial medical treatment, and often the only possible option to get rid of obesity and its ill effects permanently.
Let’s understand what bariatric surgery is and its scope in our lives for a healthier self.
What Is Bariatric Surgery?
Bariatric surgery is more commonly known as obesity surgery or weight reduction surgery. It is a procedure to reduce excessive body weight, from the bodies of obese individuals. It utilizes 100 percent safe, and medically proven approach to address obesity and illness associated with it, such as high blood pressure, diabetes, high cholesterol, sleep apnoea, osteoarthritis etc.
How does Bariatric Surgery help To Lose Weight?
There are two main principles and three approaches upon which bariatric surgeries are carried out. But before understanding the objective of these principles, let’s understand how the hunger hormones and re-absorption of nutrients play an important role is accumulating more and more body weight.
The Role of Hunger Hormones
Our body produces several types of hormone for bodily functions. ‘Ghrelin’, the hunger hormone, is released when the stomach is empty for long. This sends the signal of hunger to the brain, and thus, the individual seeks food, begin to eat and gradually the secretion stops. Once the stomach starts to fill, the hormone ‘Leptin’ is released. It indicates the brain for reaching satisfaction regarding appetite and the individual stops eating and secretion stops as well.
The imbalance of these hormones often cause overeating and binge eating and for obvious reasons, it plays an important role in developing obesity. These two hormones are released from the lining of the stomach and gastrointestinal walls.
The Role of Reabsorption
The food we eat reaches stomach after passing through the oesophagus, where it stays for about 2-3 hours. The body breaks down the food through enzymes to absorb nutrients and calories before passing it further down to the small intestine. There the body absorbs back further nutrients from the semi-digested food before they are expelled out of the body.
Thus, more the food stays in the small intestine, more calories get absorbed and thus, indirectly contribute to obesity.
The Three Bariatric Surgery Approach
1. The Restrictive Approach
As the name depicts, it restricts the quantity of food intake. It is done by resizing the stomach and is used in laparoscopic banding and sleeve gastronomy procedures, in which the stomach is reduced either temporarily or permanently up to 20 percent of its original size. It brings down the requirement of calories, and controls Ghrelin and hence gives a significant weight loss.
2. The Mal-Absorption Approach
The procedure of mal-absorption employs several means to resize and readjust the small intestine. It ensures that the semi-digested food bypasses a certain length of the small intestine and reaches the large intestine for excretion. It is done in order to limit the number of nutrients that can be reabsorbed by the body. This way, it contributes towards an overall effective weight loss.
3. The Combined Approach
The most effective procedure employs both these approaches and can be seen in the procedures duodenal switch and gastric bypass.
Types of Bariatric Surgery?
There are 3 major types of surgical procedures, in the realm of bariatric surgery that are executed routinely on the patients as a remedy for obesity, due to their high effectiveness and feasibility.
A. Lap Band
A silicone band is wrapped around the upper portion of the stomach to create a smaller pouch at the top. This is the only portion of the stomach that holds food and thus, the person feels satiated with a small portion of food. The band can be tightened or loosened as per need to make the pouch smaller and larger, respectively.
It is a temporary method and the band can be removed upon reaching a significant amount of weight loss.
B. Gastric Bypass
It is also known as the Roux-en-Y method. It works on the combined approach. It involves the following steps-
- The top portion of the stomach is cut and stapled to make a small pouch for storing food. The remaining larger portion of the stomach is not removed from the body and is left intact to produce the digestive enzymes.
- The small intestine is cut to a specific length. Similar to the larger stomach pouch, the remaining length of the small intestine is also left intact to produce digestive enzymes.
- The resized small intestine is connected to the smaller pouch of the stomach. This ensures that a much smaller food portion is accommodated in the stomach and further fewer nutrients are absorbed back into the body through the small intestine.
It is a permanent method for effective weight loss.
C. Gastric Sleeve
It is also known as the vertical sleeve gastronomy. It is based on the restriction principle. The stomach is reduced vertically by almost 60-70 percent; the thinner tube-like stomach pouch is stapled to stay connected between the oesophagus and small intestine.
When Bariatric Surgery Becomes Inevitable?
Bariatric surgery is usually not the first recommendation by an obesity consultant to an overweight patient or a patient whose BMI just recently shifted to obese range. For such patients, at first, the obesity expert would suggest proper guidance under a nutritionist and change in lifestyle regime for at least 3 to 6 months along with some medicines which aid in weight loss, before re-evaluating.
However, it remains the only feasible solution for the morbidly obese individuals. Belonging to any of the following categories often calls out for inevitable bariatric surgery.
- Conventional means not working out- Even after a dedicated session of dieting and exercise did not help to lose any significant weight or the body regains the lost weight soon after taking a pause from it.
- BMI more than 35- A BMI ranging more than 35, directly suggest morbid obesity, leaving little scope to lose weight other than the surgical method.
- Physical immobility- An individual who had developed physical immobility due to excessive body weight. Such individual who physically lost any flexible degree of freedom and thus it is impossible for them to even try any conventional means in the first place.
- The presence of two or more obesity-related illnesses- Conditions like osteoarthritis or high blood pressure restricts an obese individual to stay determined by any physical exercise and less likely to yield any fruitful result other than the surgery.
- Prolong history of obesity- In case, an individual had no luck losing body weight over a long period of time, let’s say 8 to 10 years or more, the chances are thin that they are going to lose weight conventionally.
How Effective Is Bariatric Surgery?
The excessive body weight is defined as the excess amount of body weight one has surpassing what they ideally should have, as per their BMI. The effectiveness of the bariatric surgery is measured by the overall percentage of excess weight loss after the surgery.
Who Qualifies For Bariatric Surgery?
A bariatric surgery, just like any other major surgical procedure (with an exception of cosmetic surgery) cannot be solely done with the willingness of the patient and/or the surgeon. The patient must fulfill each and every one of the following conditions in order to undergo a bariatric surgery.
- The candidate must have a BMI of more than 35 kg / m2 or have a weight of 30 kg more than the normal weight
- The candidate must have a BMI of more than 30 kg / m2 with one or more obesity-related illness, such as diabetes type 2, hypertension etc.
- The candidate for whom other weight reduction techniques did not work
- The candidate must age between 16 to 80 years
- The candidate must be psychologically sound
- The candidate must be willing to consent to the procedure.
Is It Possible To Regain Weight After Bariatric Surgery?
Bariatric surgery is a fail-safe method for losing significant body weight. For 99 percent of the people, this is a one-time procedure, as the surgery is extremely effective. The weight loss, it facilitates keeping the operated patient, off ‘the obese zone’ for a lifetime.
However, no procedure is 100 percent effective without the contribution of the patient as well. In case, an individual does not follow the guidelines provided after the surgery and goes back to lead a routine sedentary lifestyle of binge eating and being a couch potato, in a long run they might regain some pounds of weight.
Is Bariatric Surgery A Painful Procedure?
Just like any other surgery, bariatric surgery is carried out under the action of the general anesthesia. The patient cannot feel any pain during the procedure. Once they gain consciousness, they might feel a moderate pain in the abdomen for a couple of days, but it is eased with the administration of painkillers and sedatives. By the time the patient is discharged, pain is often not noted. Furthermore, the laparoscopic procedure has improved this aspect significantly.
Is Bariatric Surgery Safe?
The procedure of bariatric surgery is considered as extremely safe. It is considered as one of the safest procedure under the care of a well-trained, experienced surgeon. Furthermore, the role of laparoscopy makes it an even more convenient and safe procedure.
Scope Of Laparoscopy In Bariatric Surgery?
Laparoscopy is a surgical technique in which the size of the incisions is extremely smaller than it used to be in traditional open surgery. It is as small as 0.5 to 1.5 cm and a total of 5-6 incisions are sufficient to carry out the surgery. The surgery is carried out through inserting medical probes, tools, light source and camera inside the body through these holes, the internal images are displayed on the monitor and the skilled doctor maneuvers the portion of the tool, sticking outside to gain desired action inside the body. Due to the same reason, it is also known as keyhole surgery these days.
During the pioneer days of bariatric surgery, the procedures were carried out through open surgery. However, these days, most of the procedures are carried out laparoscopically in technologically advanced facilities, under the guidance of well trained.
Benefits of Laparoscopic Bariatric Surgery
Laparoscopic bariatric surgery is a rather new thing in the world of medical science. However, due to the immense benefits it offers, it has become almost synonymous with bariatric surgery as a whole. It offers the following benefits-
- Fewer complications during surgery- The minimal incisions reduce the chances of operative risks like internal bleeding, infection, need of blood transfusion, etc.
- Fewer complications after surgery- The laparoscopic surgery also reduces the chances of post-operative risks like a blood clot, swelling, pain, and reddening at the incision site.
- Better aesthetics- The keyhole-sized incision is aesthetically more favored over cross-abdominal scars.
- Faster recovery and quicker resume- A laparoscopic surgery makes the patient get back to his routine life in a matter of a few weeks, as compared to a few months in case of open surgery.
Role of ILS Bariatric Care in Providing Reliable Bariatric Surgery in India?
ILS Bariatric Care is a unit of the prestigious ILS Hospitals, dedicated entirely to help out the obese individuals thorough mainly surgical means. ILS Bariatric Care offers laparoscopic bariatric surgery for patients suffering from long-term obesity and its associated illnesses.
In the year 2017, it was awarded the prestigious title of ‘Centre of Excellence’ for Metabolism and Bariatric Surgery from the Surgical Review Corporation (SRC). It has been one of the hotspots for undergoing bariatric surgery in India.