Dr. Arun Prasad
Gastric Surgery helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, your stomach will be smaller. You will feel full with less food. The food you eat will no longer go into some parts of your stomach and small intestine that absorb food. Because of this, your body will not get all of the calories from the food you eat. The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed.
various gastric surgery procedures :
RESTRICTIVE PROCEDURES
The stomach size is reduced by applying staplers across it and thereby reducing the amount of food a person can eat at a given time.
- Gastric Banding is a popular restrictive procedure currently. A band is placed around the upper most part of the stomach. This band divides the stomach into two portions, one small and one larger portion. Because food is regulated, most patients feel full faster. Food digestion occurs through the normal digestive process. Other advantage is that it is EXTERNALLY adjustable ( the band can be tightened or loosened to regulate the amount of food passing ).
- The Gastric Sleeve Resection removes a great part of the stomach and leads to ‘considerable’ loss of weight. This is useful in those with a BMI between 35 and 40. Also, this procedure is being done in BMI over 60 to downgrade the obesity to a more manageable level of about 50, after which a gastric bypass / duodenal switch can be done.
COMBINED RESTRICTIVE AND MALABSORBTIVE
In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile andpancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat. According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the most frequently performed weight loss surgery in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.
The Single Anastomosis Gastric Bypass ( popularly known as ‘mini’ gastric bypass or MGB ) uses a long stomach sleeve tube that is connected to small intestine at a length between 180 and 300 cm based on original weight, eating patterns, presence of diabetes, metabolic disorders etc. The Mini-Gastric Bypass, which uses the loop reconstruction, has been suggested as an alternative to the Roux en-Y procedure, due to the simplicity of its construction, which reduced the challenge of laparascopic surgery. It is claimed that construction of a long tubular gastric pouch reduces the risk of inflammatory complications, and renders it as safe as the RNY technique. Many bariatric surgeons shun the procedure, while those doing the procedure claim to have many satisfied patients.
The other procedure in this group is of Duodenal switch. With this procedure, the surgeon removes approximately 60 percent of the stomach so that it takes the shape of a tube. The small intestine is then divided much further downstream than with gastric bypass so that more intestine is bypassed and two intestinal pathways are created: one for food, and one for the digestive juices, both of which meet to form a common channel. Duodenal switch preserves the pylorus and the outlet muscle that controls emptying of the stomach. It also offers the ability to eat near normal portion sizes and produces reliable weight loss. Since this operation induces a state of decreased absorption, patients typically experience more bowel movements and need to be monitored for vitamin, mineral, and protein levels.
PURE MALABSORBTIVE PROCEDURES
The stomach is joined to the intestine at a point further down to cause malabsorbtion of the consumed food. Jejunoileal bypass (left picture) and bilio-pancreatic bypass (right picture) had serious nutritional complications and are not done commonly.
- These operations often result in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard gastric bypass. procedure. These procedures can produce the greatest excess weight loss because they provide the highest levels of malabsorption.
When it is required
You could be a candidate for surgical weight loss if you meet any of the following criteria:
- You are more than 100 lbs. over your ideal body weight.
- You have a Body Mass Index (BMI) of over 40.
- You have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or diabetes, related to being severely overweight.
- You are unable to achieve a healthy body weight for a sustained period of time, even through medically-supervised dieting.
Is a senior bariatric surgeon at Apollo Hospital, New Delhi. He is the vice president of Obesity & Metabolic Surgery Society of India (OSSI).
