Metabolic and bariatric surgery is the treatment of morbid obesity and obesity-related diseases and conditions that limit the amount of food the stomach can hold. It limits the amount of calories absorbed, by surgically reducing the stomach’s capacity to a few ounces. Candidates for bariatric surgery have a body mass index (BMI) of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as type 2 diabetes, heart disease or sleep apnea. Advanced Bariatric surgery can improve or resolve more than 30 obesity-related conditions, including type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol.
Types of bariatric surgeries
Laparoscopic Roux en Y Gastric: This is the most common bariatric surgery performed worldwide. The top of the stomach is divided from the rest of the stomach. A smaller stomach of about one ounce is created. A portion of the small intestine is divided. The new smaller stomach is then connected to the bottom end of the small intestine, bypassing the section of the small intestine (duodenum) that absorbs the most calories. Patients eat less because stomach is smaller and absorb fewer calories because food does not travel through duodenum.
Laparoscopic Adjustable Gastric Banding: A silicone band filled with saline is wrapped around upper part of stomach to create small pouch above the band. The rest of the stomach remains below the band. Patients eat less because they feel full quickly. Size of opening can be adjusted after surgery by adding or removing saline from the band through a port under the skin. Patients experience weight loss of about 40 to 50%.
Vertical Sleeve Gastrectomy: This is an emerging procedure where approximately 85% of the stomach is removed leaving a sleeve-shaped stomach that resembles the shape of a banana. The new stomach is closed using surgical staples. This can be done as an open surgery or a laparoscopic surgery. The procedure remains irreversible because part of the stomach has been removed.
Biliopancreatic diversion or BPD: A biliopancreatic diversion with duodenal switch (BPD/DS) gastric bypass is very similar to sleeve gastrectomy. In this procedure also, part of the stomach is removed and a small tubular portion of the stomach remains behind. Additionally the first portion of the small intestine is divided just at the outlet of the stomach and the distal segment of the small intestine is connected to the new stomach.
Benefits of bariatric surgery
- Resolves type 2 diabetes in 73% – 83% of patients
- Cuts the risk of developing coronary heart disease in half
- Effective treatment for obstructive sleep apnea
- Patients can improve life expectancy by 89%
- Long term effectiveness – maximum weight loss 1-2 years after surgery and maintain a substantial weight
- Patients may lose 30% – 50% of their excess weight 6 months after surgery and 77% of their excess weight as early as 12 months after surgery
Adolescents and bariatric surgery
As obesity rates rise, an increasing number of adolescents (12-17 years old) are receiving bariatric surgery
Bariatric surgery has been performed on morbidly obese adolescents for more than 10 years; though long-term efficacy and impact remains unknown.