Laparoscopic Bariatric Surgery

Overview

Gastric bypass and other weight-reduction operations, known together as bariatric surgery, involve modifying your digestive tract to aid in weight loss. Bariatric surgery is performed when diet and exercise have failed or when you are experiencing major health concerns as a result of your weight. Some treatments limit the amount of food you can eat. Other treatments operate by decreasing the body's capacity to absorb nutrients. Some techniques provide both functions.

While laparoscopic bariatric surgery has numerous advantages, all types of weight-loss surgery are substantial procedures with significant risks and adverse effects. In addition, to assist assure the long-term effectiveness of bariatric surgery, you must make lasting healthy modifications to your diet and engage in regular exercise.

Bariatric surgery is performed to assist you in losing excess weight and lowering your risk of potentially life-threatening weight-related health problems such as: heart disease and stroke, high blood pressure, nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), sleep apnea, and type 2 diabetes. Bariatric surgery is often performed only after you have attempted to reduce weight via improved diet and exercise habits.

Gastric bypass surgery and other bariatric procedures are typically performed laparoscopically and can result in long-term weight reduction. The amount of weight you lose is determined on the type of surgery you have and the changes you make in your lifestyle. Within two years, you may be able to shed half, if not more, of your additional weight.

What is Weight-Loss Surgery?

Weight-loss surgery refers to a variety of procedures that help you lose weight by altering your digestive system. It is sometimes referred to as bariatric surgery ("bariatric" meaning "related to therapy for obesity").

Some weight-loss procedures shrink your stomach, restricting how much you can eat and drink at one time and making you feel full sooner. Other weight-loss procedures alter your small intestine, which is the area of your digestive system responsible for absorbing energy and nutrients from foods and beverages. This procedure lowers the amount of calories that the body can absorb. Weight-loss surgery can also alter hormones or bacteria in the gastrointestinal system, perhaps reducing appetite and hunger and improving how the body metabolizes fat and uses insulin.

Who Needs Bariatric Surgery?

If you are an adult with obesity and have not been able to shed your excess weight, or if you continuously gaining back weight that you have lost using other means such as meal plans, exercise, or medicines, you may be a suitable candidate for weight-loss surgery.

BMI is a measure of obesity that is used to assess who is a suitable candidate for weight-loss surgery. Body mass index (BMI) calculates body fat based on weight in proportion to height. Obesity can be difficult to manage with diet and exercise alone in those with a BMI of 35 or above, therefore doctors may consider weight-loss surgery. Weight-loss surgery may be investigated as a therapy option for persons with a BMI of 30-35 who have type 2 diabetes that is difficult to control with drugs and lifestyle modifications.

If you have major health concerns associated to obesity, such as type 2 diabetes or sleep apnea, weight loss surgery may be an option to explore. Many of the medical issues associated with obesity, particularly type 2 diabetes, can be improved by weight-loss surgery.

As of 2017, the American Society for Metabolic and Bariatric Surgery stated that it was unclear if medical weight-loss therapies or bariatric surgery affected response to later infertility treatments in both men and women. Bariatric surgery lowers the risk of gestational diabetes and hypertensive disorders of pregnancy in women who subsequently get pregnant, but it raises the chance of premature delivery.

Do Weight-Loss Surgeries Always Work?

According to studies, many patients who undergo weight-loss surgery lose 15 to 30 percent of their initial weight, depending on the type of operation. However, no therapy, even surgery, can guarantee weight loss and maintenance. Some patients who have weight-loss surgery may not get the desired results. Some people recover some of the weight they lost over time. The amount of weight that people recover varies. Weight regain may be affected by a person's weight before to surgery, the kind of procedure, and adherence to changes in activity and nutrition.

Laparoscopic Bariatric Surgery Cost

Weight-loss surgery can cost between $15,000 and $25,000 or even more, depending on what type of surgery you have and whether you have surgery-related complications. Costs may be higher or lower depending on where you live. The amount your medical insurance will pay varies by state and insurance provider.

If you receive a health care professional's recommendation and satisfy specific conditions, Medicare and some Medicaid programs may fund the primary forms of weight-loss surgery (for example, if you have a BMI of 35 or greater and obesity-related health problems). Some insurance companies may mandate that you use only approved surgeons and facilities. Some insurers may additionally need you to demonstrate that you were unable to reduce weight using a nonsurgical weight-loss program or that you fulfill other criteria.

More information on weight-loss surgery coverage, alternatives, and requirements may be obtained from your health insurance carrier or your local Medicare or Medicaid office.

Weight-loss surgery can help you eat less calories and be more physically active. Choosing nutritious meals and beverages before and after surgery may assist you in losing more weight and keeping it off in the long run. Regular physical exercise following surgery also aids in weight loss. You must commit to a lifetime of good living practices and follow the advise of your health care specialists to enhance your health.

Before Bariatric Surgery

You will visit with multiple health care specialists before surgery, including an internist, a dietician, a psychiatrist or psychologist, and a bariatric surgeon.

The internist will inquire about your medical history, do a complete physical examination, and request blood tests. If you smoke, you should try to quit at least 6 weeks before your operation.

The nutritionist will explain what and how much you will be allowed to eat and drink following surgery and will assist you in preparing for how your life will change.

A psychiatrist or psychologist may evaluate you to see if you are prepared to face the obstacles of weight-loss surgery.

The surgeon will tell you more about the procedure, including how to prepare for it and what sort of follow-up you will require.

These medical specialists will also encourage you to become more active and follow a healthy eating plan before and after surgery. Losing weight and lowering your blood glucose—also known as blood sugar—levels closer to normal before surgery may reduce your risk of experiencing surgery-related complications. Some weight-loss surgery programs provide pre- and post-surgical support groups.

How is the Surgery Performed?

Weight-loss surgery is mostly done laparoscopically, which requires only small cuts, under general anesthesia. Through these incisions, the surgeon can insert thin tools and a small scope attached to a camera that projects images onto a video monitor. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring. Recovery may also be faster with laparoscopic surgery.

Open surgery, which involves a single, large cut in the abdomen, maybe a better option than laparoscopic surgery for certain people. You may need open surgery if you have a high level of obesity, had stomach surgery before, or have other complex medical problems.

Laparoscopic Surgical Options

In the United States, surgeons most often perform 4 types of operations:

gastric sleeve
gastric bypass
adjustable gastric band
biliopancreatic diversion

Surgeons less commonly use a fourth operation, biliopancreatic diversion with duodenal switch.

1. Gastric Sleeve:

A surgeon removes most of your stomach in gastric sleeve surgery, also known as vertical sleeve gastrectomy, leaving just a banana-shaped segment secured with staples. Because the procedure lowers the quantity of food that can fit in your stomach, you will feel full faster. Having a portion of your stomach removed may potentially have an effect on hormones or bacteria in the gastrointestinal tract that impact appetite and metabolism. Because portion of the stomach is permanently removed, this type of surgery cannot be reversed.

A surgeon removes around 80% of the stomach, resulting in a lengthy, banana-shaped pouch.

Advantages:

Greater weight loss than gastric band.
No changes to intestines.
No foreign objects placed in body.
Short hospital stay.

Disadvantages:

Cannot be reversed.
Risk of vitamin and iron deficiency (shortage).
Higher chance of surgery-related problems than gastric band.
Risk of acid reflux and hiatal hernia (caused by the stomach pushing up against the diaphragm).

2. Gastric Bypass:

Gastric bypass surgery, also known as Roux-en-Y gastric bypass surgery, is performed in three stages. The surgeon will first staple your stomach, forming a tiny pouch in the top part. Because the staples shrink your stomach, you eat less because you feel full sooner.

The surgeon will next divide your small intestine into two halves and join the bottom portion straight to the tiny stomach pouch. Food will bypass the majority of your stomach and the top section of your small intestine, resulting in less calories being absorbed by your body.

The surgeon then connects the upper segment of the small intestine to a new place on the lower half of the small intestine. This permits digestive fluids in the stomach to move from the bypassed region of the small intestine to the lower part of the small intestine, allowing food to be properly digested. The bypass alters hormones, bacteria, and other chemicals in the gastrointestinal system, which may impact appetite and metabolism. Gastric bypass is difficult to reverse, yet a surgeon may do so if medically required.

Advantages:

Greater weight loss than gastric band
No foreign objects placed in body

Disadvantages:

Difficult to reverse
Higher chance of vitamin and iron shortage than gastric band or gastric sleeve
Higher chance of surgery-related problems than gastric band
May increase risk of alcohol use disorder

3. Adjustable Gastric Band:

The surgeon will wrap a ring with an inner inflatable band around the top of your stomach to form a tiny pouch. The gastric band, like the gastric sleeve and gastric bypass surgery, makes you feel full after consuming a tiny amount of food. The inner band contains a round balloon filled with saline solution. By injecting or withdrawing saline solution through a tiny device called a port that is inserted under your skin, the surgeon can alter the inner band to enlarge the opening from the pouch to the remainder of your stomach.

You will require numerous follow-up appointments after surgery to alter the size of the band opening. If the band creates complications or is not assisting you in losing enough weight, the surgeon may remove it.

Adjustable gastric band surgery is now less prevalent in the United States than gastric sleeve or gastric bypass surgery since it is linked with more problems, most notably the necessity for band removal owing to intolerance. Gastric band surgery is also associated with much less weight reduction and greater problems, most notably the necessity for band removal owing to intolerance.

Advantages:

Can be adjusted and reversed
Short hospital stay and low risk of initial surgery-related problems
No changes to intestines
Lowest risk of vitamin shortage

Disadvantages:

Less weight loss than other types of weight-loss surgery
Frequent follow-up visits to adjust band; some people may not adapt to band
Possible future surgery to remove or replace all or part of the band system.

4. Biliopancreatic Diversion with Duodenal Switch

A biliopancreatic diversion with duodenal switch, sometimes known as "mixed surgery," entails two different surgeries. The first is comparable to gastric sleeve surgery. The small intestine is divided into two tracts in a subsequent surgical surgery. Food travels via one tract, avoiding the majority of the small intestine. This decreases the quantity of calories and nutrients absorbed. Digestive juices go from the stomach to the other intestinal system, where they combine with food as it enters the colon.

What Should I Expect After Surgery?

You will need to relax and recover after surgery. Walking and moving around the house may aid in your recovery. Start carefully and listen to your doctor's instructions regarding the kind of physical activities you can undertake safely. Increase your physical activities as you get more comfortable.

You will most likely be put on a liquid diet following surgery. Over the course of many weeks, you will move to a soft diet that includes meals like cottage cheese, yogurt, and soup. You will eventually resume eating solid meals. Your doctor will advise you on which meals and beverages you should consume and which you should avoid. You must eat modest meals and chew your food properly. You will need to take dietary supplements that your doctor has prescribed to ensure you obtain adequate vitamins and minerals.

How Much Weight Can I Expect to Lose?

The amount of pounds lost following weight-loss surgery varies depending on the individual and the type of operation. According to one research, those who underwent adjustable gastric banding, gastric sleeve, or gastric bypass lost between 38 and 87 pounds after one year. Gastric bypass provided the greatest average weight reduction of the three most popular surgeries, but had the most problems in the month after surgery. Most participants gained some weight over time, although it was generally little as comparison to their initial weight reduction.

Your weight loss results may vary. Remember that achieving your objective is dependent not just on the surgery but also on maintaining good lifestyle habits.

Why Bariatric Surgery?

Weight-loss surgery can help you lose weight and improve many health problems related to obesity. These health problems include:

type 2 diabetes.
high blood pressure.
heart disease.
unhealthy cholesterol levels
sleep apnea
urinary incontinence
knee, hip, or other body pain

Weight-loss surgery can add years to the life of those who are severely obese. After surgery, you may be able to walk around and be more physically active. You may also find that your mood improves and that your quality of life improves. As an extra bonus, as you lose weight, you may be able to take fewer prescription prescriptions, reducing your financial burden.

Weight-Loss Surgery Side Effects

Side effects of weight-loss surgery may include:

bleeding
infection
leaking from the site where the sections of the stomach, small intestine, or both are stapled or sewn together
diarrhea
blood clots in the legs that can move to the lungs or heart (DVT)

Within 5 years post weight-loss surgery, follow-up treatments, surgery, and hospitalizations are relatively frequent, impacting around one-third of patients. When compared to gastric sleeve, gastric bypass requires more follow-up procedures.

Surgery-related complications can seldom result in death. Other side effects may manifest later. Your body may not absorb adequate nutrients if you do not take your vitamins and minerals as directed. Nutritional deficiencies can lead to health issues such as anemia and osteoporosis. Gallstones can form as a result of fast weight reduction. Some doctors give medication for roughly 6 months following surgery to help avoid gallstones. Gastric bands can slip out of place or dissolve through the stomach wall, necessitating their removal.

Strictures and hernias are two more potential complications. Strictures, which are narrowings of the new stomach or the junction between the stomach and the small intestine, make it difficult to ingest solid food and can induce nausea, vomiting, and difficulty swallowing. Strictures are treated by health care providers using particular devices to widen the constriction. Hernias can form at the incision site or in the abdomen following weight-loss surgery. Hernias can be corrected surgically.

According to some study, weight-loss surgery, particularly gastric bypass, may alter the way your body absorbs and breaks down alcohol, perhaps leading to increased alcohol-related issues after surgery.

Conclusion

Bariatric surgery (or weight loss surgery) refers to a group of operations done on obese people. Long-term weight reduction achieved with standard-of-care surgeries (Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch) is mostly accomplished by modifying gut hormone levels responsible for appetite and fullness, resulting in a new hormonal weight set point.

Weight-loss surgery may be an option for adults who have:

a body mass index (BMI) of 40 or more.
a BMI of 35 or more with a serious health problem linked to obesity, such as type 2 diabetes, heart disease, or sleep apnea.
a BMI of 30 or more with type 2 diabetes that is difficult to control with medical treatments and lifestyle changes.

Gastric bypass and other weight-loss operations are not always as effective as you may anticipate. If a weight-loss technique fails or becomes ineffective, you may not lose weight and may develop major health complications.

Maintain all planned follow-up appointments following weight-loss surgery. Consult your doctor right away if you aren't losing weight or if you experience issues. Your weight loss may be monitored, and issues that may be contributing to your inability to lose weight can be evaluated.