What is bariatric surgery and who needs it?

The word ’bariatric’ is derived from the Greek words “baros” meaning “weight” and “iatrikos” meaning “medicine”. Bariatric surgery is a surgical procedure of the digestive system to promote weight-loss in people with severe obesity.

Weight-loss surgery is recommended to severely obese patients (Body Mass Index [BMI] above 40), when other weight-reduction strategies, such as diet management, exercise etc, have failed. It is also suggested in severely obese patients who have medical conditions like arthritic joint diseases that restrict the physical activity.

How does bariatric surgery work?

Bariatric surgery is a weight loss tool that influences the anatomy and hormones of the stomach and digestive system. These changes reduce hunger, emotional eating, and increase satiety, thus regularize food intake and promote fat burning. Over a period of time, the physiological changes related to energy balance and fat metabolism occur, which in turn helps to achieve a steady, desired body weight.

Thus, contrary to dietary weight loss which is usually short living and reversible, surgical weight loss offers long-lasting weight loss, improved coexisting diseases, better quality of life, improved self-esteem and psychosocial status.

Most of the bariatric surgeries are done using minimal invasive techniques such as laparoscopy.

What are the different types of bariatric surgeries?

Bariatric surgeries aim at reducing the food intake and increase satiety. This is achieved by different procedures as mentioned below:

• Laparoscopic adjustable gastric banding (LAGB) – A small pouch is created with the help of a band to minimizefood intake and increase satiety.
• Gastric balloon – A balloon is placed inside the stomach to promote early satisfaction.
• Gastric bypass–Roux-en-Y gastric bypass – A small pouch is placed that bypasses stomach and deodenum. The bypass mechanism is believed to cause changes in the gut hormones, and hencepromote satiety and suppress hunger.
• Gastric sleeve– Vertical Sleeve Gastrectomy – A portion of the stomach is removed to form a narrower gastric sleeve.

What are the risks and benefits of bariatric surgery?

In addition to weight reduction, bariatric surgery may improve or resolve conditions often related to obesity, such as:

• Gastroesophageal reflux disease
• Heart disease
• High blood pressure
• High cholesterol levels
• Infertility
• Severe or obstructive sleep apnea
• Stroke
• Type 2 diabetes

However, being a surgical procedure, bariatric surgery has few risks, which include, but may not be limited to:

• Bleeding
• Blockage or leaking in bowels
• Blood clots in legs and lungs
• Damage to the nearby structures
• Heart attack
• Infection at the site of surgery
• Pneumonia
• Urinary-tract infection

What to expect before, during and after bariatric surgery?

Before Surgery: The medical team will explain to you about the procedure and also give you instructions about do’s and don’ts before and after the surgery. You will also undergo some pre-operative investigations.

During Surgery: Surgery is carried out under general anaesthesia by a specialized team of anaesthetists, surgeons and other medical staff. Depending on the type of surgery, surgeons perform the surgery in a couple of hours.

After Surgery: Depending upon your health status, you may need to stay in hospital for a few days. Recovery and rehabilitation varies from person to person. You will receive dietary and exercise guidance from the medical team, which is critical for the success of the surgery.

What is the expected post-surgery weight loss and its timeline?

Various factors influence weight-loss after surgery. However, the average weight-loss* generally observed are:

• LAGB: 15-20%after six months
• Gastric Balloon:25-33% after six months
• Gastric Bypass: 70-75% in the first year
• Gastric Sleeve: 60-65% in two years

What diet should be taken after bariatric surgery?

A dietician will provide a complete diet plan that should be followed after bariatric surgery to ensure nutritional adequacy. After a few hours of surgery, only clear liquid is given. This is followed by pureed food for few weeks and then small, tender and easily chewable pieces. After eight weeks of surgery, firmer food can be started. Normal diet may be followed after about four months of surgery.

Throughout the diet, one should eat and drink slowly, keep meals small and chew thoroughly.

What factors should be considered while choosing a hospital for bariatric surgery?

The success of the bariatric surgery depends on the medical team as well as the availability of an advanced set-up. Look out for a hospital with specialized team of doctors, nurses, dietitian, counselors, led by a highly experienced bariatric surgeon. Also, the hospital set-up should be advanced with well-equipped tools and techniques for carrying out surgery and management of post-surgery complications, if any.

What factors govern the cost of bariatric surgery? Is there an insurance coverage available?

The cost of surgery is governed by several factors, such as

• Availability of skilled and specialized surgeon and facilities
• Medical condition of the patient
• Time-to-recovery
• Usage of medications and additional investigations

Check if the hospital is enrolled with majority of Third-party Administrator (TPA) and insurers. If you have an insurance policy, seek help from the TPA desk at the hospital to determine whether your policy covers the surgery or not.

Our informative blogs :

• Obesity (Bariatric) Surgery or Weight Loss Surgery

References

• Mayo Clinic. Gastric Bypass Surgery. Available at: https://www.mayoclinic.org/tests-procedures/gastric-bypass-surgery/about/pac-20385189. Accessed on 18^thFebruary 2018.
• Mayo Clinic. Sleeve gastrectomy.Available a: https://www.mayoclinic.org/tests-procedures/about/pac-20385183. Accessed on 18^th February 2018.
• Patient education: Weight loss surgery and procedures (Beyond the Basics). Available at: https://www.uptodate.com/contents/weight-loss-surgery-and-procedures-beyond-the-basics. Accessed on 18^thFebruary 2018.
• Laparoscopic gastric banding – discharge. Available at: https://medlineplus.gov/ency/patientinstructions/000180.htm. Accessed on 18^thFebruary 2018.
• Gastric bypass surgery – discharge. Available at: https://medlineplus.gov/ency/patientinstructions/000172.htm. Accessed on 18^thFebruary 2018.
• Vertical sleeve gastrectomy. Available at: https://medlineplus.gov/ency/article/007435.htm. Accessed on 18^thFebruary 2018.
• American Society for Metabolic and Bariatric Surgery. Bariatric Surgery Procedures. Available at: https://asmbs.org/patients/bariatric-surgery-procedures#learnmore. Accessed on 18^thFebruary 2018.
• National Institute of Diabetes and Digestive and Kidney Diseases. Types of Bariatric Surgery. Available at: https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/types. Accessed on 18^thFebruary 2018.

Disclaimer:

“The content of this publication has been developed by a third party content providerwho are clinicians and/or medical writers and/or experts. The information contained herein is for educational purpose only and we request you to please consult a Registered Medical Practitioner or Doctor before deciding the appropriate diagnosis and treatment plan.”