The Different Types of Bariatric Surgery – A Complete Guide
Bariatric surgery is essentially a treatment for obesity. The incidence of obesity is steadily on the rise and in many countries, the percentage of the population that falls under the bracket of overweight and obese has reached alarming levels. While we are aware that human body best responds to proper diet and work out regimens, it has to be borne in mind that people who are morbidly obese have constraints and can neither maintain a diet nor have ease in performing workouts. This puts them in a tight spot and the only scientifically available option before such individuals is a bariatric surgery, also called weight loss surgery. Let us dig further and understand fully.
Bariatric – The Etymology of the word
“Bar” in Greek means “weight” and “Iatr”, also in Greek means “treatment”. So as the name goes, bariatric literally means “Treatment for weight” or “Treatment for obesity”.
Can all overweight and obese person undergo Bariatric Surgery?
Not really. For a person to undergo a bariatric surgery, the bariatric surgeon would evaluate if it is absolutely necessary. Here are three important criteria a bariatric surgeon would consider before recommending an individual to undergo bariatric surgery.
- Whether the person has a BMI (Body Mass Index) of 40 or more. In other words, if the patients are very severely obese or morbidly obese.
- Have a lesser BMI of 35 or even slightly lesser (these still should fall under the category of moderately obese or severely obese) but have other medical conditions associated with obesity called co-morbid conditions.
- Whether the person has tried all other methods to lose weight but is unsuccessful and is now prepared to undergo bariatric surgery fully knowing what the procedure involves with its risks.
If you are an individual who seems to fit in any of the above categories and you are meeting with the bariatric surgeon you can, in turn, ask him few questions to get more clarity. Click here to know the ten questions you can ask your bariatric surgeon before weight loss surgery.
The above criteria may now induce an inquisition to know more about BMI and co-morbid medical conditions. Let us see them briefly here.
What is BMI or Body Mass Index?
BMI stands for Body Mass Index. It is a measurement where the body weight in kg is divided by the square of height in meters.
BMI = kg/(m)2
If BMI is greater than 25 and within 30, the person is overweight. If the BMI is between 30 and 35, the person is moderately obese. If the BMI is greater than 35 and within 40, the person is severely obese and if the BMI is beyond 40, then the person is very severely obese or morbidly obese.
What are co-morbid medical conditions?
Co-morbid medical conditions or co-morbidity is basically a very general term. If a primary disease is accompanied by additional diseases or disorders then those conditions are termed as co-morbid medical conditions, also referred as co-morbidity.
The greatest co-morbid risk is the risk of acquiring type-2 diabetes. This is a co-morbid condition found invariably in all morbidly obese individuals. In India, most of the time, even obese individuals develop type-2 diabetes due to our food habits.
The other co-morbid conditions are High blood pressure, sleeping disorders like sleep apnea, stroke, fertility-related problems, osteoarthritis, etc.
You can click here to read a detailed article on health issues affecting the morbidly obese patients. It should be kept in mind that these health issues affecting the morbidly obese persons need not necessarily happen only if an individual crosses a BMI of 40. It may happen to people who have crossed a BMI of 30 or 35 also. This is quite complex and it may be tagged to the genes, lifestyle associated stress, etc.
How does weight reduction happens in any Bariatric Surgeries
The weight reduction basically happens only in either of the two ways, namely, procedures restricting the quantity of food taken (restrictive) and second by procedures that are a combination of restrictive and mal-absorption, where mal-absorption is allowing the body to absorb less.
Generally, the restrictive bariatric procedures are recommended for people who overeat and the combination bariatric procedures are recommended for people whose severe or morbid obesity is due to the combination of diseases and other factors.
The different types of bariatric surgeries and how weight reduction happens
The various commonly done bariatric procedures are given below. In each, the principles of how the weight reduction is achieved are given against each weight loss surgery types.
- Intra Gastric Balloon – Restrictive
- Gastric Banding – Restrictive
- Gastric Sleeve also called Sleeve Gastrectomy – Restrictive
- Gastric ByPass also called Roux-en-Y Gastric Bypass – Both Restrictive and Mal-Absorption
- Metabolic Surgery – Both Restrictive and Mal-Absorption
- BPD (Bilio Pancreatic Diversion) and BPD/DS (Bilio Pancreatic Diversion with Duodenal Switch) – Both Restrictive and Mal-Absorption
Gastric Banding Bariatric Surgery Type
This bariatric surgery type is also called Laparoscopic Gastric Banding or Laparoscopic Adjustable Gastric Banding (LAGB).
Surgical Procedure in Gastric Banding Bariatric Surgery
A lap band or a gastric band is placed on the upper part of the stomach by performing an advanced laparoscopic procedure on the abdomen. The lap band used is made of inflatable silicone and is biocompatible.
Weight Loss by Gastric Banding Bariatric Surgery
Basically, the weight loss is achieved by the restricted quantity of food. Since the stomach has a lap band, the stomach can hold only less quantity of food and hence this induces less eating. It is estimated that in gastric banding bariatric surgery an average of 45% of weight can be reduced in a span of two years.
To get a few more information about gastric banding procedure and their advantages you can click here.
Gastric Sleeve Bariatric Surgery Type
This bariatric surgery type is also called the Sleeve Gastrectomy.
Surgical Procedure in Gastric Sleeve or Sleeve Gastrectomy Bariatric Surgery
With the help of laparoscopic methods, the stomach is cut along the natural curvature position in a vertical fashion. After the, cut the stomach is stitched along the cut or in other words it is stapled.
Weight Loss by Gastric Sleeve or Sleeve Gastrectomy Bariatric Surgery
Here too like gastric banding, the weight loss is achieved by the restricted quantity of food. Since the size of the stomach has been permanently reduced, only a reduced quantity of food can be held by the stomach. This reduced intake aids in weight reduction. It is estimated that by a gastric sleeve or Sleeve Gastrectomy bariatric surgery an average of 55-60% of weight can be reduced in a span of five years.
Gastric ByPass Bariatric Surgery Type
This bariatric surgery type is also called Gastric Bypass with Roux-en-Y or simply Gastric Bypass. This bariatric surgery type is considered as the gold standard in all the weight loss surgery types available.
Surgical Procedure in Gastric Bypass with Roux-en-Y Bariatric Surgery
With the help of laparoscopic methods, the stomach is divided into a smaller upper portion and a larger lower portion. The food pipe is attached to the smaller upper portion on the upper part. Now the dissected smaller upper portion is connected to the small intestine somewhere down. To be more clear the lower large part of the stomach and early part of the small intestine is completely bypassed. Hence the name Gastric “Bypass”. To talk medically, the distal part of the stomach and a major part of the proximal intestine are completely bypassed.
Weight Loss by Gastric Bypass with Roux-en-Y Bariatric Surgery
Weight loss by Gastric bypass with Roux-en-Y is achieved by both restrictive and mal-absorption methods. Since the size of the stomach is reduced, the principles of restriction apply here. Since the distal part of the stomach and the considerable length of the small intestine are reduced, the actual digestion and absorption of the food take place in the distal part of the small intestine. Hence mal-absorption of nutrients also takes place. So in effect, the surgical procedure is a combination of both. It has been estimated that in two years the average weight loss achieved by this bariatric surgery type is close to 65-80%.
Metabolic Surgery Bariatric Surgery Type
This bariatric surgery type is primarily done for people who have normal BMI or simple obesity but have a combination of uncontrolled diabetes (insulin resistance), high cholesterol and high blood pressure. This combination is termed as metabolic syndrome. If a person with normal weight or BMI has any of the above two conditions, then the person is qualified for metabolic surgery.
Surgical Procedure in Metabolic Surgery Type Bariatric Surgery
Using advanced laparoscopic methods, the end part (distal) of the digestive system, namely the distal ileum is brought proximally nearer to the stomach.
What is achieved by Metabolic Surgery Type Bariatric Surgery
Because of this, the incretin (GLP-1) level in the body increases. This improves the insulin sensitivity. Hence the diabetes is brought under control. This surgery type may result in mild weight loss also. Amazingly the blood sugar level is brought to near normal within few days after the metabolic surgery. Though the real reasons are not fully known, certain theories do exist.
You can read more on how metabolic surgery reduces diabetes and brings down the blood glucose level to normalcy here.
Type of Bariatric Surgery Procedure done for individuals who have BMI of more than 50
The class of individuals who have BMI of above 50 are termed super obese. BPD (Bilio Pancreatic Diversion) and BPD/DS (Bilio Pancreatic Diversion with Duodenal Switch) are the two bariatric surgery types recommended for such people.
Surgical Procedure in BPD and BPD/DS Bariatric Surgery
In the BPD procedure, 3/4th of the stomach is removed horizontally and in this process, the upper part of the stomach is retained.
In the BPD / DS procedure, 3/4th of the stomach is removed vertically along the natural curvature exactly like the surgical procedure in the gastric sleeve.
After above procedure is completed, in both BPD and BPD/DS, two separate pathways are created, one is the digestive pathway carrying the food and the other is the biliopancreatic loop carrying the bile from the liver. Both these pathways connect to a common pathway. The digestive pathway is a connection made from the end of the stomach to the common pathway.
Weight Loss by BPD and BPD/DS Bariatric Surgery
Since the capacity of the stomach is reduced because of removal of part stomach either vertically or horizontally, the intake of food quantity is greatly reduced and hence it is part restrictive.
Also since the major small intestine part is bypassed, the nutrient absorbing capacity is greatly reduced. Hence in this part, the principle of mal-absorption comes into play.
You can click the link here to know more about BPD and BPD/DS, and also know can be the best candidate for this bariatric surgical procedure.