Bariatric Weight Loss Surgery

Obesity is a chronic, relapsing medical condition for which there is no cure, only ongoing treatment which will ameliorate the condition. For morbidly obese patients, surgical intervention is an option and is the treatment of choice.

Bariatric Surgery helps you to lose weight in different ways, either by restriction or by changing how your stomach and small intestine handle the food you eat.

There are different surgical procedures like: Sleeve Gastrectomy, Gastric Band, Gastric Mini Bypass and Gastric Bypass.

Who is Eligible for Bariatric Surgery?

In order for someone to be eligible for Bariatric Surgery, a set of parameters have to be met.

1. Have a BMI of over 35 (Asians 32.5 ) with obesity-related medical complications, such as high blood pressure, diabetes, elevated cholesterol, or sleep apnea.
2. Have a BMI of over 40 (Asians 37.5 ) without associated medical complications.
3. Have been unsuccessful after undergoing appropriate medical management like dieting, weight loss medications.

What are the Different Types of Bariatric Surgery?

 Weightlos surgical methods have changed over the years, but can be divided into gastric (stomach) restrictive procedures, wherein the quantity of food is “ restricted ” and combination of restrictive/ malabsorptive procedures like Gastric Bypass procedures, wherein there is a restrictive component but also a component that leads to incomplete absorption of food.

Sleeve Gastrectomy  

SG (sleeve gastrectomy) produces weight loss in two ways:

1. Produces the feeling of being “full” as a purely restrictive procedure
2. Reduces plasma hunger hormone (ghrelin) levels by removing a great part of the Ghrelin production tissue (a potent hunger stimulating hormone). This in turn will furthermore decrease one’s appetite.

Gold Standard in Bariatric Weight loss

COMBINATION RESTRICTIVE/MALABSORPTIVE PROCEDURES

Arguably, the “Gold Standard” in obesity surgery is the Roux-en-Y Gastric Bypass . This procedure involves both a “ restrictive ” procedure by decreasing the size of the stomach by stapling across the top of it and a “ malabsorptive ” component, achieved by bringing-up and attaching a portion of the small intestine directly to the stomach, thus “ bypassing ” part of the small intestine.This surgery causes gastrointestinal hormonal changes, which result in decreased hunger and improved satiety or fullness. Individuals undergoing this surgery will lose significant amounts of weight (mainly body fat as opposed to lean body mass or muscle tissue). Weight maintenance is generally excellent with small increases in weight occurring over subsequent years. Like any obesity surgery, the patient will require lifelong vitamin supplements & regular periodic follow-up to preventive any vitamin, iron, calcium deficiencies.

Surgical Results, Complications, and Nutritional Deficiencies

After 2 years from the surgical procedure, on average patients lost approximately 60- 80 % of excess body weight lost

Major complications related to this specific surgery are less than 3-4 % and include:

1. Marginal Ulcers at the site of attachment of the intestine to the stomach.
2. Stomal stenosis (narrowing)at the stomach outlet, resulting in nausea and vomiting
3. Leakage of intestinal contents
4. Stomach staple line disruption resulting in the ability to consume large volumes of food
5. Dumping Syndrome wherein consumption of food (especially carbohydrates) results in nausea, vomiting, diarrhea, abdominal pain, flushing, rapid heartbeats.

Nutritional Deficiencies from Roux-en-Y Gastric Bypass are specifically Iron, Vitamin B12, Folate, Vitamin D, Calcium, Thiamine, Protein, therefore patients need regular supplementation and follow up with your doctor.

This procedure is carried out usually laparoscopically, which offers faster surgical recovery & enhanced safety.

Gastric (stomach) Restrictive Procedures

GASTRIC BANDING (REVERSIBLE WEIGHT LOSS SURGERY)

Many clinicians recommend this procedure for older individual (60-65 years old) who would otherwise not be a candidate for other kinds of surgical intervention.
This procedure, which was approved in the U.S. in June 2001, is popular & is done by the Laparoscopic technique(minimally invasive, key hole surgery) and therefore recovery time is only a few days. The procedure includes an adjustable band being placed around the upper portion of the stomach, essentially resulting in a much smaller stomach. This restricts the amount of food that can be eaten, similar to the sleeve surgery.

The European literature (where the procedure has been performed for a longer period of time) shows that weight loss is similar to that seen with sleeve surgery.

Surgical Results, Complications, and Nutritional Deficiencies

At 7 years: < 50% of excess body weight lost

At 9 years: < 40 % of excess body weight lost

Major Late Complications Related to this Surgical Procedure

Medical Complications of this Procedure Include: Band slippage, Erosion of the band into the stomach, Dilation of the esophagus & infections (many of which require removal of the device).

Band eroding into the stomach: 3.3%

Slippage: 6.5 %

Leakage: 9.8%

Major reapportion: 24.4%

Nutritional Deficiencies from Gastric Banding:

Rarely significant nutritional deficiencies from the surgery itself occur

Thiamine deficiency if persistent vomiting occurs

Occasional protein deficiency from “induced ” dietary changes

MINI GASTRIC BYPASS SURGERY DUBAI

The Mini Gastric Bypass (MGB) is a Short, Simple, Successful gastric bypass weight loss surgery which has been gaining popularity in recent years. It is low risk & has excellent long-term weight loss & minimal pain.

The mini-gastric bypass procedure is restrictive and malabsorptive. It means that the procedure reduces the size of your stomach, restricting the amount you can eat. The procedure also reduces absorption of food by bypassing up to 6-7 feet of intestines. This has excellent results for individuals who has diabetes as a result of obesity. It reverses diabetes in 60- 80 % of patients.

Benefits Of Mini Gastric Bypass Compared To Gastric Bypass Surgery

1. Shorter surgery.
2. Less re-routing of the intestines.
3. Fewer anastomosis (connection of intestines), which in theory means less chance of a complication
4. Similar weight loss and recovery

Simple yet very effective weight loss surgery which is reversible too.

It is simple to perform, is more effective than  Gastric Band & safer than RNY gastric bypass.

This operation is done to treat morbid obesity type 2 diabetes, hypertension, sleep apnea and associated co morbidities.

The operation usually has hospital stay is usually 2 nights. With excellent long-term weight loss, minimal pain and the option for reversal or revision if needed.