Bariatric Surgery – Complete Guide: Step by Step
Is excess weight affecting your life and your health?
Obesity has been on an accelerates pedal for a decade, in some cases, traditional methods have not been able to show the effective progress in maintaining serious weight reduction goals.
What is Obesity?
Obesity is a serious chronic disease that is growing worldwide concern affecting the health of millions of people. Obesity is a result of high caloric intake which causes an excessive amount of body fat with its relation to body mass, wherein the energy usage is far less compared to calorie intake.
Obesity was designated as a world problem and a diseases in 2013 only by the American Medical Association. The result changed the perception that obesity was caused by lack of discipline, insufficient willpower and bad choices.
The World Health Organization reports that worldwide more than 1 billion people are overweight, at least 500 million of whom are severely obese. An estimated 115 million of these people will develop serious medical conditions, including diabetes mellitus (DM), cardiovascular diseases (CVD), stroke, liver problems, and cancer. Studies show that those potentially life-threatening conditions can be improved with weight loss.
Obesity is the second leading cause of preventable death following smoking.
Understanding of the Human anatomy – Gastric Surgery
The Gastrointestinal system
The gastrointestinal system is a part for the anatomy of the body which basically is an elongated tube which runs through the body with unique sections that are capable of digesting the food through the mouth and extracting any useful component from it, then expelling the waste products from the anus.
Food after ingestion undergoes three types of process in the body Digestion, absorption and excretion.
- The Esophagus
Once the food is chewed and mixed with saliva in the mouth, it is swallowed and passed down the oesophagus. The submucosa lining in the oesophagus secretes mucous glands with aids the passage of food down the pipe. The food to the stomach is pushed by waves of motion; it is assisted by the oesophagal wall muscle layer.
- The Stomach
The stomach is ‘J’ shaped organ with two opening the oesophagal and duodenum. The duodenum is the first and shortest segment of the small intestine.The digested food is received partly which is called chyme from the stomach. The acidic component in the stomach helps with the chemical digestion of chyme for the intake of the small intestine. Inside the stomach has four regions and each region performs different functions including mixing of the food with digestive enzymes and strong acid.Some functions of the stomach will include temporary storage of food, it monitors the amount and the rate of food that enters the small intestine, the stomach also checks the secretion of acid to dissolve the food and acts as anti-bacterial agent.
- Small Intestine
The small intestine is at the site below the stomach and is bordered by the large intestine. The functions of the small intestine are where almost all chemical and mechanical digestion is been carried out, absorption of all essential materials happens.
- Large intestine
The large intestine which is the last phase of the digestive tube it position at the end phase of the digestion process.It is the part of the tube which is used for digestion which then connects the small intestine and the an
Body Mass Index (BMI)
Accuracy is important in obtaining height and weight measurements because these measurements will be used to calculate the BMI which, in turn, is utilized to assess healthy weight status and/or provide for surveillance data.
It is ascertained by dividing person’s weight in kilograms by his height in meters, at that point dividing the response by his height once more.
The aim of the calculation was to identify sex-and-age-related values for the percentage of body fat and compare that to the prevalence of underweight, overweight and obesity in the adult men and women.
Morbid Obesity also referred to as extreme obesity wherein the BMI range is 40 or above, and the health risk involved is extreme.
|Less than 19||Underweight|
|19 to 24.9||Normal|
|25 to 29.9||Overweight|
|30 to 39.9||Obese|
|40 and above||Morbid Obesity|
What are the causes of Obesity
The causes of obesity could be a combination of the following problems:-
- It could be hereditary and genetic.
- The metabolism rate of the body to turn energy from food.
- Exercising routine
- Eating Habits
- Psychological factors
What are the Complications of Obesity?
Obesity can cause major health risk as the complications of being obese results in the anticipation of a shorter life span. Obese or overweight people have an increased risk of dying prematurely with the rate going upwards from 50% to 100%
Obesity Medical risks
- Diabetes focusing on type 2.
- Joint Trouble( E.g. Arthritis)
- Blood Pressure
- Heart Defect
- Gallbladder trouble
- A possibility of causing certain cancers
- Digestive trouble
- Breathing difficulties
- Aliment with fertility and pregnancy.
There also risks caused by obesity which affects the psychological and social well-being of the patient, which include creating a situation of portraying negative self-image, self-isolation from various social functions and activities and discrimination of self.
Obesity can cause difficulties with day to day activities and task that may seem easy for a normal person. Normal seats like in cars or bus will be too small and difficult to sit. Moments of the body are slow and troublesome which results to work becoming harder. Feeling of shortness of breath is also another major factor. Even personal hygiene also becomes difficult to maintain.
Bariatric Surgery In India
Obesity in India is growing rapidly with about 30 million people are obese or on the verge of obesity. According to sources, this figure is said to double in the next five years.
In India, the prevalence of obesity is 12.6% in women and 9.3% in men. In other words, more than a 100 million individuals are obese in India.
We are truly in the midst of an obesity epidemic, which has serious health ramifications. Obesity is associated with a higher risk of mortality and morbidity
Surgery professionals say that people in India suffer from a double trouble with the rising of obesity and diabetes. India is one of the most diabetic countries in the world with close to 65 million patients, and adding to more worry 80 percent of these patients are a diabetic cause of obesity.
Bariatric surgery in India is considered the best destination for a weight loss program. These World class doctors specializing in stomach reduction surgery receive thousands of people from different parts of the world get treatment from top hospitals in India.
There are various reasons why individuals want to undertake weight reduction medical procedure in India. The most vital reason is that the best medical centers for weight reduction medical surgery in India are equipped with advance cutting-edge machinery used to lead to a wide range of surgeries for weight reduction.
Sleeve gastrectomy is the most common and preferred surgery in India, but gastric bypass has resulted in providing the best performance for controlling of long-standing diabetes.
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Bariatric Surgery – A Complete Guide
This surgery causes significant weight loss. Bariatric surgery is a procedure which incorporates bulk of the treatment for morbid obesity, which does not only include gastric bypasses but come under a bigger umbrella of surgeries.
Bariatricis considered the ‘gold standard’ of weight loss surgery.
The procedures in Bariatric surgery can be grouped into the below main categories:
The standard method for surgery is done through laparoscopic which are called minimally invasive surgery, instead of an open surgery.
A laparoscopic method is done by creating four to six keyhole incisions on to the abdomen area; the key element is that through this keyhole incisions a long fiber optic cable system is inserted which allows the viewing of the area which needs to be operated. This method is preferred and more common nowadays as pain is to a very small extent compared to open surgery and the recovery time is also far shorter.
Patients who are with a BMI <50 , the abdominal wall is thick, visceral and omental fat which layers the stomach will have increased the complexity of the laparoscopic procedure by limiting the access and the view to the passage. In this situation the doctor will opt for an open surgery.
An open surgery involves making a seven to 10inch incision on the stomach to open the abdomen, so as to perform the surgery in an open view of the surgical team.
This procedure restricts the intake of food and changes the size of your stomach. The result is to limit how much food you can eat and your body can absorb at one time. This leads to weight loss.
- Vertical Sleeve gastrectomy
This procedure controls the amount of food the stomach can hold. It’s a restrictive surgery.The left side of the stomach is removed leaving a smaller tube that is shaped like a banana. The left side of the stomach is removed and the right side is stapled decreasing the size of the stomach. This surgical procedure is performed laparoscopically. This procedure is irreversible.The stomach allows most food to be eaten while functioning normally, but food needs to be had in smaller amounts. There is a stimulating hormone in the stomach which produces hunger (Ghrelin) is removed.There is no intestinal bypass and associated risks. Safer first stage procedure than a bypass surgery and less operative time.
- Adjustable gastric band Or LAP-BAND
This surgery is advised to people with a Body Mass Index (BMI) of at least 40 or 35 with one or more severe comorbid conditions. It is minimally invasive, involves no incision or stapling of the stomach or small bowel, and is associated with a lower risk for malnutrition. The band stoma size is adjustable according to the patient’s needs, and the belt is more easily removed when the restoration of the normal gastric anatomy is desired. The procedure involves laparoscopic placement of the band around the proximal part of the stomach to create a small pouch. The Lap-Bandprocedure is reversible.
- Gastric Balloons
The Gastric Balloon is designed to provide short-term weight loss therapy. It works effectively for people who are very overweight. It is recommended for people who need to lose weight before having a weight loss operation, to reduce their surgical risk.The surgical balloon is placed in the stomach endoscopically, through swallowing from the mouth (oesophagus) under sedation, and liquid is filled so it partially fills the stomach and creates a sensation of fullness.This will help change your eating pattern, reduce the volume of food eaten and make you feel full quicker. The maximum time a balloon can be left in is 6 months, after which it must be removed.
- Vertical banded gastroplasty
In this surgery, a small stomach pouch is created with the uses of bands and staples. Bands and the staples are used to create a small stomach pouch. The upper stomach near the oesophagus is stapled in a vertical manner along the lesser curvature of the stomach. The oesophagus pipe is connected to the stomach where the rest of the stomach is restricted through a special band. The band slows the procedure of emptying the food from the stomach creating a sense of fullness.
These procedures have a mix of blocking the absorption of food and restrictive the food intake to make to make people feel fuller.
- Roux-en-Y Gastric Bypass or Gastric bypass surgery
GBP is the most common of the restrictive-malabsorptive procedures. A large portion of the stomach is closed off with staples. This leaves a small pouch to hold food. The smaller stomach helps restrict the amount of food you can eat at one time. Gastric bypass is a permanent procedureThe small intestine is cut below the duodenum. Part of it is reattached to the new stomach pouch, leaving a shortened path for food to travel through. Because part or most of the small intestine is bypassed, less food is absorbed.
- Sleeve gastrectomy with duodenal switch
The restrictive part of the surgery is done first by doing a vertical sleeve gastrectomy. This means that most of the stomach is removed. The stomach is cut creating a long pouch that connects the oesophagus to the small intestine. The pouch or ‘sleeve’ is stapled and the rest of the stomach is removed. Since the stomach is smaller, you feel full sooner.Biliopancreatic diversion with duodenal switch is a restrictive/malabsorptive surgical procedure. It is malabsorptive and effects how food and calories are absorbed into the bloodstreams, it is also restrictive in the sense how much food the stomach can hold.The success rate of the surgery for weight loss is comparatively high for this combination of the surgery. The lower part which is the two-thirds portion of the stomach is removed.The ilium, which is the distal part of the small intestine, is attached to the part of the stomach which is remaining.
By bypassing the initial two sections of the small digestive tract, the duodenum and jejunum, the small digestive system is abbreviated thusly supplement retention is fundamentally lessened prompting weight reduction.
5 parameter to be eligible for Bariatric Surgery
Below are a set of rules which will be cross checked by the health team before admitting the patient for the surgery
- Your nutrition and weight history
The health team will look and review your weight trends, eating routine, exercise regime and other factors.
- Your medical condition
The team will evaluate what medications you are prescribed and take, how much is the consumption of alcohol and your smoking habits.You will be assessed on your sleep routine and receive a comprehensive physical exam and laboratory tests. The aftereffects of these tests and exams will help decide the qualification for weight reduction medical procedure.
- Your psychological status
Some health conditions in regards with mental state may contribute towards obesity and would adversely affect you to maintain the health benefits of the surgery. Examples: Binge-eating disorder, substance abuse, anxiety disorders, major depression. In a situation that may ensure that any condition or significant sources of stress may result in complications, the doctors may want to postpone surgery.
- Your motivation
The health team will check your willingness and the capacity to follow through the instructions and recommendations made by doctors to carry out prescribed changes in your diet and exercise regimen.
- Your age
The procedure was considered too risky for teenagers and older adults, according to recent studies. In recent times, the surgery procedure is now considered a viable option for teenagers with BMI of 35 or more which can cause serious obesity-related health problems.
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