Table of Contents
- 1 An overview of bariatric surgery
- 2 The types and procedures of bariatric surgery
- 2.1 Malabsorptive procedures
- 2.2 Restrictive procedures
- 2.3 Mixed procedures
- 3 The Aftermath
- 4 Determining if you need bariatric surgery
- 5 In conclusion
- 6 References:
An overview of bariatric surgery
The science of medicine has tremendously progressed in the last few decades, going from methods which are qualified today as being primitive all the way to complex, live-saving operations humans couldn’t even dream of performing earlier.
With obesity being an increasingly-large epidemic around the world, and especially in first-world countries, it should not come as a surprise that a number of different procedures were devised to help those with weight problems, and they are all generally referred to as bariatric surgery.
What is bariatric surgery?
To explain things in greater detail, bariatric surgery refers to a certain number of different procedures, all of which are focused on helping obese people lose weight, particularly in the stomach and abdomen areas. The way in which it is done depends on the actual method used, but more on that later.
The U.S. National Institutes of Health have set in place official recommendations for when people ought to consider undergoing such a procedure, and according to their guidelines, all obese people with a BMI (Body Mass Index) over 40 should think about it, and that goes double for anyone with pre-existing medical conditions.
It must be noted that recent forays into bariatric surgery have produced results which indicate that some of the procedures may be suitable for people with a BMI between 30 and 40. Of course, as was already mentioned before, whether or not bariatric surgery is worth undergoing for a patient is largely based on the specific procedure he or she is aiming for, and so here is an overview of what each one of them entails.
The types and procedures of bariatric surgery
The malabsorptive procedures purpose to reduce stomach size and capacity, these procedures are effective basically from creating a physiological condition of malabsorption.
A very complex operation (the original version of which is no longer performed due to various complications), the biliopancreatic diversion consists of restricting a certain part of the stomach and lowering its total size.
After that, the distal part of the small intestine is taken and fused together with the stomach pouch, allowing it to bypass the jejunum and duodenum, two other sections of the intestine.
Because of the tremendously-powerful effects of the surgery, those who undergo it are often forced to take various nutrients in the form of supplements just for maintenance purposes.
Without them, the patients run a tremendous risk of suffering from malnutrition-related illnesses, such as osteoporosis and anemia. Also, the patient may be required to take medication in order to reduce the likeliness of any gallstones developing. 
A procedure for those who don’t really want to go under the knife, the endoluminal sleeve is inserted through the mouth and installed right in the upper part of the small intestine, alongside the jejunum and duodenum.
In other words, this is going to create a bypass without any kind of surgery, preventing you from over-eating. During the first week or two the patient is very likely to feel some type of discomfort and may vomit if too much food is ingested. 
This procedure is no longer performed. However, it’s an old surgical weight loss procedure that was performed in the 50′s to the 70′s of the 20th century. 
The restrictive procedures purpose to limit food intake by reducing stomach size, and leaving the alimentary canal in continuity to minimize the metabolic risks and complications, it also produces fast satiation, lap band is one of the known procedures.
Also referred to as a gastric sleeve, this is a weight loss surgery which once again focuses on the stomach more than anything else.
More precisely, it removes a large portion of it and causes it to shrink to around 15% to 25% of it’s original size. The openings are naturally re-attached together, leaving the stomach in the shape of a banana.
Though the process is permanent and cannot be undone in any way, many patients have been observed to lose up to 50% of their excess body weight over a period of six months to a year, perhaps making it worthwhile.
Though the procedure does not prevent the stomach from functioning as it usually does, it tremendously limits the amount food you can ingest. 
There are two main banded gastroplasty procedures for you to consider, with the first one being the vertical variant.
Basically, it consists of stapling together parts of your stomach, effectively lessening the total size being used for the digestion of food.
The other variant is the adjustable gastric band also referred as lap band, and as its name indicates, this little silicone band can be adjusted or removed with the use of saline through a special port located right under the patient’s skin. 
In many cases patients choose to have this procedure done laparoscopically (meaning only small incisions are inflicted) for it is quite safe and simple, with a mortality rate of 0.05%.
This procedure prevents your body from absorbing a size-able portion of the food you eat because of the much smaller gastric pouch.
Before talking about the procedure itself, it should be noted that it hasn’t yet been approved by the FDA, but it is commonly performed in various countries around the world, including Australia, Canada, Mexico and India. 
It is a simple procedure that consists of inserting a deflated balloon into the patient’s stomach and then pumping it up until the desired amount of gastric space remains. It estimated that those who have undergone the procedure have seen their BMI drop from 5 to 10 points over a period of six months. 
Basically speaking, this is a different version of the sleeve gastrectomy bariatric surgery, with the only difference being that this one has much more impactful results, in the sense that the size of the stomach is very significantly reduced.
A study was actually conducted over a period of three years, following sixty-six patients (forty-four of which were women) as they lived normally after undergoing gastric plication. None of them developed complications and the results were very similar to those provided by a gastric bypass. 
Here it is, the one most common weight loss procedure performed in the United States of America, being done, on average, more than 140,000 times per year.
The most common type of gastric bypass for which patients go for is called Roux-en-Y, and it consists of creating a smaller stomach pouch with the use of stapler device and connecting it to the small intestine, the upper part of which is then re-attached to form the shape of the letter “Y”.
Though the procedure was believed to be irreversible, there are some instances where gastric bypasses were at least partially reversed.
Implantable Gastric Simulation
A procedure which was developed only recently, it entails the implantation of a device that regularly stimulates the stomach by sending out electrical discharges to it, not unlike a pacemaker used to make hearts beat.
At the moment, the method is still under examination, but it is believed that the electrical stimulation is capable of changing the way in which the nervous system of the stomach acts, effectively tricking the brain into thinking the body is full and satiated, helping to deal with hunger cravings. 
Sleeve Gastrectomy with a Duodenal Switch
Finally, there is this variation of the biliopancreatic diversion, and it involves restricting a part of the stomach and turning it into a tube with a total volume of around 150-200ml, preventing too much food or drink from being ingested.
After that, the stomach is completely sectioned from the duodenum and reattached to the distal part of the small intestine.
Finally, the duodenum and the upper small intestine are re-connected around 75cm to 1m away from the colon. 
The Post-Surgery Effect
As you can tell, most of the procedures described above require the patient to undergo some type of surgery, and for the most part, the consequences are the same. For starters, you will have to contend with all the general symptoms which come from using an anesthetic, but that really isn’t anything new.
If you have endured the type of procedure which requires your stomach to be sectioned somewhere, then you should prepare to deal with regular pains as the wounds heal up in your digestive tract. In addition, the amount of food and types of it you can eat will be severely restricted, and it will be of utmost importance to adhere to your nutrition plan without deviations for you could end up damaging some of your organs.
One of the main gripes people have with bariatric surgery is the fact that once all is said and done, you are still used to living your old lifestyle, the one that got you into the operating room in the first place. Once you get out of the hospital, it is highly-recommended that you progressively increase your level of activity every day, without, of course, bringing any kind of harm to your body.
By the end of the first month, you ought to be able to walk distances of up to two miles per day. You could always enroll in physical therapy or rehabilitation classes should you wish to, but maintaining an active lifestyle will become very important for the upkeep of your system.
Because bariatric surgery entails a sudden and drastic loss of weight, many patients experience problems with their skin and hair after the effects of the procedures have kicked in. Certain patients end up having:
- Flabby skin on their face, neck, arms, legs, chest and ankles.
- Minor hair loss.
As a matter of fact, a study was performed by Dr. Saleh M. Aldaqal  on the cosmetic effects after bariatric surgery, and it was determined that 70.58% of women and 46.15% of men (those who participated in the study) expected a better cosmetic appearance after the surgery, citing sagging skin as being the main problem (p.305). Though it can be repaired, don’t expect it to be a pleasing sight.
Gallstones development is expected when the weight drop rapidly after bariatric surgery, almost 50% of people who had gastric bypass surgery will develop gallstones and it’s not harmless. Thus, it can cause vomiting, nausea and abdominal pain which leads to surgery, a small percentage of people who had gastric bypass have to remove the gallbladder.
How will you benefit from bariatric surgery?
First off, to get the obvious out of the way, you are going to:
- Lose plenty of weight in a short amount of time,
- Drastically reduce your chances of developing an array of different conditions, most of them related to your heart and circulation system.
- Become healthier in general and live longer.
Apart from that though, there are many who firmly believe that bariatric surgeries can actually be used to fight against diabetes. As was discussed in a news article by Isabel Teotonio , “Studies show that bariatric surgery is even more effective than diabetes medications and lifestyle changes at reducing and reversing type 2 diabetes”.
Within days of having had surgery, even before pounds are shed, there’s a dramatic improvement in glucose levels.” (P.1). In other words, this surgery can tremendously benefit people with diabetes as it was shown to be more effective, at least in certain cases, than diabetes-specific medication. However, more research will be required before conclusive results are in.
Determining if you need bariatric surgery
Who needs and qualifies for bariatric surgery?
Even though there are hundreds of thousands of people who would like to and really should focus on losing some weight, relatively few actually qualify for such drastic procedures. Only people with a weight problem that poses a threat to their lives are considered to be viable candidates for it. In other words, people who are overweight by a hundred pounds or more (in relation to their ideal body weight) are considered for a surgery, and in practically every case they have a BMI of over 35.
As if that wasn’t enough, insurance companies also require you to display proof that you have already tried to lose weight through a clinically-supervised program, although many doctors believe this part to be useless and borderline senseless. 
To explain it in other words, if you are in danger of dying due to your weight (meaning you are severely obese) and have either tried other methods or are running out of time to do so, then bariatric surgery is an option you definitely ought to examine. However, if you are simply looking for an easy to drop the pounds without having to exercise, it is highly recommended you give traditional methods a shot first before plunging yourself under the knife.
Should you try it?
Finally, the time has come to decide whether or not you should actually go for this type of surgery. As was discussed above, bariatric surgery procedures were created for those who have no other options and are at risk of developing serious health problems because of their weight.
As such, you must first determine by how much you are overweight, which shouldn’t be too hard with the help of a scale and a measuring tape (that’s all you need to determine your BMI). If you want an expert opinion though you can always visit a physician for an official diagnosis.
If you are severely overweight, then try to go for traditional weight loss methods first, such as eating less calories and exercising regularly. If you won’t notice any improvements after diligently following a reliable weight loss program, then perhaps the time has come to consider undergoing an operation.
It is estimated that on average, the procedure can cost anywhere from $10,000 to $40,000, so you need to be ready physically, mentally, emotionally and financially for such a drastic change to your life.
- ↑ Wikipedia. (2013) Biliopancreatic diversion.
- ↑ Gersin, K. Endoluminal Liner: Surgery-Free Weight Loss with Surgical Results?. Consumer Guide to Bariatric Surgery.
- ↑ Wikipedia, Jejunoileal bypass.
- ↑ Wikipedia, Sleeve gastrectomy.
- ↑ Surgical Procedures & Innovations: Gastric Bandings Columbia University, Center for Metabolic and Weight Loss Surgery; New York, NY: 2007.
- ↑ Rosenthal, Elisabeth (January 3, 2006). “Europeans Find Extra Options for Staying Slim”. The New York Times.
- ↑ Mathus-Vliegen EM (2008). “Intragastric balloon treatment for obesity: what does it really offer?”. Dig Dis 26 (1): 40–4. doi:10.1159/000109385. PMID 18600014.
- ↑ http://en.wikipedia.org/wiki/Bariatric_surgery#Gastric_Plication.
- ↑ Pardo JV, Sheikh SA, Kuskowski MA, et al. (November 2007). “Weight loss during chronic, cervical vagus nerve stimulation in depressed patients with obesity: an observation”. Int J Obes (Lond) 31 (11): 1756–9. doi:10.1038/sj.ijo.0803666. PMC 2365729. PMID 17563762.
- ↑ http://en.wikipedia.org/wiki/Bariatric_surgery#Sleeve_gastrectomy_with_duodenal_switch
- ↑ Aldaqal, S. M., Makhdoum, A. M., Turki, A. M., Awan, B. A., Samargandi, O. A., Jamjom, H. (2013). Post-Bariatric Surgery Satisfcation and Body-Countouring Consideration after Massive Weight Loss. North American Journal of Medicine Sciences, 5, 4, 301-305.
- ↑ Teotonio, I. (2013). Scientists Unraveling Mystery of how bariatric surgery helps reverse Type 2 diabetes. The Star.
- ↑ DukeMedicine. (2010). Weight Loss or Bariatric Surgery: What you Need to Know. US News Health.