Metabolic & Bariatric Surgery

Introduction

Bariatric surgery (or gastric bypass) is a surgery performed to manage obesity and related conditions. The procedure is recommended for morbidly obese people when diet and exercise don’t help them, and their excess weight causes significant health problems like diabetes, high blood pressure, etc. With advancements in modern medicine, metabolic and bariatric surgeries are carried out through small incisions using minimally invasive surgical techniques (laparoscopic and robotic surgery). The procedure is safe, less painful, lasts for a few hours, and is associated with fewer complications, leading to shorter hospital stays.

Types of Bariatric or Metabolic Surgeries

Bariatric surgery is performed under general anesthesia. There are four types of bariatric surgery. The choice of the type of bariatric surgery adopted for an individual depends on factors including individual health conditions, body mass index, eating habits, previous surgeries, a person’s preference, and the risks involved with each procedure. 

• Gastric Bypass (Roux-en-Y): It involves cutting the top of the stomach and sealing it off from the rest of the stomach, forming a small pouch. The surgeon then cuts the top of the small intestine and stitches it into the pouch. This reduces the food intake and restricts the absorption of fat and calories as very little food enters the small pouch of the stomach and the small intestine.
• Sleeve Gastrectomy: This procedure isolates the stomach from the surrounding organs, removes almost 80% of the stomach that produces the hunger hormone, and reduces its size. The stomach holds less food and liquid, reducing the appetite and maintaining a healthy body weight.
• Biliopancreatic Diversion With Duodenal Switch (BPD/DS): This surgical procedure consists of two steps. The first step comprises a sleeve gastrectomy. The next step involves sealing the small intestine’s middle section and attaching remaining parts together. The closed-off middle section is then connected to the end of the intestine. It helps reduce appetite and absorption of nutrients. 
• Single-Anastomosis Duodenal-Ileal Bypass With Sleeve Gastrectomy (SADI-S): Similar to BPD/DS, the SADI-S procedure also has two steps, with the first step being a sleeve gastrectomy. In the second step, a portion of the small intestine is closed just below the stomach and connected to the lower small intestine. The bypass routes food through only about 10 feet of the small intestine instead of the usual 25, reducing the time and area of fat and calorie absorption but allowing more absorption of nutrients as compared to BPD/DS.

How to Prepare for Surgery?

Before the surgery, the team of healthcare providers ensures that the person is mentally and physically ready for the procedure and counsels them about the complications involved. The person is required to go through screening tests to confirm if surgery is a safe option for them. A pre-bariatric diet is also recommended to reduce the fat in the abdomen, along with total restriction on tobacco and alcohol.

Benefits of Bariatric Surgery

• Significant Weight Loss: Bariatric surgeries facilitate long-term weight loss. Although different procedures have different outcomes, the majority of people lose 50% and maintain it. The results are measured after a period of 18 to 24 months. People who opt for bariatric or metabolic surgery lose much more weight than people who choose medical therapy for their weight loss.
• Decreased Hunger Hormones With Enhanced Metabolism: The surgery reprograms the body’s metabolic system to prevent weight regain.
• Improved Health Conditions: The procedure improves or resolves health problems like heart disease, high blood pressure, high cholesterol, sleep apnea, type-2 diabetes, nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), gastroesophageal reflux disease (GERD), joint pain, and skin conditions such as psoriasis.
• Better Quality of Life: Laparoscopic surgery increases a person’s ability to carry out daily activities, improving their level of independence and overall quality of life. Additionally, the surgery can increase their life span as the surgery decreases the risk of death by over 40%.

Risks of Bariatric Surgery

It is crucial to consider the risks and possible side effects of a bariatric surgery.

Surgical complications include:

• Bleeding
• Infection
• Anesthesia side-effects
• Breathing problems
• Blood clots
• Hernias
• Bowel obstruction
• Gastrointestinal leaks

The procedure can lead to some digestive complications, such as: 

• Dumping Syndrome: The stomach can dump food too fast into the small intestine, causing symptoms such as nausea, diarrhea, abdominal cramps, and hypoglycemia. 
• Malabsorption and Malnutrition: Deliberate malabsorption can cause runny stools and nutritional deficiencies.
• Bile Reflux: The backlash of bile into the stomach erodes the stomach lining and causes gastritis and stomach ulcers.
• Gallstones: Rapid weight loss leads to excessive cholesterol build-up in the gall bladder and can form cholesterol gallstones. 

After-Surgery Care

Eating is restricted for two days after the surgery to allow the digestive system to heal. Within the next few months, the diet gradually progresses from liquid and soft food to regular food. The quantity of the food and liquids is also limited. Regular follow-ups are required with bloodwork and other tests. The healthcare team needs to monitor weight loss and investigate if weight loss is not happening or if there is weight gain.

How Long Does it Take to Recover From Bariatric Surgery?

People are required to spend around 2–3 days in the hospital for recovery. Post-discharge, they may need to rest for a few weeks at home before returning to the normal routine. It is important to avoid strenuous physical activities for around six weeks.

Fortis is a premier center for bariatric surgery with a state-of-the-art infrastructure, including the most experienced and skilled surgeons, dietitians, counselors, nurses, and caregivers in the region to provide comprehensive care for healthy, long-term weight loss.