Definition and Facts for Bariatric Surgery

Definition and Facts for Bariatric Surgery: Obesity is defined as having a body mass index (BMI) of 30 or more. BMI is a measure of your weight in relation to your height. Class 1 obesity means a BMI of 30 to 35, Class 2 obesity is a BMI of 35 to 40, and Class 3 obesity is a BMI of 40 or more. Classes 2 and 3, also known as severe obesity, are often hard to treat with diet and exercise alone.

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What is Bariatric Surgery?

Bariatric surgery is an operation that helps you lose weight by making changes to your digestive system. Some types of bariatric surgeries make your stomach smaller, allowing you to eat and drink less at one time and making you feel full sooner. Other bariatric surgeries also change your small intestine the part of your body that absorbs calories and nutrients from foods and beverages.

Bariatric surgery may be an option if you have severe obesity and have not been able to lose weight or keep from gaining back any weight you lost using other methods such as lifestyle treatment or medications. Bariatric surgery also may be an option if you have serious health problems, such as type 2 diabetes or sleep apnea, related to obesity. Bariatric surgery can improve many of the medical conditions linked to obesity, especially type 2 diabetes.

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Does bariatric surgery always work?

Studies show that many people who have bariatric surgery lose about 15 to 30 percent of their starting weight on average, depending on the type of surgery they have. However, no method, including surgery, is sure to produce and maintain weight loss. Some people who have bariatric surgery may not lose as much as they hoped. Over time, some people regain a portion of the weight they lost. The amount of weight people regain may vary. Factors that affect weight regain may include a person’s level of obesity and the type of surgery he or she had.

Bariatric surgery does not replace healthy habits but may make it easier for you to consume fewer calories and be more physically active. Choosing healthy foods and beverages before and after the surgery may help you lose more weight and keep it off long-term. Regular physical activity after surgery also helps keep the weight off. To improve your health, you must commit to a lifetime of healthy lifestyle habits and follow the advice of your healthcare providers.

How much does bariatric surgery cost?

On average, bariatric surgery costs between 1.5 lac and 2.5 lac, depending on what type of surgery you have and whether you have surgery-related problems. Costs may be higher or lower based on where you live. Medical Insurance companies in India generally do not provide cover for Bariatric procedures till now.

Three common types of bariatric surgery are covered under CGHS—gastric bypass, gastric band, and gastric sleeve surgery—if you meet certain criteria and have a doctor’s recommendation.

Types of Bariatric Surgery

The type of surgery that may be best to help a person lose weight depends on a number of factors. You should discuss with your doctor what kind of surgery might be best for you or your teen.

What is the difference between open and laparoscopic surgery?

In open bariatric surgery, surgeons make a single, large cut in the abdomen. More often, surgeons now use laparoscopic surgery, in which they make several small cuts and insert thin surgical tools through the cuts. Surgeons also insert a small scope attached to a camera that projects images onto a video monitor. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring than open surgery. Laparoscopic surgery also may lead to a faster recovery.

Open surgery may be a better option for certain people. If you have a high level of obesity, have had stomach surgery before, or have other complex medical problems, you may need open surgery.

What are the surgical options?

In India, surgeons use three types of operations most often:

• Gastric sleeve surgery, also called sleeve gastrectomy roux en Y gastric bypass
• Mini gastric bypass
• Surgeons use a fourth operation, Lap adjusted Gastric band, less often.

Gastric Sleeve

In gastric sleeve surgery, also called vertical sleeve gastrectomy, a surgeon removes most of your stomach, leaving only a banana-shaped section that is closed with staples. Like gastric band surgery, this surgery reduces the amount of food that can fit in your stomach, making you feel full
sooner. Taking out part of your stomach may also affect gut hormones or other factors such as gut bacteria that may affect appetite and metabolism. This type of surgery cannot be reversed because some of the stomach is permanently removed.

Gastric Bypass

Gastric bypass surgery, also called Roux-en-Y gastric bypass, has two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so you eat less and feel full sooner.

Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the stomach and the upper part of your small intestine so your body absorbs fewer calories. The surgeon connects the bypassed section farther down to the lower part of the small intestine. This bypassed section is still attached to the main part of your stomach, so digestive juices can move from your stomach and the first part of your small intestine into the lower part of your small intestine. The bypass also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although a surgeon may do it if medically necessary.

Laparoscopic Adjustable Gastric Band

In this type of surgery, the surgeon places a ring with an inner inflatable band around the top of your stomach to create a small pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled with salt solution. The surgeon can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing the solution through a small device called a port placed under your skin. After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose enough weight, the surgeon may remove it.

Most Common Weight-loss Surgeries

• Gastric Band
• Gastric Sleeve
• Gastric Bypass

What It Is?

The surgeon places an inflatable band around the top part of the Surgeon and removes about 80 percent of the surgeon staples top part of the stomach, creating the stomach, creating a small pouch with an adjustable opening.

Pros

• Stomach, creating a long, banana-shaped pouch.
• Small pouch and attaching it to the middle part of the small intestine.
• Can be adjusted and reversed.
• Short hospital stay and low risk of surgery-related problems.
• No changes to intestines.
• The lowest chance of vitamin shortage.
• Greater weight loss than gastric band.
• No changes to intestines. No objects are placed in the body. Short hospital stay.
• Greater weight loss than gastric band. No objects are placed in the body.

Cons

• Less weight loss than other types of bariatric surgery.
• Frequent follow-up visits to adjust the band; some people may not adapt to the band.
• Possible future surgery to remove or replace a part or all of the band system.
• Cannot be reversed.
• Chance of vitamin shortage.
• Higher chance of surgery-related problems than gastric band.
• Chance of acid reflux.
• Difficult to reverse.
• Higher chance of vitamin shortage than with a gastric band or gastric sleeve.
• Higher chance of surgery-related problems than gastric band.
• May increase the risk of alcohol use disorder.

What should I expect before surgery?

Before surgery, you will meet with several health care providers, such as a dietitian, a psychiatrist or psychologist, an internist, and a bariatric surgeon.

• The doctor will ask about your medical history, do a thorough physical exam, and order blood tests. If you are a smoker, he or she will likely ask you to stop smoking at least 6 weeks before your surgery.
• The surgeon will tell you more about the surgery, including how to prepare for it and what type of follow-up you will need.
• The dietitian will explain what and how much you will be able to eat and drink after surgery and help you to prepare for how your life will change after surgery.
• The psychiatrist or psychologist may assess to see if bariatric surgery is an option for you.
• These healthcare providers will also advise you to become more active and adopt a healthy diet before and after surgery. In some cases, losing weight and bringing your blood sugar levels closer to normal before surgery may lower your chances of having surgery-related problems.
• Some bariatric surgery programs have groups you can attend before and after surgery that can help answer questions about the surgery and offer support.

What should I expect after surgery?

After surgery, you will need to rest and recover. Although the type of follow-up varies by type of surgery, you will need to take supplements that your doctor prescribes to make sure you are getting enough vitamins and minerals.

Walking and moving around the house may help you recover more quickly. Start slowly and follow your doctor’s advice about the type of physical activity you can do safely. As you feel more comfortable, add more physical activity. After surgery, most people move from a liquid diet to a soft diet such as cottage cheese, yogurt, or soup, and then to solid foods over several weeks. Your doctor, nurse, or dietitian will tell you which foods and beverages you may have and which ones you should avoid. You will need to eat small meals and chew your food well.

How much weight can I expect to lose?

The amount of weight people lose after bariatric surgery depends on the individual and the type of surgery he or she had. A study following people for 3 years after surgery found that those who had gastric band surgery lost an average of about 45 pounds. People who had gastric bypass lost an average of 90 pounds. 1 Most people regained some weight over time, but weight regain was usually small compared to their initial weight loss.

Researchers know less about the long-term results of gastric sleeve surgery, but the amount of weight loss seems to be similar to or slightly less than gastric bypass.

Your weight loss could be different. Remember, reaching your goal depends not just on the surgery but also on sticking with healthy lifestyle habits throughout your life.