Types of Bariatric Surgery

Bariatric Surgery is derived from the Greek words “weight” and “treatment”. Bariatric Surgeries are major gastrointestinal operations that seal off most of the stomach to reduce the amount of food one can eat and they rearrange the small intestine to reduce the calories the bodies can absorb. Weight loss operations fall into three categories. The first category is the Restrictive procedures make the stomach smaller to limit the amount of food intake. The second category is the Malabsorptive techniques reduce the amount of intestine that comes in contact with food so that the body absorbs fewer calories and the third category is a combination of the operations that employ both restriction and malabsorption.

There are several different types of Bariatric weight loss surgical procedures, but they are all collectively known as “bariatric surgery”. The surgical procedures fall into two categories which are Restrictive Operations and Gastric Bypass Operations. The two Restrictive Operations are known as Gastric Banding (Lap-Band) and Vertical Banded Gastroplasty. Gastric Bypass Operations include Roux-en-Y Gastric Bypass and DISTAL Gastric Bypass.

The Gastric Banding procedure performed by introducing a Gastric Band device through tiny incisions in the abdomen and it is then placed around the upper part of the stomach. The resulting pouch dramatically reduces the functional capacity of the stomach. The band has a balloon from inside that is adjustable and can reduce stoma size. This prolongs the periods of fullness. The operation is performed under general anesthesia and lasts between thirty minutes to one hour. The Gastric Banding procedure has many advantages including no cutting of the stomach, no stapling of the stomach, calibrated pouch and stoma size, it can be adjusted to patients needs after surgery with no operation to adjust stoma, laparoscopic removal is possible, it is fully reversible and there is a short hospital stay following the procedure that does not exceed 48 hours.

The Vertical Banded Gastroplasty (VBG) is done by making an incision in the upper abdomen that measures several inches. A circular window is made through the stomach a few inches below the esophagus. A surgical stapler is used to create a small vertical pouch by putting a row of staples from window toward the esophagus. The pouch is carefully measured at the time of the surgery and will hold about one tablespoon of solid food. The next step involves a polypropylene band being placed through the window around the outlet of the pouch and it is secured to itself with stitches. The band controls the size of the outlet and keeps it from stretching. VBG limits the amount of food a patient can eat at one time. It works solely by restricting the amount a patient can eat, unlike the Roux-en-Y Gastric Bypass. The procedure is performed under general anesthesia and requires four or five days in the hospital.

The Roux-en-Y Gastric Bypass is the most common Gastric Bypass Surgery. The stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle of the portion of small intestine, bypassing the rest of the stomach and upper portion of the small intestine. This procedure requires a four to six day stay in the hospital or two to three days for the laparoscopic procedure. It is possible to return to normal activity three to five weeks after the surgery.

The DISTAL Gastric Bypass is performed by removing a portion of the stomach. The remaining small pouch is directly connected to the last portion of the small intestine. There is a risk of nutritional deficiencies with this procedure. The procedure is intended for patients who are more than 200 pounds overweight. The operation adds malabsorption to restriction of intake. The stomach stapling component is the same as the standard procedure, the difference is the location of the distal connection of the intestine which is reconnected much closer to the colon.
Patients generally have more success with the Gastric Bypass Operations than the Restrictive procedures. The risks are similar for both the Gastric Bypass Operations and the Restrictive procedures, although the risk of nutritional deficiencies for iron, calcium and vitamin B-12 are higher in patients who undergo Gastric Bypass operations. There is also a risk of intestinal leaking. There is a possibility of the Gastric Bypass operations causing “dumping syndrome”. This is when food moves too fast through the small intestine. This causes nausea, weakness, sweating, faintness and sometimes diarrhea.

In 2003, 103,000 weight loss operations were performed. Every year that number increases. More and more people are using bariatric surgeries to deal with obesity. Although it seems like a fast way to lose weight the risks need to be carefully evaluated.

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