In another article posted in this blog, I have explained in
detail about the circumstances leading to excess weight and the treatment
options and the mediations available for reducing excess weight. In
continuation of that, I am explaining some of the common surgical procedures practiced
by physicians to reduce obesity and related problems.
In surgeries intended
to reduce the obesity of a patient, an attempt is made to reduce the food eaten
by the patient or to reduce the absorption of nutrients from the food he eats.
Weight loss surgeries are commonly known as bariatric surgeries. Most surgeons
go for these surgeries as they have lesser chance of complications and have often achieved the desired results.
Why is it done?
These surgeries are done only if you have not reduced your
excess body weight after prolonged treatment and related activities. These surgeries
are done to save the patient from weight related problems like
·
Gastroesophageal
reflux disease
·
Stroke,
·
Severe
sleep apnea,
·
Type
2 daibetes
·
High
blood pressure
Who its for
This surgery is done only for patients
who have a BMI index of more than 40. It is also done for persons whose obesity
index lies between 30 and 35 and who suffer from weight related problems like sleep
apnea, high blood pressure etc. Some patient whose BMI index is between 30 and 34
and who undergo serious weight related problems are also some times found to be
the suitable candidates for this surgery.
This surgery is not meant for all
persons who have excessive body weight. Only
after a complete screening test the eligibility of a candidate for this surgery
can be decided.
Risks
Like any other surgery weight loss surgeries
also have some risk factors associated with it. Some of them are explained
below.
Infection
Excessive bleeding
Reactions to anesthesia
Breathing problems
Gastro intestinal system leakage
Other long term difficulties
following the surgery include gallstones, bowel obstruction, hernias, stomach
perforations, ulcers etc.
Preparing for the surgery
Your health care provider will give
you instructions regarding how to prepare for the surgery. Various lab test and
examinations will be suggested. You will be given instruction about what to eat
and what to drink. Which medicines you can continue and which has to be stopped
etc will be informed to you. You will
have to stop smoking and start some physical activity program. Bring a driver
for returning home after surgery and also arrange a helper in your house for
helping you in the recovery period.
These surgeries are done in hospital under
general anesthesia. Therefore you will be unconscious during the surgery.
Traditionally weight loss surgeries were done with large incisions. At present
most surgeries are done as laparoscopic surgeries.
Laparoscope is an instrument with a
camera on one end of a long tube. Through small incisions made in your body the
laparoscope is inserted and is slowly driven till it reaches the operation
site. Through the camera surgeon will be able to see the operating area and the
actions going on there in a monitor placed near him. Special tools for carrying
out the surgery are inserted through other small incisions. The surgeon controls the instruments remotely
seeing the process in his monitor. This type of surgeries has the benefits that
they are less pain full and recovery in this case is faster. The blood loss
during these surgeries is lesser.
There are different types of
bariatric surgeries in practice. Depending upon the merit of each case, the
surgeon will select the surgical procedure most suitable for the patient. Each
of the surgeries is explained in brief below.
Rousx-en-Y(roo-en-y)
This is the most common procedure used for gastric bypass. This surgery
has the disadvantage that, it is not reversible. The surgery helps in reducing
the food one can eat in one sitting and reducing the nutrients absorbed from
the food one eats. The surgeon cuts the patient’s
stomach and reduces its size so that it can contain only one ounce of food. Normal
stomach of person is capable of holding 3 pints of food. The surgeon also cuts
the small intestine and the cut portion is directly connected to the pouch
shaped new stomach. In doing so a good a good portion of the small intestine is
by passed. The reduced stomach helps the patient to eat only small amount of
food and feel full. Similarly the reduced length of small intestine helps less absorption
of nutrients from the food eaten by the patient. Thus food is bypassed from
most of your stomach as well as the first portion of your small intestine.
Billiopancreatic diversion
In this procedure 80 % of the stomach
is cut and removed. The pyloric valve
and duodenum the first portion of the small intestine remains there. Major
portion of the small intestine is bypassed in this case and it is connected to
the duodenum. This surgery helps to limit the food the patient eats and also
prevents all nutrients of the eaten food being absorbed. This surgery is
generally used on patients who has a BMI greater than 50.
Laparoscopic gastric banding
In this procedure the surgeon inserts an
inflammable band. This band is place around the upper portion of the stomach. A
channel is connected between this band and the middle portion of the small intestine
bypassing the duodenum of the small intestine. The inflammable band can be inflated
through a port placed in the inner side of the skin. When this band is inflated
the other portion of the stomach is isolated and the volume of the active portion
of the stomach is reduced considerably. The digestive part of the intestine
named duodenum is also not available after the surgery thereby reducing the
amount of nutrients intake. By adjusting the band, the volume of food can be
fixed at the most appropriate level. Because of its simple nature, the LAGB is
one of the common procedures in this arena.
But the weight loss the patient gains in this case has been found to
be lower compared to other surgical methods and the patient may need to
adjust the band periodically.
Sleeve gastrectomy
This procedure is sometimes called ad
vertical sleeve gastrectomy. This procedure can be considered as the first part
of the billiopnacreatic diversion. The only difference is that the second
portion of the surgery which is bypassing the initial portion of the small
intestine is not done in this case. This surgery changes the structure of the
stomach like a tube. This reduces the
amount of food the patient eats and the amount of nutrients absorbed by his
body.
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