Weight loss surgery – options?

Weight loss surgery – what are your options?

Weight loss surgeries are increasingly being accepted as a treatment option for weight loss, diabetes, hypertension or high blood pressure, infertility, poly cystic ovarian disease (PCOD), sleeping problems like obstructive sleep apnoea, various types of hernias, skin diseases, varicose ulcers, varicose veins, joint replacement, organ replacement like liver transplant and many more diseases.

If you have been suggested weight loss surgery by your respective treating doctor, or if you are curious to know its various types and then you have hit the right page. Read on.

1.Gastric banding/ band operation/ adjustable gastric band operation.

A silicone band is placed on the stomach which physically restricts the food intake by not allowing the stomach to expand.

It is done via laparoscopy or key-hole incisions under general anesthesia and the procedure itself may last up to one hour. How ever, adding time for pre anesthesia preparation and post anesthesia recovery, the patient may be in the operating room for two to three hours.

Once the operation is done, the patient can be sent home after 24 hours of observation.

Coupled with diet modification and lifestyle changes, it can bring about moderate weight loss.

Pros :  Completely reversible.

No mal absortion or nutrition deficiency.

Band diameter can be adjusted from a port under the skin.

Cons : Weight loss less compared to other procedures.

Band related complications like erosion of stomach wall, band migration, twisting of stomach around the band etc may require re surgery for removing the band or solving complication.

2. Vertical Sleeve Gastrectomy / VSG/ Sleeve gastrectomy/ or simply “sleeve surgery”

In this operation the stomach is cut into two halves vertically, with almost 50 % of your stomach being removed and the remaining stomach looks like a tube or a sleeve, hence the name “sleeve operation.”

Mechanism of action: The fundus of the stomach is known to secrete a hormone called Ghrelin. This hormone is secreted when the stomach is empty and hence we get the urge to eat. The stomach is not the only source but one of the important sources of Grelin secretion. Hence removing that part causes less hunger.

Also, the stomach becomes physically smaller hence its capacity to store food also decreases. Therefore you eat less because you feel full faster.

This surgery is by far the most popular in India, considering various factors like cost, complications, side effects, patient compliance, patient education, etc.

If necessary lifestyle changes are adopted, one can spend a healthy life free of side effects and complications.

How is sleeve gastrectomy done? I hear you ask. So, most of the weight loss surgeries these days are done via laparoscopy or key hole surgery. Multiple (3 to 5 ) small punctures ( 0.5- 1 cm) are made over the abdomen and instruments are inserted – via them to perform the surgery.

The procedure generally lasts around one hour, but expect more time spent in pre operative preparation, anaesthesia induction and recovery.

As a rough estimate, you may see your patient 3-4 hours after he or she enters the operating room.

Pros :  Less nutrition deficiency.

Simpler procedure, more commonly performed.

Cons : Less weight loss compared to gastric bypass operation.

Weight regain or insufficient weight loss is more common.

 It is an irreversible procedure.

3. Vertical sleeve gastrectomy with a band/ Vertical band gastrectomy/ banded gastrectomy.

Sometimes, patients are found to regain their lost weight after a few years due to dilatation of their gastric sleeve.

The solution to that problem was to put a plastic band around the gastric sleeve to prevent it from expanding.

The plastic band prevents over eating by restricting food intake. It makes the person feel full faster by inducing discomfort if he eats more.

But adding a a foreign body into the human body comes with its share of troubles and complications.

The band may migrate from its initial position. It may erode the gastric wall. It may cause twisting of the stomach around the plastic band.

The benefits of taking the trouble of putting the band on top of a sleeve have been debatable till date.

Pros : Prevents gastric sleeve from expanding.

Cons : Adds more complications related to band which may require re surgery.

               It is an irreversible procedure.

4. Gastric bypass surgery/ Roux en Y gastric bypass/ Standard gastric bypass.

This surgery has held the gold standard status of bariatric surgery since a long time.

In this surgery, a small pouch of approx. 50 to 100 ml  is cut from the existing normal, bigger stomach. In addition, a significant portion of small intestine is bypassed starting from the duodenum.

The length of the bypassed intestine depends on various factors like eating habits, expected weight loss, other co morbidity, etc.

This surgery is successful because it gives consistent results as it works by two mechanisms. Firstly, the stomach pouch is small, hence the patient feels fuller fast and cannot consume large meals. Secondly, the bypassed intestine is not available to absorb food hence less calories are absorbed.

But, at the same time, this surgery is not advisable for everyone. A wise surgeon will take into account factors like compliance of the patient to future diet changes, understanding and acceptability of complications and side effects like diarrhea, nutritional deficiency, hypoglycemia etc. before advising this procedure.

As with other bariatric procedures, this one is also performed via key-hole or laparoscopic surgery technique. The total operating time is around 3 hrs, if you add anesthesia and preparation time, then it may take up to 6 hrs for the patient to return back from the operating room.

to sum it up,

Pros : Better weightloss than previous operations.

              It is a reversible procedure.

Cons : More side effects like diarrhea, nutritional deficiency, bowel herniation etc.

5. Duodenal Switch/ Bilio-Pancreatic Bi partition surgery.

It is a more complex but equally more promising surgery by far. In this operation, the stomach is cut vertically as in sleeve gastrectomy. Then, the duodenum, or the first part of the intestine is directly joined close to the end of the small intestine, hence bypassing a significant portion of intestine.

Along with more drastic procedure comes more complications and side effects. Compliance and understanding on the patient and his relative’s part can make this surgery worth the effort.

It works by two mechanisms. One, just like sleeve gastrectomy, it makes the stomach smaller, casing mechanical restriction to food intake. It also takes the Ghrelin secreting fundus part of the stomach out of the body, hence decreasing hunger. Two, bypassing the intestine causes mal absorption. Also, the way in which intestine is bypassed in this operation is different from standard gastric bypass, making it a more effective surgery.

As with previous operations, it is also performed via laparoscopy technique and takes approx 6 hrs of operation theatre time from start to finish of the procedure.

Pros : Better weight loss than previous operations.

Cons : More side effects like diarrhoea, nutritional deficiency, bowel herniation etc.

                It is an irreversible procedure.

Very important : What is effective weight loss?

Approx. 60-80 percent of excess weight loss over two year period of time is a good, realistic weight loss expectation.

Have more questions ? find me here and here.

Have a great day..!

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