Bariatric Surgery: Types, Risk, Recovery and Success Rate

Excessive weight gain and being overweight or morbidly obese is a sort of an epidemic that is prevalent not only in India but on a global scale as well.

It is now an established fact that the higher the body mass index (BMI), the greater is the risk for comorbid conditions like hypertension, sleep apnea, diabetes, high cholesterol, and coronary artery disease along with various others. When insanely obese individuals hold one or more of the above-mentioned conditions their risk of morbidity increases, and quality of life is severely affected.

Bariatric Surgery refers to weight-loss surgery to treat obese people. Check out below its types, risks, recovery and success rates.

 

Types of Bariatric Surgery

 

  • Roux-en-Y Gastric Bypass:- It uses parallel rows of titanium staples to surgically divide your stomach into 2 sections. The smaller upper segment connected to your oesophagus keeps receiving food, while the lower segment no more comes in contact with food. A section of your small intestine is disconnected, letting the surgeon re-channel food directly from the small stomach pouch into the remaining intestine to allow digestion. It’s mostly done laparoscopically. It’s a non-reversible procedure which results in the most rapid weight loss.
  • Sleeve Gastrectomy:- Here, your stomach is stapled and divided vertically to be restricted. The section of it which gets food is shaped like a ‘sleeve’ (hence the name) or a very slim banana. The nerves running to your stomach and the valve connecting your stomach with your small intestine remain intact. This retains the functions of your stomach while drastically shrinking its volume. Your small intestine also stays intact. This technique is sometimes employed as the first of two procedures for the most critical patients. A second procedure (check Duodenal Switch below) may be performed after several months of notable weight loss. 
  • Biliopancreatic Diversion with Duodenal Switch:- Its first stage involves Sleeve Gastrectomy (as discussed above). During stage 2 (typically after 12-18 months of stage 1), the Biliopancreatic Diversion with Duodenal Switch is performed. Here, the remaining portion of your stomach is connected to the lower part of your small intestine. This helps in significant malabsorption of nutrients and calories. It’s a high-risk surgery which may pose long-term health problems as your body now has a harder time absorbing food. If you undergo this surgery, you’ve to take vitamin and mineral supplements for your remaining life, which becomes quite expensive.
  • Laparoscopic Adjustable Gastric Banding:- Here, a silicon elastic ring is placed laparoscopically (with small cuts) around the upper part of your stomach. The ring is then injected and inflated with saline. A tube connects the ring to a port placed beneath your abdomen. The doctor injects or withdraws saline to give it the ideal tightness around the opening from your upper stomach to your lower stomach. Tightening the band reduces hunger, allowing you to eat less yet feel full. The frequency of adjustments reduces after the first year. It’s a reversible procedure (if you need weight-regain). An appropriate candidate for this procedure is typically active with a lower BMI (Body Mass Index) under 40. It’s the least invasive and hence the safest procedure.

    Risks

Short-term risks related to the surgical procedure are:

  • Excessive bleeding
  • Adverse reactions to anaesthesia
  • Infection
  • Blood clots
  • Leaks in the gastrointestinal system
  • Breathing or lung problems
  • Death (rarely)

Long-term risks vary according to the type of surgery and include:

  • Bowel hindrance

Vomiting

  • Hernias
  • Gallstones
  • Dumping syndrome, causing nausea and diarrhoea
  • Hypoglycemia (low blood sugar)
  • Stomach perforation
  • Malnutrition
  • Ulcers
  • Death (rarely)

Recovery

  • After Roux-en-Y Gastric Bypass:- Mostly performed laparoscopically, it’s followed by 3 days of typical hospital stay and 2-4 weeks of restricted activity.
  • After Sleeve Gastrectomy:- It’s followed by a typical hospital stay of 2-3 days. You recover after 2-3 weeks.
  • After Biliopancreatic Diversion with Duodenal Switch:- A typical hospital stay of 3 days follows. The recovery period is at least 2 weeks.
  • After Laparoscopic Adjustable Gastric Banding:- A hospital stay of 2-3 days follows. You can resume non-strenuous work in 1 week and regular activities in 6 weeks after surgery.

Success Rates

Weight-loss is arbitrarily defined as ‘successful’ if it’s equal to or more than 50% of your excess body weight.

  • A clinical study revealed that after surgery, most patients drop weight rapidly and persistently until 18-24 months.  They may lose 30-50% of their excess weight within the first 6 months and 77% of excess weight in the first 12 months following their surgery.
  • Another study found that patients keep up a 50-60% loss of excess weight until 10-14 years after their surgery. Patients having lower primary BMI lose more excess weight, coming closer to their IBW (Ideal Body Weight).
  • 50% of patients may regain little weight (5% approx.) in 2 or more years after bariatric surgery.