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| Gastric Sleeve: |
| It is a procedure which is restrictive, where the stomach is converted into a long sleeve. The stomach is then stapled along its length and converted to a reduced volume of about 100-150 ml. It is simple and is associated with a low morbidity and rapid recovery. It is performed as a staged procedure in patients with BMI >60 Kg/m2 or as a primary procedure in patients with a low BMI. |
| Gastric Bypass: |
| It is a procedure, which is both restrictive and malabsorptive. In this procedure, stapling creates a small stomach pouch (15-20 ml), this forms the restrictive element. The outlet from this newly formed pouch empties directly into the lower portion of the small intestine, thus bypassing a certain length of the intestine. This forms the malabsorptive element, as no absorption occurs in the segment of the intestine bypassed. This surgery is more effective in inducing weight loss. It has other major advantages like significant improvements and even cure of diseases like diabetes mellitus, hypertension and metabolic syndrome. |
| Gastric Banding: |
| It is a procedure which is done by placing a band in the upper part of the stomach, dividing it into two sections. There is a small opening between the sections, allowing the food to pass through. The section above the band acts like the stomach that fills with food quickly. As this section of the stomach is filled and stretches, signals are sent to the satiety centre of the brain causing you to feel satisfied for several hours. This surgery does not restrict the quality of food intake and high calorie liquid intake can hinder weight loss. |
| Biliopancreatic Diversion (Not included in vegetarian Asian population): |
The procedure is complicated and includes a 200-500cc gastric pouch, an ileal alimentary limb of 200 cm and a common channel of about 50cm. The rest of the small bowel is included in the biliopancreatic limb. It forms an extreme in the spectrum of bariatric surgical procedures inducing weight loss at the cost of severe malabsorption. The procedure creates a need for lifelong supervised physician care due to its attendant morbidities. The post cibal syndrome, which occurs due to the extreme shortened gut, induces the patient to eat a healthy diet i.e. high protein, low carbohydrates. The original procedure recommended elimination of the gastric pylorus with rapid gastric emptying to facilitate weight loss. However recent advances of a sleeve gastrectomy with pylorus preservation (BPD-DS) has shown equally good results with a decrease in the incidence of marginal ulcers and dumping syndrome
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All these surgeries are being performed by key-hole (laparoscopy) with its advantages like early recovery, less hospitalization, minimal blood loss, minimal wound complications and better cosmesis.
What needs to be understood beyond doubt is that bariatric surgery is not a cosmetic surgery. This surgery is aimed only to treat the comorbidities consequential to obesity thus increasing the longevity and quality of life in morbidly obese patients.
Bariatric surgery in the young is performed with the aim to increase longevity and quality of life whereas in the elderly it is primarily for improving quality of life. |
| Bariatric surgery cures Type II Diabetes & Metabolic Syndrome |
The prevalence of obesity is increasing in epidemic proportions worldwide, and subsequently raises the risk for both type 2 diabetes and heart disease.
Obesity is a recognized cause of insulin resistance (IR) that leads to impaired glucose tolerance. Incidence of T2DM is increasing in Asia. India by 2025 is predicted to become the global capital for Diabetes. This can be related to the growing affluence & rising incidence of overweight & obesity. The multiple diseases or co morbidities associated with central obesity are termed the "Metabolic Syndrome," Despite aggressive management; current therapies fail to achieve satisfactory control in majority of patients.
It has been seen that operations for morbid obesity not only induce significant weight loss but also have a significant impact on the course of the Metabolic Syndrome (MS) and Type II Diabetes. Resolution of all parameters of the metabolic syndrome occurs dramatically in operated patients. Resolution of diabetes occurs in > 90% patients following a gastric bypass surgery even before significant weight loss occurs. The procedure therefore appears to work beyond anti-obesity having a key metabolic impact towards improvement of obesity related co-morbidities. |
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