Obesity has become one of the most common medical conditions affecting about 1.9 billion people worldwide. Such a wide prevalence has given a rise to severe and complicated cases of obesity which cannot be treated by medications and lifestyle adjustments only. Obesity is believed to cause multiple long-term complications and reduce life expectancy. Statistics have shown that obesity is the 2nd most preventable cause of death after smoking. Therefore surgeons have innovated surgical procedures to overcome the high mortality rate of obesity.
Overview
Bariatric surgeries or weight-loss surgeries refer to surgeries that are usually performed for patients with moderate to severe obesity. Bariatric surgeries developed gradually in the 19th century as the first operation was performed in the early 50th by Dr. A.J. Kremen in which he bypassed the jejunum and the ileum to reduce the intestinal capacity of food absorption. It is estimated that there are more than 500 thousand bariatric surgeries are done annually worldwide. The united states only contribute to approximately 228 thousand surgeries a year.
Who is eligible to have bariatric surgery?
Bariatric surgeries are the treatment of choice for people with a body mass index (BMI) of 40 kg/m2 or greater. They may be indicated for people with a BMI between 35 and 40 kg/m2 and serious medical comorbidities such as diabetes mellitus and cardiovascular diseases that may exacerbate due to obesity. Physicians usually follow a step-wise approach in dealing with an overweight patient. However, failed attempts at non-surgical weight reduction often necessitate surgical interference. Incompliant overweight patients who cannot follow a dietary plan nor have an unhealthy lifestyle may be elected to have bariatric surgery.
Although obesity itself is an indication for bariatric surgery physicians may recommend having surgery to treat other systemic diseases. Overweight patients with chronic diseases as hypertension, diabetes mellitus, and osteoarthritis get much improved after reducing their weight by following a weight-loss regimen, exercising, or even by a Bariatric surgery. Hypertension for instance is found to get significantly improved after weight reduction. Obesity-related mortality is dramatically diminished after gastric sleeve operation.
Are bariatric surgeries worth it?
Bariatric surgeries have a high success rate. It is believed that patients that undergo bariatric operation lose up to 50 % of their weight within 6 months afterward. 80% of patients who had bariatric surgery stated that they reached their desired weight. Results of weight loss surgeries are significantly noticeable considering that the more obese the patients are, the more beneficial bariatric surgeries are.
Bariatric surgeries are also capable of the prevention of multiple long-term complications and improvement of the quality of life.
Types of bariatric surgeries
Bariatric surgeries are tailored for each patient according to his medical condition. Bariatric procedures have three main types – we will discuss them individually- from which surgeons choose the most suitable for each patient, and they include:
1. Adjustable gastric banding (LAGB)
gastric banding involves placing a band which is an inflatable silicone device on the upper half of the stomach to adjust its size as desired. Gastric banding is also called lap-band surgery and it’s been approved by the FDA (Food and drug administration) since 2001. Gastric banding is believed to be the simplest and the safest weight loss operation as it is less invasive than other types of bariatric surgery.
FDA has established guidelines for gastric banding and it includes obese patients with BMI (body mass index) 35 or more. Obese people with BMI 30 to 35 are eligible to have a lap-band operation if they failed to reduce their weight by following a healthy diet, avoiding a sedentary lifestyle, and other conservative treatments. Patients with obesity-related comorbidities are also elected to have a lap-band surgery to avoid further complications.
Gastric banding helps in reducing patients’ consumption by constricting their stomach size. Lap-band has a reasonably high success rate as surgeons expect patients to lose up to 50% of their weight after two years of the surgery. Surgeons often reassure patients before the surgery by clarifying the neglectable risks of lap-band as the Failure and the mortality rates of it aren’t common and barely noticeable. Patients who underwent lap-band rarely complain of long-term complications. However, 26% of patients may find mild unexpected results right after the surgery.
It is important to know what to expect from a lap band surgery as it has many advantages over other types of bariatric surgeries. Operation time is the shortest as it ranges from 1 to 2 hours and patients stay in the hospital for only 1 to 2 days afterward. Patients usually could get back to practice their daily activities after two weeks of the surgery.
Gastric banding isn’t permanent and could be easily adjusted or removed in a simple procedure that takes a few minutes. Lap band is less invasive than other procedures as the surgery doesn’t include cutting or transecting a part of the stomach or the intestine. Abdominal skin scarring after lab-band surgery is not large as the operation requires making 3 to 5 incisions each is about 1 inch. Surgeons often use a laparoscope to visualize the viscera better with minimal incisions.
Gastric banding is cheap relative to other bariatric surgeries as it cost about 9000 to 30,000 dollars. The price range of the lab-band system varies according to where you are going to have it and whether your health insurance will cover part of its costs or not. In the United States for instance most insurance companies cover lab-band surgeries.
Patients should consider the cons as well as pros of lap band surgery. Tolerability and probability to regain weight is the most common disadvantage that some patients may experience. Some Patients may need to get their band readjusted so they found some sort of discomfort due to ongoing maintenance. Although gastric banding is successful it is less efficient in weight loss than other bariatric surgeries.
2. Vertical sleeve gastrectomy (VSG)
It’s a surgical operation that involves removing a portion of the stomach resulting in getting the stomach to a smaller hollow tube and it is also called a gastric sleeve. The operation is aided with a laparoscope which is a tube-like telescope that helps the surgeons visualize the viscera. The idea of sleeve gastrectomy is about reducing the stomach to less than half of its size to decrease its food capacity so the patient feels satiety earlier. The first documented sleeve gastrectomy was performed in 1998.
In recent years, laparoscopic vertical sleeve gastrectomy has gained a wide reputation as a successful restrictive weight loss procedure. There has been a noticeable increase in the rate of sleeve gastrectomy as the high success rate of sleeve gastrectomy encouraged surgeons to enlist it as a first-line surgery for obese patients. 60% of the bariatric surgeries that were performed in the US in 2019 were gastric sleeves with a total count of 150,000 operations.
Is gastric sleeve successful? Gastric sleeve has a dramatic effect on patients’ weight by easing their feeling of fullness. It is believed that patients could lose up to 65% of their weight in the first year after surgery. Many surgeons favor sleeve gastrectomy over gastric bypass to avoid mal-absorption disorders that aren’t common in patients who had sleeve gastrectomy. Skin scarring after is said to be minimal and fade gradually with time.
Although gastric sleeve has a high success rate estimated to be 90%, patient’s commitment is the main key to getting the best outcome out of the surgery. Regaining weight after surgery is usually owed to a lack of patients’ compliance. Lifestyle modification after gastric sleeve is a must to restore a healthy life. Keep in mind that setting realistic expectations is essential.
What are the disadvantages of the gastric sleeve? On the other hand, sleeve gastrectomy has a few disadvantages. Irreversibility is considered the main disadvantage of sleeve gastrectomy as the excised part of the stomach cannot be reattached. Gastric sleeve is more invasive than gastric banding, therefore it exposes patients to more risks. Patients who had gastric sleeves may complain about moderate abdominal pain but mostly it could be suppressed by simple analgesics. Pricing of gastric sleeve is really variable and has a wide range from 3000 to 27000 dollars. Most Health insurance companies cover up to 80% of the costs.
3. Roux-en-Y gastric bypass (RYGB)
Roux-en-Y gastric bypass is a well-known bariatric surgery that was performed in the 50s. Gastric bypass is called roux-en-y procedure because it was first described and demonstrated by a Swiss doctor called dr. Cesar roux and the letter “Y” resemble the shape of the gastrointestinal tract after the surgery. Gastric bypass simply involves modifying the tract in which the food passes by bypassing the stomach and the duodenum that most of the food is absorbed.
What is the process of gastric bypass? Gastric bypass operation takes approximately 1.5 hours and it goes as follows: firstly the bariatric surgeon will cut a small upper portion of the stomach and sew its free end to make a pouch. Then an intestinal transection is made at the level of the jejunum dividing the intestine into two parts. The surgeon connects the lower part of the intestine to the small pouch he made out of the stomach. Finally, the rest of the stomach and the upper part of the intestine is connected to the new gastro-intestinal tract to secrete their digestive juice in it.
Statistics showed that gastric bypassing is the second most common bariatric surgery after gastric sleeve. Surgeons often favor gastric bypassing over gastric sleeve for diabetic patients because rerouting the passage of food is found to improve diabetes mellitus. According to ASMBS (American Society for metabolic and bariatric surgery), about 40,000 gastric bypass operations are performed in the US in 2019.
Gastric bypass has significant results as patients are believed to lose up to half of their weight within six months after having it. It is believed that gastric bypassing not only restricts food consumption and reduces food absorption but also regulates hormones secretion resulting in rebooting the brain’s sense of fullness. Patients who underwent gastric bypass feel fewer cravings for food.
Although gastric bypass surgery is remarkably effective it has some disadvantages that obese patients should be aware of. First of all, Gastric bypass costs much more than other bariatric operations as the average cost of it is about 24,000 dollars. Pricing of the operation varies according to where you will have the surgery so make sure that your insurance will cover part of the expenses.
It is believed that gastric bypass is more aggressive and invasive than other bariatric options, therefore it exposes the patient to more risks. Mal-absorption and nutritional deficiency are frequent complaints from patients who had the surgery, yet they could be treated with supplements.
Recovery duration after gastric bypass may be longer than other bariatric options. It is reported that patients may complain about mild to moderate symptoms after surgery such as nausea, vomiting, abdominal cramps, discomfort, and abdominal pain. Patients who had bypass surgery should follow up with a dietitian regularly to discuss their options in their diet and to assess the results.
What are the possible complications of bariatric surgeries?
Complications of bariatric surgeries usually aren’t serious and not to be considered fatal. Nutritional deficiencies are the most commonly reported complications particularly vitamin C, vitamin D, and vitamin A. iron deficiency anemia is found in some patients who had a bariatric surgery especially gastric sleeve. Hypocalcemia (low calcium level in blood) caused due to defect in calcium absorption may be presented by multiple bone fractures
Gastrointestinal complications include anorexia, vomiting, and discomfort. GIT complications are rarely risky, yet infection, stricture, and hernia are red flags that need rapid medical interference. It is important to mention that If you suspect any abnormal sensation after your bariatric surgery never hesitate to consult your physician.