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Bariatric Surgery

By

Catherine Spader, RN

What is bariatric surgery?

Bariatric surgery refers to weight-loss surgery. Bariatric surgery can help obese adults and adolescents achieve significant weight loss. Weight loss can lower the risk of heart disease and resolve and improve  diseases associated with obesity. This includes type 2 diabetes, hypertension, and high cholesterol. Bariatric surgery requires a lifelong commitment to healthy dietary and exercise habits, vitamin supplementation, and regular follow-up care.  

Bariatric surgery can be a life-saving treatment for people whose obesity seriously threatens their health. Bariatric surgery is used for people who have not lost weight through diet, exercise, counseling, and medication.

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Bariatric surgery is only one part of a complex obesity treatment plan. Less invasive treatment options that have less risk of complications are available to help you lose weight. Consider getting a second opinion about your treatment choices before having bariatric surgery. 

Types of bariatric surgery

Bariatric surgeries incorporate one or two general techniques that work in different ways to reduce your calorie intake. These include:

  • Restrictive procedures reduce the size of the stomach. This limits the amount of food you can eat. Restrictive procedures include adjustable gastric banding (Lap-Band), vertical sleeve gastrectomy (stomach stapling), and vertical banded gastroplasty (stomach stapling and banding).

  • Malabsorptive/restrictive procedures (gastric bypass) alter the normal digestion process. The stomach is stapled down to a small pouch (typically the size of a small test tube). It is then attached to the middle of the small intestine. This allows food to bypass most or all of the first section of the small intestine (the duodenum). It reduces the amount of calories and nutrients absorbed into the body. Procedures include the Roux-en-Y gastric bypass (RYGB) and the biliopancreatic diversion with a duodenal switch (BPD-DS). This technique combines the restrictive and malabsorptive procedures to increase weight loss success.

Why is bariatric surgery performed? 

Your doctor may recommend bariatric surgery to treat obesity and reduce the risk of life-threatening complications of obesity. Complications include diabetes, heart disease, and severe sleep apnea

Bariatric surgery is not a treatment option for people who are mildly overweight. It is generally used for adults with a body mass index (BMI) of 40 or more. This means being about 100 pounds overweight for men and 80 pounds overweight for women. People who are less obese with a BMI of about 35 to 39.9 and have serious weight-related health problems, such as type 2 diabetes or high blood pressure may also have bariatric surgery.

Bariatric surgery may be an option if other treatment options that involve less risk and fewer complications have not helped you lose weight. Other options include diet, exercise, behavioral and nutritional counseling, and medication. Ask your doctor about all of your treatment options and consider getting a second opinion before having bariatric surgery.

Who performs bariatric surgery?

A bariatric surgeon or general surgeon performs bariatric surgery. Bariatric surgeons are often general surgeons who have specialized in bariatrics. Bariatrics is the field of medicine that deals with the causes, prevention, and treatment of obesity. A general surgeon specializes in the surgical treatment of a wide variety of diseases, disorders and conditions. 

How is bariatric surgery performed?

Your bariatric surgery will be performed in a hospital. It is often a minimally invasive surgery. This involves  inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a long, thin camera that transmits pictures of the inside of your body to a video screen viewed by the doctor during surgery.

Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make several small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

Your surgeon will determine if you are a good candidate for minimally invasive bariatric surgery. Your surgeon will decide how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. 

Surgical approaches to restrictive bariatric procedures

A restrictive procedure helps you lose weight by reducing the size of your stomach and the amount of food you can eat. Procedures include:

  • Adjustable gastric banding (AGB, Lap-Band surgery, gastric band surgery) involves attaching an inflatable band (called a gastric band) around the top portion of the stomach. The surgeon tightens the band like a belt to form a smaller stomach. Your physician adjusts the size of the stomach by adding or removing saline (salt water) to the band through a port. The port is inserted in the tissue just under your skin in your abdominal wall.

  • Vertical sleeve gastrectomy (VSG, gastric sleeve surgery, gastric sleeve resection, tube gastrectomy) involves removing part of the stomach and using staples to create a smaller tube-shaped stomach. It is the first step of a two-step surgery. The second surgery is a Roux-en-Y gastric bypass (RYGB) or less commonly, a biliopancreatic diversion with a duodenal switch (BPD). The second surgery is performed after the patient has lost sufficient weight to be healthy enough to undergo this more complex procedure. In some cases, VSG by itself has been shown to be effective in achieving significant and fast weight loss. 

Surgical approaches to malabsorptive/restrictive bariatric procedures

A malabsorptive/restrictive procedure helps you lose weight by reducing the size of your stomach and the amount of food you can eat. It also changes the normal digestion process. This reduces the amount of calories and nutrients that are absorbed into the body. Procedures include:

  • Biliopancreatic diversion with a duodenal switch (BPD-DS, duodenal switch) is performed by removing part of the stomach and using staples to create a smaller tube-shaped stomach (vertical sleeve gastrectomy). In another surgery, the stomach is attached to the middle of the small intestine. Food then bypasses a large part of the small intestine, reducing the amount of calories and nutrients that are absorbed into the body. Bile and other digestive juices are also diverted to further reduce digestion. This is a high-risk surgery that is less commonly performed due to many of the potential long-term health risks.

  • Roux-en-Y gastric bypass (RYGB) involves stapling the stomach to create a small pouch that holds less food. The new stomach pouch is attached directly to the middle of the small intestine. This allows food to bypass much of the stomach and the first section of the small intestines. This reduces the amount of calories and nutrients that are absorbed into the body.

Types of anesthesia that may be used

General anesthesia is used for bariatric surgery. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain. 

What to expect the day of your bariatric surgery

The day of your surgery, you can generally expect to:

  • Talk with a nurse who will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

  • A surgical team member will start an IV.

  • You may be given an injection of blood thinner to reduce the risks of blood clots during surgery

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and during recovery until you are alert, breathing effectively, and your vital signs are stable.

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