Bariatric surgery - Wikipedia. For the medical journal, see Obesity Surgery. Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who have obesity.
Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re- routing the small intestine to a small stomach pouch (gastric bypass surgery). Long- term studies show the procedures cause significant long- term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a mortality reduction from 4.
National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 4. BMI of at least 3. The most recent ASMBS guidelines suggest the position statement on consensus for BMI as an indication for bariatric surgery. The recent guidelines suggest that any patient with a BMI of more than 3. A doctor–patient discussion of surgical options should include the long- term side effects, such as a possible need for reoperation, gallbladder disease, and malabsorption. Patients with a body- mass index of 4.
Future trends are attempting to achieve similar or better results via endoscopic procedures. Predominantly malabsorptive procedures. The original form of this procedure is now rarely performed because of problems with malnourishment. It has been replaced with a modification known as duodenal switch (BPD/DS). Part of the stomach is resected, creating a smaller stomach (however the patient can eat a free diet as there is no restrictive component). The distal part of the small intestine is then connected to the pouch, bypassing the duodenum and jejunum.
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In around 2% of patients there is severe malabsorption and nutritional deficiency that requires restoration of the normal absorption. The malabsorptive effect of BPD is so potent that those who undergo the procedure must take vitamin and dietary minerals above and beyond that of the normal population. Without these supplements, there is risk of serious deficiency diseases such as anemia and osteoporosis. Others prefer to prescribe medications to reduce the risk of post- operative gallstones. It was a surgical weight- loss procedure performed for the relief of morbid obesity from the 1.
Endoluminal sleeve. A study recently done in the Netherlands found a decrease of 5. BMI points in 3 months with an endoluminal sleeve. Predominantly restrictive procedures. This operation can be performed laparoscopically, and is commonly referred to as a . Weight loss is predominantly due to the restriction of nutrient intake that is created by the small gastric pouch and the narrow outlet.
The open edges are then attached together (typically with surgical staples, sutures, or both) to leave the stomach shaped more like a tube, or a sleeve, with a banana shape. The procedure permanently reduces the size of the stomach.
The procedure is performed laparoscopically and is not reversible. This combined approach has tremendously decreased the risk of weight loss surgery for specific groups of patients, even when the risk of the two surgeries is added. Most patients can expect to lose 3.
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The timing of the second procedure will vary according to the degree of weight loss, typically 6 – 1. Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts. Removes the portion of the stomach that produces the hormone that stimulates hunger (Ghrelin), although the durability of this removal has yet to be confirmed. The balloon can be left in the stomach for a maximum of 6 months and results in an average weight loss of 5–9 BMI over half a year.
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Average quoted costs by region are as follows (provided in United States Dollars for comparison): Australia: $4,1. USD; Canada: $8,2.
We enrolled 50 overweight or obese patients without diabetes in a 10-week weight-loss program for which a very-low-energy diet was prescribed.
USD; Mexico: $5,8. USD; United Kingdom: $6,1. USD; United States: $8,1.
USD). Gastric plication significantly reduces the volume of the patient's stomach, so smaller amounts of food provide a feeling of satiety. Mean patient age was 3. BMI of 3. 5. Follow- up visits for the assessment of safety and weight loss were scheduled at regular intervals in the postoperative period. No major complications were reported among the 6.
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Weight loss outcomes are comparable to gastric bypass. The study describes gastric sleeve plication (also referred to as gastric imbrication or laparoscopic greater curvature plication) as a restrictive technique that eliminates the complications associated with adjustable gastric banding and vertical sleeve gastrectomy—it does this by creating restriction without the use of implants and without gastric resection (cutting) and staples.
Mixed procedures. A patient will feel full with less food. The gastric bypass had been the most commonly performed operation for weight loss in the United States, and approximately 1. Its market share has decreased since then and by 2.
In such patients, although earlier considered to be an irreversible procedure, there are instances where gastric bypass procedure can be partially reversed. The part of the stomach along its greater curve is resected. The stomach is . This volume reduction provides the food intake restriction component of this operation. This type of gastric resection is anatomically and functionally irreversible. The stomach is then disconnected from the duodenum and connected to the distal part of the small intestine.
The duodenum and the upper part of the small intestine are reattached to the rest at about 7. Electrical stimulation is thought to modify the activity of the enteric nervous system of the stomach, which is interpreted by the brain to give a sense of satiety, or fullness. Early evidence suggests that it is less effective than other forms of bariatric surgery.
This diet is continued until the gastrointestinal tract has recovered somewhat from the surgery. The next stage provides a blended or pureed sugar- free diet for at least two weeks. This may consist of high protein, liquid or soft foods such as protein shakes, soft meats, and dairy products. Foods high in carbohydrates are usually avoided when possible during the initial weight loss period.
Post- surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting. Diet restrictions after recovery from surgery depend in part on the type of surgery.
Many patients will need to take a daily multivitamin pill for life to compensate for reduced absorption of essential nutrients. Patients have difficulty drinking the appropriate amount of fluids as they adapt to their new gastric volume. Limitations on oral fluid intake, reduced calorie intake, and a higher incidence of vomiting and diarrhea are all factors that have a significant contribution to dehydration. In order to prevent fluid volume depletion and dehydration, a minimum of 4. L) should be consumed by repetitive small sips all day. A meta- analysis from University of California, Los Angeles, reports the following weight loss at 3. More recent studies have demonstrated that the medium (3–8 years) and long term (> 1.
RYGB and LAGB become very similar. Data (beyond 5 years) for sleeve gastrectomy indicates weight loss statistics similar to RYGB. Reduced mortality and morbidity. It is uncertain whether any given bariatric procedure is more effective than another in controlling comorbidities. There is no high quality evidence concerning longer- term effects compared with conventional treatment on comorbidities.
Short- term complications from laparoscopic adjustable gastric banding are reported to be lower than laparoscopic Roux- en- Y surgery, and complications from laparoscopic Roux- en- Y surgery are lower than conventional (open) Roux- en- Y surgery. However, costs can vary significantly by location. Quoted costs generally include fees for the hospital, surgeon, surgical assistant, anesthesia and implanted devices (if applicable). Depending on the surgical practice, costs may include or omit pre- op, post- op or longer- term follow- up office visits. A study of insurance claims of 2.
This was more common in those over 4. Common problems were gastric dumping syndrome in about 2.
Leak rates have now globally decreased to a mean of 1- 5%. Metabolic bone disease manifesting as osteopenia and secondary hyperparathyroidism have been reported after Roux- en- Y gastric bypass surgery due to reduced calcium absorption.
The highest concentration of calcium transporters is in the duodenum. Since the ingested food will not pass through the duodenum after a bypass procedure, calcium levels in the blood may decrease, causing secondary hyperparathyroidism, increase in bone turnover, and a decrease in bone mass. Increased risk of fracture has also been linked to bariatric surgery. Adverse effects on the kidneys have been studied.
Hyperoxaluria that can potentially lead to oxalate nephropathy and irreversible renal failure is the most significant abnormality seen on urine chemistry studies. Rhabdomyolysis leading to acute kidney injury, and impaired renal handling of acid and base has been reported after bypass surgery. Seizures due to hyperinsulinemic hypoglycemia have been reported. Inappropriate insulin secretion secondary to islet cell hyperplasia, called pancreatic nesidioblastosis, might explain this syndrome.
Difficulties and ethical issues arise when making decisions related to obesity treatments for those that are too young or otherwise unable to give consent without adult guidance. This makes it difficult for them to make an informed decision and give consent to move forward with a treatment. It involved anastomosis of the upper and lower intestine, which bypasses a large amount of the absorptive circuit, which caused weight loss purely by the malabsorption of food.
Howard Payne, Lorent T. De. Wind and Robert R. Commons developed in 1. Jejuno- colic Shunt, which connected the upper small intestine to the colon.