Weight reduction surgery, also called bariatric surgery refers to a series of procedures carried out on overweight people. The size of the stomach is either reduced or a portion of it removed. This is possible either through use of a gastric band or sleeve gastrectomy respectively. Gastric bypass can also be done by resecting and diverting the small intestine to the stomach. Research has shown that this procedure helps in improving the condition of diabetic patients and reducing the risk of cardiovascular risks.
Bariatric surgery is most helpful in persons that have a body mass index, BMI, of more than 40. It is also recommended for those that have medical conditions that are likely to be worsened by obesity. These include among others, glucose intolerance, hyperlipidaemia and diabetes. Surgical options are reserved for cases that are unresponsive to medical therapy.
The benefits and risks of the procedure should be considered in full before a decision is made as to whether or not to have it. Most common complications that should be considered are malabsorption syndromes and gall bladder diseases. There is a high risk of patients getting into depression and as such pre-operation counselling is warranted.
Surgical procedures are grouped in to three main categories. These are malabsorptive, restrictive or mixed. The most commonly performed is the malabsorptive procedure. Malabsorptive operations aim at creating a physiological state of malabsorption. Biliopancreatic diversion combined with duodenal switch (BDS/DS) is one such undertaking. A section of the stomach is resected, creating a smaller pouch which is then directly connected to the ileum, bypassing the duodenum and jejunum. The malabsorption that results can be severe enough to cause serious deficiency diseases such as osteoporosis and anemia unless vitamins and mineral supplements are administered.
Predominantly restrictive procedures aim at minimizing oral intake by restricting gastric volume. This produces early food satisfaction. Vertical banded gastroplasty involves permanent stapling of the stomach to create a small stomach to handle the food. It is regarded as one of the safest operations carried out today.
Another restrictive technique is known as sleeve gastrectomy. In the hands of a skilled surgeon, up to 15% of the original size of the stomach can be successfully removed. The greatest portion is taken from the greater curvature. The stomach shape is transformed into more of a tube. In advanced centers, laparoscopes are used so as to improve on the accuracy.
In the immediate post-operation period, one should only take liquid foods such as fruit juices and broth and gelatin desserts which are sugar-free. One should eat these foods until the gut fully recovers from the operation. Other diets to be introduced slowly include skimmed milk, cream soup, protein drinks and blended foods.
As happens with any surgical operation, there are a number of risks that should be anticipated both in the short term and long term. In these patients calcium absorption is often compromised leading to metabolic bone diseases. Osteopenia and secondary hyperparathyroidism are some clinical features that may be encountered. Rapid loss of weight is a predisposing factor for gall stone formation and one will therefore need to have this at the back of their mind. Other complications of weight reduction surgery include decreased absorption of nutrients such as vitamin B12, thiamine, iron and folate.
Bariatric surgery is most helpful in persons that have a body mass index, BMI, of more than 40. It is also recommended for those that have medical conditions that are likely to be worsened by obesity. These include among others, glucose intolerance, hyperlipidaemia and diabetes. Surgical options are reserved for cases that are unresponsive to medical therapy.
The benefits and risks of the procedure should be considered in full before a decision is made as to whether or not to have it. Most common complications that should be considered are malabsorption syndromes and gall bladder diseases. There is a high risk of patients getting into depression and as such pre-operation counselling is warranted.
Surgical procedures are grouped in to three main categories. These are malabsorptive, restrictive or mixed. The most commonly performed is the malabsorptive procedure. Malabsorptive operations aim at creating a physiological state of malabsorption. Biliopancreatic diversion combined with duodenal switch (BDS/DS) is one such undertaking. A section of the stomach is resected, creating a smaller pouch which is then directly connected to the ileum, bypassing the duodenum and jejunum. The malabsorption that results can be severe enough to cause serious deficiency diseases such as osteoporosis and anemia unless vitamins and mineral supplements are administered.
Predominantly restrictive procedures aim at minimizing oral intake by restricting gastric volume. This produces early food satisfaction. Vertical banded gastroplasty involves permanent stapling of the stomach to create a small stomach to handle the food. It is regarded as one of the safest operations carried out today.
Another restrictive technique is known as sleeve gastrectomy. In the hands of a skilled surgeon, up to 15% of the original size of the stomach can be successfully removed. The greatest portion is taken from the greater curvature. The stomach shape is transformed into more of a tube. In advanced centers, laparoscopes are used so as to improve on the accuracy.
In the immediate post-operation period, one should only take liquid foods such as fruit juices and broth and gelatin desserts which are sugar-free. One should eat these foods until the gut fully recovers from the operation. Other diets to be introduced slowly include skimmed milk, cream soup, protein drinks and blended foods.
As happens with any surgical operation, there are a number of risks that should be anticipated both in the short term and long term. In these patients calcium absorption is often compromised leading to metabolic bone diseases. Osteopenia and secondary hyperparathyroidism are some clinical features that may be encountered. Rapid loss of weight is a predisposing factor for gall stone formation and one will therefore need to have this at the back of their mind. Other complications of weight reduction surgery include decreased absorption of nutrients such as vitamin B12, thiamine, iron and folate.
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