The American Surgecenter

What is Bariatric Surgery ?

Exercise and diet alone often fail to effectively treat people with extreme and excessive obesity. Bariatric surgery is an operation that is performed to help such individuals lose weight. Evidence suggests that bariatric surgery may lower death rates for patients with severe obesity, especially when coupled with healthy eating and lifestyle changes after surgery.

Principles of Bariatric Surgery

The basic principle of bariatric surgery is to restrict food intake and decrease the absorption of food in the stomach and intestines.The digestion process begins in the mouth where food is chewed and mixed with saliva and other enzyme-containing secretions. The food then reaches the stomach where it is mixed with digestive juices and broken down so that nutrients and calories can be absorbed. Digestion then becomes faster as food moves into the duodenum (first part of the small intestine) where it is mixed with bile and pancreatic juice.

Bariatric surgery is designed to alter or interrupt this digestion process so that food is not broken down and absorbed in the usual way. A reduction in the amount of nutrients and calories absorbed enables patients to lose weight and decrease their risk for obesity-related health risks or disorders.

Body Mass Index (BMI)

Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity and help determine whether bariatric intervention is required. Clinically severe obesity describes a BMI of over 40 kg/m2 or a BMI of over 35 kg/m2 in combination with severe health problems.

Health problems associated with obesity include type 2 diabetes, arthritis, heart disease, and severe obstructive sleep apnea. The Food and Drug Administration (FDA) approves the use of adjustable gastric banding for patients with a BMI of 30 kg/m2 or more who also have at least one of these conditions.

There are various types of bariatric surgeries that can be performed. Surgery may be performed using an “open” approach, which involves cutting open the abdomen or by means of laparoscopy, during which surgical instruments are guided into the abdomen through small half-inch incisions. Today, most bariatric surgery is laparoscopic because compared with open surgery, it requires less extensive cuts, causes relatively minimal tissue damage, leads to fewer post-operative complications and allows for earlier hospital discharge.

There are three types of operations that are offered:

Adjustable gastric banding (AGB)
Roux-en-Y gastric bypass (RYGB)
Vertical sleeve gastrectomy (VSG)

Each of the surgery types has advantages and disadvantages and various patient factors affect which procedure is chosen including BMI, eating habits, health problems related to obesity, and a number of previous stomach surgeries. The patient and provider should discuss the most suitable option by considering the benefits and risks of each type of surgery.

Surgical and post-operative risks

People who have had bariatric surgery need to adhere to a rigorous and lifelong diet and exercise plan to prevent complications and to avoid putting on weight after surgery. In addition, patients may develop excess loose and folded skin that requires further surgery to remove and tighten.

What should the patient expect during the consultation with the surgeon?

The preoperative evaluation is similar for all bariatric procedures. The components include determining a patient’s indications for surgery, identifying issues which may interfere with the success of the surgery, and assessing and treating co morbid diseases. Typical assessment includes psychological testing, nutrition evaluation, and medical assessment.

Psychological evaluation

Patients referred for bariatric surgery are more likely than the overall population to have psychopathology such as somatization, social phobia, obsessive-compulsive disorder, substance abuse/dependency, binge-eating disorder, post-traumatic stress disorder, generalized anxiety disorder, and depression. Patients with psychiatric disorders may have a suboptimal outcome after bariatric surgery. It is not certain which psychosocial factors predict success following bariatric surgery, yet many programs exclude patients who are illicit drug abusers, have active uncontrolled schizophrenia or psychosis, severe mental retardation, heavy alcohol use, or lack of knowledge about the surgery.

Nutrition consultation

We offer nutrition consultations for people undergoing gastric surgery and post-op consultations. Consultations include one-on-one counselling with a registered dietician. The nutrition consultant is an integral part of multidisciplinary bariatric care. He/she is charged with nutritional assessment, diet education regarding postoperative eating behaviours, and preoperative weight loss efforts.

Preoperative medical evaluation

Medical assessment prior to bariatric surgery is similar to abdominal operations of the same magnitude. Thorough history and physical examination with systematic review is used to identify issues that may complicate the surgery. Routine laboratory evaluation typically includes complete blood count, metabolic profile, coagulation profile, lipid profile, thyroid function tests, and ferritin. Vitamin B12, and fat-soluble vitamin levels may be evaluated if considering a malabsorptive procedure. Cardiovascular evaluation includes electrocardiogram and possible stress test to identify occult coronary artery disease. Respiratory evaluation may include chest X-ray and pulmonary function tests. Sleep apnea may be diagnosed by a sleep study if any was suspected. Upper endoscopy may be used if suspicion of gastric pathology exists. If H. pylori infection is present, preoperative therapy is advised. The liver may be assessed by hepatic profile and ultrasound. Ultrasound may be used to detect gallstones as well, allowing the surgeon to decide on concomitant cholecystectomy.

What are the different procedures that can be done surgically to lose weight ?

Laparoscopic Roux-en-Y gastric bypass
Laparoscopic adjustable gastric banding
Laparoscopic sleeve gastrectomy

How will my diet change after the surgery?

The goal is to limit the amount of calories you consume, while providing balanced meals that help prevent nutrient deficiencies and preserve muscle tissue. It is very important to follow the nutritional guidelines to prevent weight gain, deficiencies and complications.

After the surgery, you will have to go on a liquid diet for the first two weeks, gradually changing to pureed diet after week 2, and finally moving on to eating solids after week 4. Protein supplements and different vitamins and minerals might be necessary to help with the healing process.

The general guidelines that you need to follow are:

Always eat slowly
Chew your food thoroughly
Only eat small portions of food at a time
Do not eat and drink at the same time
Eat a balanced, healthy diet that contains the recommended amounts of protein and other nutrients.
Do not eat foods that contain sugar and fat
Exercise regularly

The success of the surgery is very much dependent on changing your lifestyle and eating habits. With time, the new habits will become easier and the results that you get from the surgery and the new lifestyle are very rewarding and the positive effects on your health and your body are very worthwhile.

BMI Calculator

If you want to compare your weight status to others, BMI is a great method of analysis.

BMI	Term	Class of Obesity
<19	Underweight
19-25	Ideal BMI
25-30	Overweight
>30	Obese	I
>35	Severely Obese	II
>40	Morbidly Obese	III
>50	Super Obese	IV

To be a candidate for obesity surgery, you must have the following criteria

Your BMI is 40 or higher
You weigh at least 60 pounds more than your ideal body weight
Your BMI is over 35 and you have other serious health issues
Your age is above 18 years
You have a history of being overweight
Your earlier efforts to lose weight provided minimal results or short- term success
You do not have any other disease that may have caused your obesity, and you do not drink alcohol in excess

Bariatric Surgery