Gastric reduction surgery
This article is mainly for those who have tried “every diet possible” but are still gaining weight.
Gastric reduction operations (bariatric) are performed in order to:
- Make sure that the patient simply cannot eat too much at one meal;
- Reduce the body's ability to absorb nutrients;
- Reduce both the amount of food that the patient can eat at one time, and limit the body's ability to absorb nutrients;
Accordingly, surgical stomach reduction is a weight reduction option for those who cannot control what and how much they eat.
Bariatric surgery allows you to lose up to 80% of excess weight within one to two years. However, you should know that these are medical operations during which the structure of some internal organs changes, which, in turn, can cause serious risks and side effects.
Types of bariatric surgery
There are pros and cons to each type of bariatric surgery. The most common types of bariatric surgery are:
Gastric bypass surgery
Gastric bypass surgery (Roux-en-Y) is the most common method of weight loss surgery. This operation is usually irreversible. As a result of the operation, the amount of food that the patient can eat at one time is reduced, and the absorption of nutrients is also limited.
The surgeon separates the upper part of the stomach from the rest of the stomach. The resulting pouch is about the size of a walnut and can only hold about 0.028 liters of food. For comparison, the stomach can usually hold about 1.4 liters of food.
Then the small intestine is cut and part of it is sewn to the separated upper part of the stomach.
Food does not enter the main part of the stomach and immediately enters the middle part of the small intestine.
Vertical sleeve gastrectomy
A Gastric Sleeve reduces the amount of food a patient can eat at one meal because about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can no longer hold as much food as it used to, and food passes through the intestinal tract faster. After surgery, the stomach also produces less of the appetite-regulating hormone ghrelin, which can reduce appetite.
This operation is more gentle because the intestines are not affected.
Biliopancreatic diversion with duodenal switch (BPD/DS)
This surgery reduces the size of the stomach and the length of the small intestine. This limits both how much food the patient can eat and how much food the digestive tract can digest and absorb.
The operation is performed in 2 stages - first, the stomach is reduced by 75 to 80 percent (similar to the Gastric Sleeve operation).
Then the small intestine is separated from the stomach and a very short section of the last part of the small intestine is lifted and attached to the stomach, completely bypassing the upper part of the small intestine. When eating, food passes only through the newly formed, smaller stomach, and then enters the last part of the small intestine.
In other words, most of the calories and nutrients are quickly transferred to the large intestine, where they are not absorbed.
This operation is very effective in terms of weight loss, but over time it can lead to nutritional deficiencies and other complications.
Adjustable gastric band
A gastric band is an inflatable (adjustable) silicone ring used to reduce the size of the stomach and control the amount of food entering the digestive tract.
A gastric band is placed around the upper part of the stomach, creating a small "pouch" in the upper part of the stomach that connects to the rest of the stomach through a small channel.
The size of the bag and the channel depends on how inflated the ring is - the more inflated it is, the narrower the channel becomes, and the passage of food becomes more difficult.
The gastric band is connected by a narrow tube with a small port directly under the patient's skin. This allows to adjust the food supply by inflating or deflating the bandage as needed.
Gastric balloons (also called intragastric balloons) partially fill the stomach and leave less room for food and drink. Thus, the amount of food taken is reduced, as the feeling of satiety occurs faster.
The balloon is inserted into the stomach with an endoscope (through the mouth) and filled with sterile saline (usually saline).
The balloon can remain in the stomach for six to twelve months.
The balloon is removed exactly as it was inserted - with an endoscope.
Restrictions after bariatric surgery
After surgery, it is usually impossible to eat for 1-2 days. After that, for several weeks you will have to adhere to a special diet – first only liquids, then puree, then very soft food, gradually switching to regular food.
There will also be many restrictions on how much and what you can eat and drink.
Who qualifies for gastric reduction / bariatric surgery?
Bariatric surgery is not appropriate for everyone who is overweight. Most likely, you will need to pass several tests to make sure that the operation is possible (safe), and you will need to change both your eating habits and your lifestyle.
In general, bariatric surgery is recommended if:
- Your body mass index (BMI) is 40 or higher (extreme or very severe obesity);
- Your BMI is between 35 and 39.9 (obesity of the second degree) and you have serious weight-related health problems such as type 2 diabetes, high blood pressure, or severe sleep apnea;
- In some cases, certain types of bariatric surgery are also recommended if your BMI is between 30 and 34 (obesity of the first degree) and you have serious weight-related health problems.
Bariatric surgery is performed to help you lose excess weight and reduce the risk of potentially life-threatening weight-related health problems, including:
- Heart disease and stroke;
- High blood pressure;
- Non-alcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH);
- Sleep apnea;
- type 2 diabetes.
Like any surgical procedure, bariatric surgery carries potential health risks, both short-term and long-term.
Risks associated with surgery may include:
- Excessive bleeding;
- Adverse reactions to anesthesia;
- Formation of blood clots;
- Lung or breathing problems;
- Leakage in the gastrointestinal tract;
- Death (very rare).
The long-term risks and complications of weight loss surgery vary depending on the type of surgery. These may include:
- Intestinal blockages;
- Dumping syndrome, which causes diarrhoea, dizziness, nausea or vomiting;
- Formation of gallstones;
- Hypoglycemia (low blood sugar);
- Nutrient deficiency;
- Acid reflux;
- The need for a second or "error correction" operation;
- Death (very rare).
Bariatric surgeries can provide long-term weight loss. In two years, you can lose half or even more excess weight.
Exactly how much weight will be lost depends on:
- Type of operation;
- Changes in your lifestyle and eating habits.
In addition to weight loss, bariatric surgery can also improve symptoms and reduce the risk of certain obesity-related diseases, such as joint pain (osteoarthritis).
When does weight loss surgery not work?
The main reason that gastric reduction operations do not give the desired result is the belief of some patients that after recovering from surgery they can eat, drink and do whatever they want.
That is if you return to your previous lifestyle and dietary habits (ignore lifestyle changes recommended by your doctor, such as regular physical activity and eating healthy food, and start eating all sorts of rubbish ...), weight loss may eventually stop or weight may even begin to increase (even if the operation has passed successfully and was carried out correctly).
Weight loss surgeries don't always work as well as you might hope:
- Your weight may stay the same (rare);
- Weight loss may stop after a while;
- Serious health problems may occur.
Bariatric surgery is not a miracle cure, that is, it is not a procedure that by itself will solve your problem with excess weight. To achieve the desired weight loss, you also need to review your eating habits and lifestyle.
If you do not do this, there will be no long-term success.
Before surgery, a liquid diet (decaffeinated coffee and tea, fat-free milk, broths, juices without added sugars or preservatives, and gelatin without sugar and additives) is usually prescribed to prevent excessive abdominal distension.
You will need to quit smoking and drinking alcohol at least 6 weeks before bariatric surgery.
After the initial recovery, you will need to follow your doctor's recommendations on diet, exercise, and a healthy lifestyle.
To help maintain results and reduce the risk of complications, it is usually recommended to:
- Take multivitamins (to help compensate for the reduced ability of the body to process and/or absorb nutrients);
- Reduce fat and sugar intake (to avoid unwanted weight gain over time);
- Increase protein intake (to provide your body with the amount of protein it needs);
- Physical activity every day (to maintain your overall health and help maintain a healthy weight long term);
- Avoid alcohol consumption (especially in the early stage of postoperative weight loss);
- Reduce daily stress (to reduce the risk of gastrointestinal disorders).
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