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Bariatric Surgery: What It Is, Types And Risks

Bariatric surgery is a set of surgical techniques used to treat excess weight, where the digestive system is altered in order to reduce the amount of food that enters the body and to modify the natural process of digestion, facilitating weight loss and improving or curing diseases associated with obesity. 

There are several surgical techniques which can be restrictive or restrictive and malabsorptive at the same time. The restrictive techniques will only allow to reduce the amount of food ingested due to the reduction of the stomach volume. In the case of restrictive and malabsorptive techniques, in addition to reducing the size of the stomach, the intestine is also modified to reduce the absorption of nutrients, thus reducing the calories that enter the body.

Because it is an invasive type of surgery, bariatric surgery is only indicated when the person has already tried to lose weight using other methods without obtaining any results, or when the excess weight puts the individual’s life in danger. 

Who can be a candidate for this surgery

Bariatric surgery is indicated in people with grade II obesity who have failed to achieve weight loss results, after several months, through nutritional treatment and regular physical activity. 

To know if an individual is a candidate or not for this surgery, the surgeon indicates a series of medical evaluations, as well as a rigorous control with a multidisciplinary team comprised by a nutritionist, psychologist, endocrinologist, among others, and it is only performed when all these specialists indicate that the individual is ready for the procedure. 

This surgery is indicated in people aged between 16 and 65 years, being indicated according to the American Association for Metabolic and Bariatric Surgery (ASMBS) in individuals with:

  • BMI equal to or greater than 50 kg/m²;
  • BMI equal to or greater than 40 kg/m², without associated comorbidities;
  • BMI equal to or greater than 35 kg/m² and the presence of 1 or more associated comorbidities such as hypertension, hyperlipidemia, obstructive sleep apnea, hypoventilation syndrome, fatty liver, asthma, gastroesophageal reflux, urinary incontinence, debilitating arthritis, diabetes, metabolic syndrome, among others. 
  • Likewise, the ASMBS indicates some cases in which bariatric surgery is contraindicated such as substance abuse or suffering from a poorly controlled psychiatric disease, suffering from bulimia nervosa, use of alcoholic beverages, uncontrolled heart or lung disease, portal hypertension with esophageal varices, inflammatory diseases of the upper digestive tract or suffering from Cushing’s syndrome due to cancer. 

    Types of bariatric surgery

    The type of surgery to be performed is chosen by the surgeon taking into account the medical conditions of each individual. These surgeries can be performed through a normal cut in the abdomen or by video-laparoscopy, the latter being the most used technique, since only a few small holes are made during the surgery to introduce the medical instruments. The types of bariatric surgery are:

    1. Gastric banding

    This is the least invasive and restrictive type of bariatric surgery, it consists of placing a silicone band with an inflatable ring around the stomach, decreasing its size and at the same time the amount of food that the individual ingests, thus reducing the calories that enter the body. 

    Generally, this type of surgery has less health risks and the recovery time is faster, however, its results are less satisfactory since once the band is removed, the size of the stomach returns to normal. 

    2. Gastric bypass

    Gastric bypass, also called Roux-en-Y gastric bypass, is an invasive surgery where a restrictive and malabsorptive technique is used, because the doctor removes a large part of the stomach, leaving only a small portion of about 30 mL of capacity, where he connects the second portion of the small intestine called jejunum, reducing not only the amount of food that is ingested but also reducing the surface area for absorption of nutrients. 

    This type of surgery has excellent results, allowing to lose up to 70% of the initial weight, however, it has more risks and its recovery is slower. Besides this, since it creates malabsorption of nutrients, it requires a rigorous control by a nutritionist.a to supplement vitamins and minerals that may be affected, as well as monitor the weight loss process very carefully.

    Learn more about gastric bypass.

    3. Gastric sleeve

    Gastric sleeve, also called vertical gastrectomy, is a type of restrictive bariatric surgery where, unlike gastric bypass, the natural connection of the stomach to the intestine is maintained but part of the stomach is removed, in order to reduce its size and in turn the amount of food ingested, thus promoting weight loss.

    This surgery has less risks than the bypass, but the results are less satisfactory, allowing to lose about 40% of the initial weight, being very similar to the gastric band. 

    See how the gastric sleeve surgery is performed. 

    4. Biliopancreatic diversion

    This surgery is the least frequent, applying both a restrictive and malabsorptive surgical technique, in which a gastric sleeve is performed first, leaving the stomach in the form of a tube and a large part of the small intestine is removed, reducing the absorption of nutrients and therefore the calories entering the body.

    However, although a large part of the small intestine is removed, bile continues to be released into the first portion of the small intestine, which is then connected to the final portion of the small intestine, so as not to interrupt the flow of bile.

    This technique like gastric bypass has excellent results, however it can cause malnutrition and vitamin deficiency, so close monitoring with a nutritionist is important. 

    Main advantages

    In addition to significant weight loss, bariatric surgery also improves diseases associated with obesity, improving or curing diseases such as:

  • High blood pressure;
  • Heart failure;
  • Respiratory failure;
  • Asthma;
  • Diabetes;
  • High cholesterol.
  • This surgery also provides improvements on a social and psychological level, decreasing the risk of depression and helping to increase self-esteem, social interaction and physical mobility. 

    Possible risks of surgery

    The risks of bariatric surgery are associated with the severity of the diseases presented by the individual, so the main complications are:

  • Pulmonary embolism, which is the obstruction of a blood vessel in the lung, causing severe pain and difficulty breathing;
  • Internal bleeding in the region where surgery was performed;
  • The formation of a fistula, which is an abnormal connection between two organs, originating mainly where resection was performed at the intestinal level;
  • Vomiting, diarrhea and bloody stools.
  • Generally, these complications usually arise during the hospital stay and are quickly resolved by the medical staff. However, depending on the severity of the symptoms, further surgery may be necessary to correct the problem.

    In addition, it is common after bariatric surgery for patients to have nutritional complications such as anemia, folic acid, calcium and vitamin B12 deficiency. In addition, severe malnutrition can also occur, in case a regular control with the nutritionist is not maintained.

    To recover faster and with fewer complications, see how the nutrition after bariatric surgery should be.

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