What is bariatric surgery?

What is Obesity?

What is Obesity?

Why do diets fail?

Why do diets fail?

metabolic setpoint

The metabolic set point

What is Bariatric Surgery?

What is Bariatric Surgery?

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what is bariatric surgery nw

Broadly speaking bariatric surgery can be grouped together as surgery that is performed to help you lose weight, it is not a quick fix and is not something you can do alone. The support of a dedicated team of professionals that can guide you through the process is essential. Just as obesity did not start in isolation it cannot be treated in isolation. The support of family friends and colleagues can be valuable in helping you achieve the best result.

Broadly speaking bariatric surgery can be divided into three groups, restrictive meaning limiting the amount of food that can be comfortable ingested at a specific time, mal absorptive meaning the limiting the amount of food that you absorb in your digestive system and combinations of above.

Restrictive: The lap- band/ LAGB

What is bariatric surgery 1

With a gastric band placed laparoscopically the stomach is divided in two, the smaller pouch restricts the amount of food that can be comfortably eaten at any given time. The band can be adjusted by injecting fluid into a small port placed under the skin. The drawback of this type of procedure is that the rest of the stomach remains in the digestive loop and all calories ingested ends up being absorbed into the body. The hormonal signals from the stomach remains largely unchanged so any metabolic benefit is only reached later as the weight is finally shed. Because the band is a foreign object the body reacts to this and a high intervention rate of up to 60% is reported. This form of surgery is not currently endorsed by SASSOM though widely practised.

The gastric sleeve/ sleeve gastrectomy

What is bariatric surgery 2

With the gastric sleeve or sleeve gastrectomy the surgeon will resect (cut away) approximately 75% of the stomach leaving a small sleeve in place, roughly the size of a banana. Therefor this procedure can never be reversed as the resected piece of the stomach has to be removed from the abdomen.

The surgery is slightly faster and easier to perform than a gastric bypass and was traditionally performed as the first part of the duodenal switch operation to facilitate initial weight loss and break the surgery in two stages. Surgeons performing this as the first stage of the procedure found that a large part of their patients didn’t need to return for the duodenal switch part of the operation as they had achieved adequate weight loss. Resolution rates of obesity and diabetes though comparable are slightly inferior to gastric bypass and long term studies show a greater weight regain after five years than gastric bypass.

Malabsorptive procedures: Jejunoilial bypass/jib procedure:

What is bariatric surgery 3

The jejunoilial bypass is performed by is performed by bypassing the majority of the jejunum (the second part of the small bowel). During surgery the jejunum is divided and reattached to the distal ilium about 30-40 cm before it joins to the colon. Five meters of small bowel is no longer used in the digestion of food and all the food passes largely undigested to the colon. The patient can therefor eat anything he wants as no restriction is involved. Due to the malabsorption of nutrients weight loss is rapid and dramatic. This however leads to a lot of morbidity and life threatening complications and has finally been outlawed in south Africa. Patients that previously had this procedure are advised to contact a bariatric surgeon to have it reversed or converted to another procedure.

Restrictive and malabsorptive procedures:
The gastric bypass/roux -y gastric bypass

What is bariatric surgery 4

The roux y gastric bypass combines the most effective parts of bariatric surgery, namely restriction, malabsorption and bypass of the first part of the duodenum. Surgery is done laparoscopically using 5 small 1 cm cuts, in the first part of the surgery a small pouch (approximately 20-30ml) is created by dividing the stomach with a stapling device. The rest of the stomach is then left in the body still attached to its blood supply and though it remains hormonally active does not receive any food during the digestive process. The small bowel is then divided early in the jejunum (second part of the small bowel) and this loop of bowel is attached to the stomach. Between 120 and 150 cm of small bowel is then bypassed and reattached to the jejunum forming a common channel of four to five meters of small bowel where food and nutrients are absorbed.

The roux-y gastric bypass remains the golden standard against which all bariatric procedures are measured and is the procedure of choice for resolution of diabetes (up to 85%) and for sustained weigh loss. This procedure is fully endorsed by SASSOM and is the procedure of choice at north west bariatric. The procedure has proven to be safe, effective and gives consistent results across the broad range of obese patients.

Biliopancreatic diversion with duodenal switch./BPD-DS

What is bariatric surgery 5

The biliopancreatic diversion with duodenal switch is the most powerful operation in the hands of the bariatric surgeon and is reserved for patients with BMI over 50. During the procedure a sleeve gastrectomy is performed and the first part of the duodenum is then attached to the third part of the small bowel (the ilium) a 120-150cm common limb is then created where nutrients are absorbed and the majority of the jejunum and duodenum no longer take part in digestion serving as a conduit for bile and pancreatic juices.

Although this procedure leads to drastic weight loss and malabsorption, long term safety has been proven and if patients stick to regular follow up schedules and receive their intra venous vitamin supplements a great quality of life can be achieved. This procedure should only be done I highly specialised units and can cost in excess of R300 000 if contemplated by private paying customers.