This is an option for people who remain severely obese after conventional approaches to weight loss such as diet and exercise have failed, or who have an obesity-related disease. It is recommended only if BMI is at least 40 or person is at least 100 pounds more than the ideal body weight or when BMI is 35 to 40 with other serious illnesses, such as diabetes, cardiovascular disease, hypertension, or sleep apnea, also being present.
There are various techniques/procedures as explained below –
Roux-en-Y Gastric Bypass:
Under general anaesthesia, a small stomach pouch is created, limiting the food intake. The intestine is then connected to this pouch, so that food bypasses the lower stomach, the first segment of the small intestine (duodenum) and part of the second segment (jejunum). With this direct connection from the stomach to the lower segment of the small intestine, portions of the digestive tract that absorb calories and nutrients are bypassed. It is therefore considered a combined restrictive and malabsorptive procedure.
Laparoscopic Adjustable Gastric Banding:
As the name suggests, this procedure involves placing an adjustable, inflatable silicone band around the upper part of the stomach. The band is connected to a port placed in the abdominal wall, through which the diameter of the band can be adjusted. The technique makes the stomach smaller, thus restricting the amount of food intake. It requires frequent postoperative visits for band adjustments. The procedure is reversible and, if patients fail to lose adequate weight after LAGB, it can be converted to a Roux-en-Y gastric bypass.
Laparoscopic Sleeve Gastrectomy:
It is a restrictive procedure, where approximately 75 percent of the stomach is removed, leaving a narrow gastric sleeve. This not only restricts the amount of food intake as the person feels full even with small quantity of food but also reduces the production of hormone ghrelin thus reducing hunger.
This is a simple, non invasive procedure where an inflatable gastric balloon is endoscopically inserted and then inflated in the stomach by introducing saline into the balloon, to reduce capacity to consume large quantities of food. It is completely reversible and effective in temporarily reducing hunger, controlling food intake, and helping to achieve a target weight loss of 10 to 30kg. The Intra Gastric Balloon remains in the stomach for a six-month period and is then removed in the same way as it was placed.
It depends on the type of procedure being done. Intragastric balloon placement may take 20-30 minutes, and is done as a day care procedure. The other surgical procedures require 2-3 hours to perform and hospital stay of 3-5 days may be needed.
Routine work can be started a week or 10 days after the surgery. Strenuous activity is to be avoided for at least 6 weeks. The desired weight loss may take 6-12 months to be visible. A strict regimen of diet and exercise is to be followed as per the surgeon's and dietician's recommendation for quick recovery.
Besides infection, bleeding, persistent vomiting, abdominal pain, etc; the complications may vary depending on the type of procedure and include abdominal hernia, leakage through staples or sutures, strictures, band slippage, ulcers in the stomach or small intestine, blood clots in the lungs or legs, inflammation of the gallbladder, etc.
All these risks are minimized if the procedure is carried out by qualified and experienced Bariatric surgeon.