Obesity Surgery
Obesity surgery provides substantial and sustained effects on weight loss.
Studies have shown that bariatric surgery results in more significant weight loss and is more effective than nonsurgical treatments in treating obesity-related diseases in obese patients. Long-term observations have also shown that these benefits last more than five years after surgery.
You can find information about the most common types of obesity surgery below.
Gastric Sleeve Surgery
Procedure:
1. Preparation: Before the surgery, patients undergo a thorough evaluation to determine their suitability for the procedure. This may include medical tests, consultations with healthcare professionals, and lifestyle assessments.
2. Anesthesia: The patient is put under general anesthesia to ensure they are unconscious and pain-free during the surgery.
3. Incisions: The surgeon typically performs the procedure using minimally invasive techniques (laparoscopic[key hole] surgery). Small incisions are made in the abdomen, and a laparoscope (a small telescopic camera) and special surgical instruments are inserted.
4. Stomach Reduction: The surgeon cut and staple about 75-80% of the stomach, the staples help ensure that the stomach retains it’s new form. The remaining portions of the stomach is a narrow, banana-shaped tube. This reduction in stomach size restricts the amount of food the patient can consume, leading to weight loss.
5. Closure: The incisions are closed with subcutaneous stitches.
How Gastric Sleeve Works:
Reduced Stomach Size: By removing a significant portion of the stomach, the surgery limits the amount of food it can hold. This reduces the production of the hunger hormone ghrelin, helping patients feel full with smaller amounts of food.
Caloric Restriction: The primary mechanism of weight loss is caloric restriction. With a smaller stomach, patients consume fewer calories, leading to weight loss over time.
Benefits:
Effective Weight Loss: Gastric sleeve surgery often results in significant and sustained weight loss.
Improved Health: Many patients experience improvements in obesity-related health conditions such as type 2 diabetes, high bloodpressure, and sleep apnea.
Minimally Invasive: The laparoscopic approach reduces the size of incisions, leading to faster recovery and fewer complications compared to open surgery.
Risks and Considerations:
Complications: While generally safe, like any surgery, gastric sleeve carries risks such as infection, bleeding, or leakage at the surgical site.
Lifestyle Changes: Success with gastric sleeve requires significant lifestyle changes, including a modified diet and regular exercise.
Irreversible: The surgery is not reversible, as a portion of the stomach is permanently removed.
Post-Surgery:
Diet Progression: Patients typically start with a liquid diet and gradually progress to solid foods over several weeks.
Follow-Up Care: Regular follow-up appointments with healthcare professionals are crucial to monitor progress and address any concerns.
Gastric sleeve surgery is one of the various weight-loss surgeries available and is often recommended for individuals with severe obesity who haven’t achieved significant weight loss through other means. It’s important for individuals considering this procedure to thoroughly discuss the potential risks and benefits with their healthcare team.
Mini Gastric Bypass Surgery
Procedure:
The mini gastric bypass (MGB) is a type of weight loss surgery that shares similarities with the traditional Roux-en-Y gastric bypass (RYGB) but involves a simplified and shorter surgical procedure.
Preparation: Patients undergo a thorough evaluation, including medical tests, nutritional counseling, and psychological assessments, to determine their suitability for the procedure.
Anesthesia: The patient is placed under general anesthesia to ensure unconsciousness and pain relief during the surgery.
Incisions: Mini gastric bypass is typically performed using minimally invasive techniques (laparoscopic[key hole] surgery). Small incisions are made in the abdomen, and a laparoscope (a small telescopic camera) and special surgical instruments are inserted.
Stomach Division: The surgeon creates a small, tubular stomach pouch, similar to the one formed in traditional gastric bypass. However, in the mini gastric bypass, a longer portion of the stomach remains intact compared to the Roux-en-Y procedure.
Intestinal Bypass: Instead of creating a Roux limb and a biliopancreatic limb, the surgeon connects the small intestine to the newly formed stomach pouch at a point that is further down the intestinal tract. This allows for the bypass of a portion of the small intestine, reducing nutrient absorption.
Closure: The incisions are closed with subcutaneous stitches.
How Mini Gastric Bypass Works:
Restriction: The small stomach pouch limits the amount of food a person can eat, leading to a sense of fullness with smaller meals.
Malabsorption: Bypassing a portion of the small intestine reduces the absorption of calories and nutrients, contributing to weight loss.
Hormonal Changes: Similar to the traditional gastric bypass, the rearrangement of the digestive system alters hormonal signals related to hunger and satiety.
Advantages:
Simplicity and Shorter Procedure: The mini gastric bypass is generally simpler and quicker to perform than the traditional Roux-en-Y gastric bypass.
Effective Weight Loss: Many patients experience significant and sustained weight loss after the procedure.
Improvement in Obesity-Related Conditions: Like other weight loss surgeries,the mini gastric bypass can lead to improvements or remission of conditionssuch as type 2 diabetes, high blood pressure, and sleep apnea.
Considerations and Risks:
Lifestyle Changes: Success with mini gastric bypass requires significant lifestyle modifications, including dietary changes and regular exercise.
Nutritional Deficiencies: Reduced nutrient absorption may necessitate lifelong vitamin and mineral supplementation.
Surgical Risks: As with any surgery, there are potential risks, includinginfection, bleeding, and complications related to anesthesia.
Post-Surgery:
Diet Progression: Patients follow a gradual diet progression, starting with liquids and progressing to solid foods over several weeks.
Follow-Up Care: Regular follow-up appointments with healthcareprofessionals are crucial for monitoring progress, addressing complications,and providing ongoing support.
In summary, the mini gastric bypass is a weight loss surgery that involves creating a small stomach pouch and rerouting a portion of the small intestine. While it shares similarities with the traditional gastric bypass, it is distinguished by its simplified procedure and shorter operative time. Like other weight loss surgeries, it can be effective in promoting significant weight loss and improving obesity-related health conditions. Individuals considering this procedure should thoroughly discuss the potential risks and benefits with your healthcare team.
Roux-en-Y Gastric Bypass Surgery
Procedure:
Preparation: Patients undergo a thorough evaluation to assess their suitability for the procedure, including medical tests, nutritional counseling, and psychological assessments.
Anesthesia: The patient is placed under general anesthesia to ensure unconsciousness and pain relief during the surgery.
Incisions: RYGB is often performed using minimally invasive techniques (laparoscopic[key hole] surgery). Small incisions are made in the abdomen, and a laparoscope (a small telescopic camera) and surgical instruments are inserted.
Stomach Division: The surgeon creates a small stomach pouch, typically using staples, which restricts the amount of food a person can eat. This pouch is then disconnected from the rest of the stomach.
Small Intestine Reconstruction: The surgeon divides the small intestine and attaches the lower part (the jejunum) directly to the stomach pouch. The upper part of the divided small intestine is then reconnected to the lower part further down, forming a “Y” shape.
Food Bypass: This reconstruction bypasses a portion of the stomach and the upper part of the small intestine, leading to reduced calorie and nutrient absorption.
Closure: The incisions are closed with subcutaneous stitches.
How Roux-en-Y Gastric Bypass Works:
Restriction: The small stomach pouch limits the amount of food a person can eat, leading to a sense of fullness with smaller meals.
Malabsorption: Bypassing a portion of the small intestine reduces the absorption of calories and nutrients, contributing to weight loss.
Hormonal Changes: The rearrangement of the digestive system alters hormonal signals related to hunger and satiety.
Advantages:
Significant Weight Loss: RYGB often results in substantial and sustained weight loss.
Improvement in Obesity-Related Conditions: Many patients experienceimprovements or remission in conditions such as type 2 diabetes, high bloodpressure, and sleep apnea.
Long-Term Success: RYGB has demonstrated long-term effectiveness in weight management for many patients.
Considerations and Risks:
Lifestyle Changes: Success with RYGB requires significant lifestyle modifications, including dietary changes and regular exercise.
Nutritional Deficiencies: Reduced nutrient absorption may lead to the need for lifelong vitamin and mineral supplementation.
Surgical Risks: As with any surgery, there are potential risks, including infection, bleeding, and complications related to anesthesia.
Post-Surgery:
Diet Progression: Patients typically start with a liquid diet and gradually progress to solid foods over several weeks.
Follow-Up Care: Regular follow-up appointments with healthcare professionals are crucial for monitoring progress, addressing potentialcomplications, and providing ongoing support.
RNY Gastric bypass is a well-established and effective procedure, but it is essential for individuals considering it to thoroughly discuss the potential risks and benefits with your doctor.
SASI-S Bypass Surgery
SASI-S is a modification of the Omega loop or mini gastric bypass, combining features of sleeve gastrectomy and intestinal bypass. Unlike traditional procedures, the sleeved stomach is not divided, and the food stream is partially diverted from the duodenum and proximal small bowel. The remnant stomach is completely removed. This surgery results in reduced appetite and enhanced weight loss by combining the benefits of both sleeve and bypass procedures.
How It Works:
Sleeve gastrectomy removes 65-70% of the stomach, reducing capacity and ghrelin (hunger hormone).
Intestinal bypass redirects the food stream from the antrum (bottom part of the sleeved stomach) to the ileum (lower part of the small bowel).
This reduces absorption of fats, sugar, and calories, triggering the release of “intestinal brake hormones” that signal fullness to the brain.
Desired weight loss is achieved by varying the length of small bowel bypassed.
Advantages:
Greater weight loss compared to standard sleeve gastrectomy or traditional Roux en Y Gastric bypass.
Combines benefits of sleeve and bypass, impacting Type 2 diabetes and cholesterol.
Potentially less weight regain than a sleeve in the medium term.
Reduced risk of staple line leaks and reflux; improved gastric emptying.
Lower risk of long-term nutritional deficiencies compared to some other procedures.
Reversible to a simple sleeve by stapling across the join.
Disadvantages and Risks:
Increased risk of bile reflux into the stomach.
Risk of ulcers at the join(stomach-small intestine anastomosis), especially in smokers.
Potential risks include staple line leaks or bleeding, nutritional deficits,and bile reflux.
In conclusion, SASI-S appears to offer significant advantages in terms of weight loss and metabolic improvements while addressing some concerns associated with other bariatric procedures. However, like any surgical intervention, it comes with specific risks and considerations that should be carefully weighed and discussed with healthcare professionals.
