Weight loss surgery is also known as bariatric or metabolic surgery. These terms are used to show its positive effect on patients’ weight loss and the improvement of their metabolism (the process of converting food into energy). In addition to the ability to cure obesity, bariatric surgery methods are very effective in combating diabetes, hypertension, sleep apnea, hypercholesterolemia, etc. They can also prevent future health problems. The benefits of bariatric surgery allow obese patients who choose to undergo the treatment to improve their quality and life expectancy.
Today, the bariatric and metabolic surgery is one of the most studied treatments in medicine. The procedures are performed using minimally invasive methods (laparoscopic, robotic), that reduce postoperative pain, the number of complications and hospitalizations and contribute to faster recovery. These operations are quite safe, and the likelihood of complications does not exceed the usual number of complications in operations such as laparoscopic cholecystectomy, hysterectomy or hip replacement.
The goal of bariatric surgery is to change the shape or volume of the stomach and of the small intestine, to treat obesity and related diseases.
During surgery you can reduce the capacity of the stomach and bypass a part of the small intestine. As a result, the amount of food consumed is reduced, and the absorption of nutrients occurs with a decrease in the feeling of hunger.
The following bariatric surgical procedures (I.F.S.O.) are currently recognized:
- Sleeve gastrectomy
- Roux-en-Y gastric bypass
- Adjustable gastric band
- Biliopancreatic diversion with duodenal switch (BPD/DS)
- Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S)
Sleeve gastrectomy
1. Laparoscopic vertical gastrectomy, also often called sleeve gastrectomy, involves the removal of up to 80% of the stomach after a vertical separation along the lesser curvature of the stomach, using laparoscopic trocars and scissors.
2. How it works
The new stomach holds less food and liquids, which helps reduce the amount of calories you eat. Removing the part of the stomach called the dome, where the hunger hormone (ghrelin) is produced, has a metabolic effect. The gastric sleeve reduces hunger, enhances satiety, and helps maintain body weight and blood sugar levels within normal limits. The operation is relatively simple to perform, and the number of complications during its implementation is minimal.
3. Advantages
- Technically simple and fast operation.
- Can even be performed on high-risk patients.
- It can be carried out as the first stage in the fight against severe obesity.
- As a result – there is significant weight loss and improvement or even cure of some concomitant diseases.
4. Disadvantages
- Technically more difficult than the gastric band.
- It is a possible cause of the dumping syndrome, especially after consuming sugars.
- Temporarily increased hair loss.
- The likelihood of gastroesophageal reflux.
Adjustable gastric band
1. An adjustable gastric band is a special silicone device that is placed around the stomach, just below the gastroesophageal junction, to limit the amount of food you eat. Applicable since 2001. Compared to other methods it is less effective in combating obesity and for long-term weight loss. Over the past decade, the frequency of use of the technique has dropped dramatically.
2. How it works
The feeling of satiety depends on the size of the opening between the pouch of the stomach and the rest of the stomach, which is regulated by the introduction of fluid to the valve (port).
3. Advantages
- Extremely low incidence of postoperative complications.
- No parts of the stomach or intestines are crossed or removed.
- One day operation.
- The gastric band can be easily removed if necessary.
- Low levels of vitamin and mineral deficiencies.
4. Disadvantages
- Frequent doctor visits are required to adjust the ring, especially during the first year.
- Slower weight loss compared to other surgeries.
- Possible ring movement (slipping) or abdominal erosion over time.
- High reoperation frequency.
- Possible problems with swallowing and with the esophagus.
Biliopancreatic diversion with duodenal switch (BPD/DS)
1. This method begins with the creation of a gastric “sleeve” as in a standard gastric sleeve. Then it bypasses most of the small intestine, which is not involved in the active absorption process.
2. How it works
A smaller banana-shaped stomach allows the patient to eat less food. The passage of food bypasses about 75% of the small intestine. As a result, the amount of digestible nutrients and calories is significantly reduced. After surgery, patients should take vitamin and mineral supplements.
3. Advantages
- More effective in combating obesity.
- The surgery affects the gut hormones and causes less hunger and faster satiety.
- The most effective treatment for type 2 diabetes.
4. Disadvantages
- Higher incidence of operation related complications.
- Increased malabsorption and deficiency of vitamins and minerals.
- Increased diarrhea.
- Technically more complicated and time-consuming operation.
Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S)
1. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy, known as SADI-S, is a newer procedure. The operation is similar to biliopancreatic bypass surgery, but it is simpler and takes less time to complete, since only one connection of the digestive tract (anastomosis) is performed. The procedure begins with a sleeve gastrectomy, creating a gastric sleeve. The duodenum is divided just after the stomach, and the end of the small intestine, about 80-100 cm in size, is attached to the stomach (anastomosis).
2. Advantages
- More effective in combating obesity and type 2 diabetes.
- Technically easier and faster than biliopancreatic bypass surgery.
3. Disadvantages
- vitamin and mineral deficiencies.
- A relatively new methodology with insufficient data to track long-term results.
- Possibility of complications or recurrence.