Bariatric And Metabolic Surgery - When Should You go For It?

Bariatric surgery(weight loss surgery) includes a variety of procedures performed on people who have obesity. Metabolic surgery is defined as “a set of gastrointestinal operations performed with the intent to treat diabetes (diabetes surgery) and metabolic dysfunctions (which includes obesity). Over the past 5 years, the term “metabolic surgery” has become increasingly popular. In 2002, it was suggested that gastrointestinal surgery could be used with the primary intent to treat type 2 diabetes. The idea derived from the factor that the gastrointestinal tract is a major player in the regulation of glucose homeostasis.

In patients with a BMI above 35, surgical treatment of diabetes is now recommended by virtually all professional organizations.

Weight loss is achieved by:

1. Reducing the size of the stomach with agastric bandor through theremoval of a portion of the stomach
2. By resecting and rerouting the small intestineto a small stomach pouch.

Statistics

Long-term studies show that the procedures cause significant long-term loss of weight, recovery fromdiabetes, improvement in cardiovascular risk factors and a mortality reduction from 40% to 23%.

Indications for Bariatric Surgery

1. Excess body weight affecting the quality of life and restricting routine activities
2. Patients with a BMI of 40kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy
3. Patients who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea

Types of Bariatric Surgery

1. Vertical sleeve surgery
2. Gastric bypass surgery
3. Intragastric balloon surgery
4. Duodenal switch surgery
5. Lap band surgery

Eating Schedule After Bariatric Surgery

Immediately after bariatric surgery, the patient is restricted to a clear liquid diet until the gastrointestinal tract recovers from the surgery. This is followed by a blended diet for at least 2 weeks, consisting of a high protein diet and dairy products. Foods high in carbohydrates are usually avoided when possible during the initial weight-loss period. Many patients need to take a daily multivitamin pill to compensate for reduced absorption of essential nutrients.

Effectiveness of Surgery

• Weight loss
• Reduced mortality and morbidity
• Psychiatric/psychological health can improve after bariatric surgery

Adverse Effects of Surgery

1. Metabolic bone disease manifesting as osteopenia and secondary hyperparathyroidism
2. Rapid weight loss after obesity surgery contributing to the development of gallstones
3. Hyperoxaluria that can potentially lead to oxalate nephropathy and irreversible renal failure
4. Rhabdomyolysis leading to acute kidney injury and impaired renal handling of acid and base balance has been reported after bypass surgery
5. Nutritional derangements due to deficiencies of micronutrients

Complications of Bariatric Surgery

• Anemia
• Osteoporosis and bone degeneration
• Malnutrition
• Dumping syndrome
• Erosion
• Spleen injury
• Suture-line disruption
• Long-term nausea and inability to tolerate food
• Hernia
• Migration of the band
• Narrowing of the stomach outlet (stenosis)
• Leakage
• Ulcers
• Constipation
• Nutritional deficiencies
• Weight Regain