Bariatric Surgery Overview:


Bariatric surgery, also known as weight loss or metabolic surgery, involves procedures designed to help individuals with obesity achieve significant weight loss by altering the digestive system. These surgeries either reduce the size of the stomach or bypass parts of the digestive tract to limit food intake and nutrient absorption.


Indications:


  • BMI Levels: Bariatric surgery is generally recommended for individuals with a Body Mass Index (BMI) of 40 kg/m² or higher, or those with a BMI between 35-39.9 kg/m² who have obesity-related health conditions. For individuals of Asian descent, the threshold can be lower, with a BMI over 27.5 kg/m² being considered for surgery.

  • Health Comorbidities: Surgery is also indicated for those with a BMI of 30-34.9 kg/m² if they have metabolic diseases like type 2 diabetes, especially if these conditions are difficult to manage with lifestyle changes and medication alone.

  • Failure of Non-Surgical Methods: Patients must have tried and failed to achieve or maintain adequate weight loss through diet, exercise, and possibly medication.

  • Age Considerations: While primarily aimed at adults, bariatric surgery can be considered for adolescents with severe obesity and related comorbidities under specific criteria.


Types of Bariatric Surgery:


  1. Gastric Bypass (Roux-en-Y Gastric Bypass):

    • Involves creating a small stomach pouch and rerouting the small intestine to connect to this pouch, bypassing a portion of the stomach and the upper part of the small intestine. This reduces the amount of food a person can eat and limits calorie and nutrient absorption.

  2. Sleeve Gastrectomy:

    • About 80% of the stomach is removed, leaving a banana-shaped 'sleeve'. This restricts food intake by reducing stomach size and affects hunger hormones, leading to decreased appetite.

  3. Adjustable Gastric Banding:

    • An inflatable band is placed around the upper part of the stomach to create a small pouch. The band can be adjusted to control the rate at which food moves into the lower stomach, reducing food intake.

  4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS):

    • More complex, involving both a sleeve gastrectomy and a significant rerouting of the small intestine. This results in the greatest reduction in calorie absorption but requires lifelong nutritional monitoring due to potential malabsorption issues.

  5. Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S):

    • A variation of BPD/DS, it's simpler with one intestinal connection, offering significant weight loss with less risk of complications compared to traditional BPD/DS.


Each procedure has its own set of benefits and potential complications, and the choice depends on factors like the patient's overall health, weight loss goals, and the surgeon's expertise. Post-surgery lifestyle changes, including dietary adjustments, vitamin supplementation, and exercise, are crucial for long-term success.


For more detailed information on each procedure, indications, and patient outcomes, refer to the guidelines and studies from organizations like the American Society for Metabolic and Bariatric Surgery (ASMBS) and the Mayo Clinic.