BDC #27 - Bariatic Surgery: You better never have to undergo this one !!

Are you currently studying in medical degree, and/or considering which specialist you would like to be, maybe you could consider to become  a Bariatic Surgeon. It's a specialist in bariatic surgery.

WAIT !! What is it?!!

I can give you a hint... It's a type of surgical procedure which gains its popularity due to rapid increase of the number of people with overweight or obesity. 

Ouh yeah... I think you start to get a glimpse of idea. ^^

Practically bariatic surgery includes all procedures related to the attempt of reducing the size of the alimentary tract, such as the stomach or the intestines. You start thinking of gastric bypass surgery? YUP it's one of it.

Basically, in the major cases, overweight or obese people gain their weight due to the massive amount of food they munch each time. It literally expands their stomach capacity every time their overeat, thus the stomach and all of the digestive tract are getting larger and larger.

Based on the US National Institutes of Health recommends this surgery for people with BMI at least 40, and people with BMI 35 and serious complication (e.g. diabetes and high blood pressure). However, lately they reduce the limitation to people with BMI 35-40 with no comorbidities, or a BMI of 30-35 with significant comorbidities. Even, due to the alarming progression of the obesity, the ASMBS guidelines suggest the bariatic surgery to people with BMI more 30 with comorbidities. OK, in medical term, comorbidity is equal to complication. Let's say, if you have diabetes problem, you might have another problem, like heart failure, high blood pressure, blindness.. YUP !! Those are comorbidities. 

 

Image credit: Walter Pories, M.D. FACS.

The image above is the image of several surgical options.

Practically, the bariatic surgery is divided into 3 subtypes with several types of surgical options, as mentioned:

1. Predominantly restrictive procedures : primarily reduce the stomach size

•  Vertical Banded Gastroplasty: also called the Mason procedure or stomach stapling, a part of the stomach is permanently stapled to create a smaller pre-stomach pouch, which serves as the new stomach.
• Adjustable gastric band: stomach is restricted by using a silicone band, which can be adjusted by addition or removal of saline through a port placed just under the skin.  
• Sleeve gastrectomy : the stomach size is reduced to about 15% of its original size. Under a surgery, of a large portion of the stomach is removed, following the major curve. And then, the open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape. The procedure will permanently reduce the size of the stomach and is not reversible.
• Intragastric balloon : This surgery means to insert a deflated balloon into the stomach, and then filling it to decrease the amount of gastric space. The balloon can be left in the stomach for a maximum of 6 months and results in an average weight loss of 5-9 BMI over half a year. Though this procedure is not yet approved in the USA, the Intragastric balloon is approved in Australia, Canada, Mexico, India and several European and South American countries.

2. Predominantly malabsorptive procedures : although it also reduce the stomach size, but the surgeries are based mainly on creating malabsorption.  However, due to the high case of heavy malnourishment after the surgery, the popularity is remarkably decreasing.

•  Biliopancreatic diversion: This complex operation is also known as ''biliopancreatic diversion'' (BPD), or ''Scopinaro procedure''. This surgery is rare now because of problems with malnourishment. It has been replaced with the Duodenal switch, also known as the BPD/DS. Part of the stomach is resected, creating a smaller stomach (however the patient can eat a free diet as there is no restrictive component). The distal part of the small intestine is then connected to the pouch, bypassing the duodenum and jejunum. 
• Endoluminal sleeve: this procedure is still only performed on mice at present, It involves of placing a 10cm long impermeable sleeve into the intestine to block absorption of food in the duodenum and upper jejunum. A study at Massachusetts General Hospital Weight Center and Gastrointestinal Unit found that mice who had the surgery ate 30% less food and lost 20% more weight than counterpart mice, while blood glucose levels returned to normal levels in all mice who had the surgery.

3. Mix procedures : which apply both techniques simultaneously.  

• Gastric Bypass Surgery: A common form of is the Roux-en-Y gastric bypass. A small stomach pouch is created with a stapler device, and connected to the distal small intestine. The upper part of the small intestine is then reattached in a Y-shaped configuration. The gastric bypass had been the most commonly performed operation for weight loss in the United States. It has been considered as the "gold standard" in the U.S.A with a highly strict post-surgical adherence to a gastric bypass diet for healthier pattern of eating.

• Sleeve gastrectomy with duodenal switch: It is a variation of the biliopancreatic diversion includes a Duodenal switch. The part of the stomach along its greater curve is resected. The stomach is "tubulized" with a residual volume of about 150 ml. This volume reduction provides the food intake restriction component of this operation. This type of gastric resection is anatomically and functionally irreversible. The stomach is then disconnected from the duodenum and connected to the distal part of the small intestine. The duodenum and the upper part of the small intestine are reattached to the rest at about 75-100 cm from the colon. 
  (credit to the link above for the explanation)

• Implantable Gastric Stimulation: This procedure implants a device similar to a heart pacemaker, with the electrical leads stimulating the external surface of the stomach. The electrical stimulation is thought to modify the activity of the enteric nervous system of the stomach, which is interpreted by the brain to give a sense of satiety, or fullness. Early evidence suggests that it is less effective than other forms of Bariatric Surgery.

As mentioned before, Bariatic surgery is supposed to be the final effort to help overweight and obese people to lose weight. It is due to the fact that after the surgery, the patient will only get a highly restricted diet. Immediately after the surgery, the patient is only allowed to gulp only sugar-free clear liquid diet until the digestive tract is recovered. Afterward, the diet will get a little more solid with the addition with sugar-free salt-free dietary products, pureed fruit, and mashed potato (YAY !!!). But STILL, it's a baby food !!! Post-surgery, the patient will definitely vomit every time they overeat than the baby portion. They even have to take daily multivitamin pill for life to compensate the highly reduced absorption of essential nutrients. UWAH...it is definitely not nice !!!!

THAT IS WHY... I tell you guys, before it's too late, and we have to control our food intake. Even before we are suggested to undergo this surgery, imagine how hard is life with an overweight body??!! We don't have to have a superskinny body like super models, NO... it's also not healthy...

As long as we are in a proper balance of body proportion, it's GOOD !!

Stay healthy... stay in shape !!!!