Weight Loss Surgery - Which one should I choose?

Weight loss surgery, also known as bariatric surgery, helps an obese patient to lose weight to lower his/her risk to medical issues associated with excess body weight."Every 10 KG increase, reduces the life span by 3 years" says Dr. Pradeep Chowbey, Vice Chairman of Max Healthcare and Director of Institute of Minimal Access, Metabolic and Bariatric Surgery. Weight loss surgeries work on two basic principles to help with weight loss in different ways:

1. Restriction - This kind of surgery physically limits the amount of food that can be kept in the stomach and slows down digestion, which further limits the amount of calories consumed. Less a person eats, more weight is lost.
2. Mal-absorption - This form of surgery shortens or bypasses a section of the small intestine to reduce calorie and nutrient absorption by the body. These are more invasive type of weight loss surgeries.

Type of Weight Loss Surgery

Four common types of weight loss surgery are:

1. Adjustable gastric banding
2. Gastric bypass surgery
3. Sleeve gastrectomy
4. Duodenal switch with biliopancreatic division

Adjustable gastric banding Gastric banding is the least invasive, restrictive form of weight loss surgery. It involves the use of an inflatable band to squeeze the stomach into two sections - a smaller upper pouch and a larger lower section. While the two sections still remain connected, the passage between the two is very narrow, slowing down the movement of food from upper to lower section. Overall, gastric banding restricts the amount of food a patient can take in in one go before feeling too full or sick. Benefits

• The band is removable in case the person is unable to adapt to the restrictive gastric system.
• There is no need to take dietary supplements after the surgery.
• The risk of complications is low.
• Patients can experience dramatic improvement in other obesity-related conditions like high blood pressure and diabetes.

Drawback - Some people stand the risk of developing food intolerance, or experience slippage of band that requires another surgery for replacement. Gastric Bypass Surgery This is the most common type of weight loss surgery that combines both restrictive and mal-absorptive techniques. It is performed either as an open or minimally invasive surgery. The Roux-en-Y gastric bypass surgery requires a surgeon to create a small pouch at the top of the stomach where food will later collect. The small intestine is cut at a short distance below the stomach and connected to the newly added pouch. This allows food to directly flow from the pouch to the directed region of small intestine. The original portion of small intestine that is connected to the main stomach is reattached much further down to allow for the digestive juices from stomach to flow into small intestine. With this arrangement, only a small amount of food can be eaten at any given time, and the main absorption channel in small intestine is bypassed through a shorter route. Benefits

• More weight is lost in the first year as compared to gastric band surgery.
• Other health conditions related to obesity like diabetes and high blood pressure also see marked improvement.

Drawbacks

• Patients need to take dietary supplements for the rest of their lives.
• A blockage at the site of bypass is possible, and requires separate treatment.

Sleeve Gastrectomy This is a form of restrictive weight loss surgery that is usually done laparoscopically. About 75 per cent of the stomach is removed from the body, and the remaining part is formed into a tube-like structure that cannot hold much food. This section also produces the hormone ghrelin that regulates appetite and reduces the desire to eat. This surgery, however, does not affect the absorption of nutrients in the intestines. Benefits - This surgery is useful for patients who are too obese to undergo other types of surgeries given the safety concerns. Duodenal Switch with Biliopancreatic Diversion This surgery is a more complicated version of gastric bypass surgery in which as much as 70 per cent of the stomach is removed along with even more portion of the small intestine. The 'duodenal switch' surgery is a less extreme version of the original surgery.

The surgeon begins by removing a large part of the stomach.

The valve that releases food into the small intestine is left intact, along with the initial part of the small intestine known as the duodenum. Next, the middle section of the intestine is closed off and the last portion of the small intestine is attached directly to the duodenum (Duodenal switch). In this surgery, the separated portion of intestine is not removed from the body; rather it is reattached to the end of the intestine to allow bile and pancreatic digestive juices to flow in (bilopancreatic diversion). Overall, this surgery aims to bypass most of the small intestine and limit the absorption of nutrients and calories by the body. The smaller size of stomach further accentuates this effect. Benefits

• This surgery shows one of the best results among all weight loss surgeries.
• It is beneficial in addressing a serious obese condition where rapid weight loss is required.

Drawbacks

• The patient needs to take dietary supplements for the rest of his/her life.
• Diarrhoea and foul-smelling flatulence is common.

Which Weight Loss Surgery is my best option?

The right weight loss surgery for a patient depends on his/her current body type and health status. The patient and the doctor must discuss all parameters before deciding on the type of surgery. For example, a minimally invasive surgery is not possible on patients who are very obese or have had an abdominal surgery before. Also, weight loss surgery is recommended only in the following cases:

1. People with a body mass index (BMI) of 40 or more.
2. People with a low BMI of 35 to 40, but with serious health concerns linked with obesity such as type-2 diabetes, heart disease, sleep apnoea, and high cholesterol.
3. Patients who have tried to lose weight by other methods and have been unsuccessful.