Weight loss surgery, also referred to as Bariatric surgery,is performed to cause weight loss in severely obese people. This is performed by controlling the amount of food the stomach can hold, causing a combination of both gastric restriction and malabsorption. Bariatric surgical procedures also often result in hormonal changes. Bariatric surgery is performed when fat reduction methods such as diet management and physical exercise are not effective.
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Who Should Consider Bariatric Surgery?
The standard criteria for candidates going for bariatric surgery include:
- A candidate with a Body Mass Index(BMI) between 35-40 suffering from serious obesity-related health conditions such as diabetes mellitus, severe sleep apnea, cardiovascular disease, and hypertension,
- Previous unsuccessful attempts of weight loss with diet management and physical exercise,
- The candidate is overweight for more than 5 years
- The candidate is willing to make changes in lifestyle and eating habits
- The candidate is free from an auto-immune disease.
Basic Tests For Bariatric Surgery
- Thyroid Stimulating Hormone(TSH) Test: A TSH test is a test to measure the amount of Thyroid Stimulating Hormone(TSH) in the blood. TSH is produced by the pituitary gland located at the base of the brain which is responsible for regulating the amount of hormone released by the thyroid. A TSH test is often done to determine the cause of abnormal thyroid hormone levels and to screen for an underactive/overactive thyroid gland. The doctor can determine how well the thyroid is working by measuring the levels of TSH in the blood.
- Cortisol Level Test: A cortisol level test uses a blood sample for measuring the level of cortisol present in the blood. Cortisol is a steroid hormone released by the adrenal glands that regulate many processes throughout the body, including metabolism and the immune response. The cortisol level test checks if the cortisol production levels are either too high or too low. Certain diseases, such as Addison’s disease and Cushing’s disease, affect the amount of cortisol produced by adrenal glands. This test diagnoses these diseases and is a way to examine the functioning of the adrenal & pituitary glands.
Types of Bariatric Surgeries
The most common bariatric surgical procedures are:
- Gastric Bypass Surgery: In gastric bypass surgery, the stomach is divided into a larger lower remnant pouch and a small upper pouch. The small intestine is then rearranged to connect to both the upper pouch and lower pouch. A gastric bypass surgery causes a marked reduction in the functional volume of the stomach. Rerouting of the food stream results in gut hormone changes that reverses one of the primary mechanisms by which obesity induces type 2 diabetes and suppresses hunger.
- Sleeve Gastrectomy: Sleeve gastrectomy, also referred to as vertical sleeve gastrectomy, is a surgical procedure for weight loss that is typically performed laparoscopically. This involves the insertion of small instruments through multiple small incisions in the upper abdomen. During sleeve gastrectomy, about 80% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana. Limiting the size of the stomach restricts the amount of food consumed. Additionally, the procedure causes hormonal changes that help in weight loss and also help relieve conditions associated with being overweight, such as high blood pressure or heart disease.
- Adjustable Gastric Band: Adjustable gastric banding is a procedure where a band containing an inflatable balloon is placed around the upper part of the stomach and fixed in place. This results in a small stomach pouch above the band with a narrow opening to the rest of the stomach. A port is then placed under the abdomen skin which is then connected to the band by a tube. The balloon can be inflated or deflated, by injecting/removing the fluid through the port to adjust the size of the band. Gastric banding restricts the amount of food that the stomach can hold so that you feel full sooner. However, it doesn’t reduce the absorption of calories and nutrients.
- Biliopancreatic Diversion with Duodenal Switch(BPD/DS): A Biliopancreatic Diversion with Duodenal Switch(BPD/DS) is a weight-loss procedure that comprises two major steps. The first step is sleeve gastrectomy where about 80% of the stomach is removed, leaving a smaller tube-shaped stomach similar to the size and shape of a banana. However, the pyloric valve that releases food to the small intestine remains, along with a limited portion of the small intestine that normally connects to the stomach. The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS limits the amount of food consumption as well as reduces the absorption of nutrients, including proteins and fats. This procedure is generally recommended for people with a Body Mass Index(BMI) greater than 50.
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