Bariatric Surgery

Bariatric Surgery

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Overview

One of the most prime keys to a healthy lifestyle is the ideal weight. Being overweight may lead to many health issues that may have a serious effect on daily activities. When people try to attain ideal weight with the help of dieting and exercise but fail, the role of weight loss surgery comes into play. Weight loss surgery is also known as bariatric surgery.

What is bariatric surgery?

Bariatric surgery is the common term used collectively for various weight-loss surgeries. These surgeries make some changes to your digestive system to help you lose weight. Some procedures work by limiting how much you can eat and other activities by reducing the body's ability to absorb nutrients. Some methods do both. Most surgeons prefer gastric bypass due to less complications than other weight-loss surgeries do.

Why is Bariatric surgery done?

Some of the indications where your doctor may suggest you go for bariatric surgery are:

  • People with BMI >37.5 without the presence of any obesity-related co-morbidities
  • People with BMI > 32.5 with the presence of type 2 Diabetes / any obesity-related comorbidities
  • Patients who want to lose weight and are committed to long term follow up
  • A patient who attempted conservative methods of weight loss and failed

What are the types of Bariatric surgery?

  • Biliopancreatic diversion or duodenal switch (BPS/DS).: This weight loss surgery is a less common method. The first step of BPS/DS is sleeve gastrectomy, where about 80 percent of the stomach is removed, leaving a smaller tube-shaped stomach. The pyloric valve remains intact (which releases food to the small intestine), along with a limited portion of the small intestine that usually connects to the stomach (duodenum). The second step diverts most of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS reduces the absorption of nutrients, including proteins and fats, and limits how much you can eat. While a BPD/DS is very effective, it has more risks, including vitamin deficiencies and malnutrition. It is usually suggested for people with a body mass index (BMI) of more than 50.
  • Endoscopic sleeve gastroplasty: This procedure is one of the latest weight loss surgery. This surgery is less invasive and has fewer complications. The stomach size of the patient is reduced with the help of the endoscopic suturing device. This procedure limits the intake of food.
  • Gastric bypass (Roux-en-Y gastric bypass): It is the most common procedure for weight loss. This procedure creates a small pouch from the stomach and connects directly to the small intestine. After the surgery, food swallowed will go into this small pouch of the stomach and then into the small intestine directly, bypassing most of your stomach and the first section of your small intestine.
  • Intragastric balloon: In this procedure, a saline-filled balloon made of silicon is fixed in the stomach, and this helps in losing weight as patients feel full even after a small meal.
  • Sleeve Gastrectomy: It is also known as vertical sleeve gastrectomy. With the help of a small instrument, multiple incisions on the upper stomach are made. About 80% of the stomach is removed. Hormonal changes are induced in this procedure to help in weight loss.

How to prepare for Bariatric surgery?

Once you have been qualified for the surgery, take the time to plan and prepare for surgery. Making a lifestyle change is an essential component of the surgery as it will help you even after the procedure. Talk to your doctor and dietician for a preoperative diet that will help in reducing the size of your liver. The diet will be high in protein and low in carbohydrates, leading your body to use your excess fat as energy.

Some other changes include:

  • Smoking cessation
  • Quitting or limiting alcohol intake
  • Involve in some form of exercise
  • Taking a multivitamin
  • Changing your eating habits

What happens after Bariatric surgery?

On average, patients spend 2-5 days in the hospital following bariatric surgery or maybe longer in case of complications. Patients who underwent laparoscopic bariatric surgery usually have a shorter stay in the hospital. Once you are shifted to the room, you will be closely monitored by the doctor and nurses. Generally, you won't be allowed to eat for 1-2 days so that your digestive system and stomach can heal. You may experience nausea, vomiting, excessive fatigue, pain, etc. For these problems, you may be given medications. If something else is bothering you, please consult the doctor. You will be discharged once your doctor feels you are stable.

What happens after discharge?

Your doctor and physiotherapist must have given you home care advice and taught you exercises to practice at home. You'll have to follow a specific diet routine for a few weeks. The diet initially with liquids only, then progress to pureed, soft foods, and eventually to regular foods. You may have to follow many restrictions on what and how much to eat. You'll also have frequent follow-up and medical check-ups to monitor your health in the first few months after weight-loss surgery. Usually, most patients return to their usual activities 3-5 weeks after surgery. However, it may also depend on your physical condition before your surgery and the complexity of your operation.

What are the risks and complications related to Bariatric surgery?

  • Excessive bleeding
  • Infection
  • Adverse reactions to anesthesia
  • Blood clots
  • Lung or breathing problems
  • Leaks in your gastrointestinal system
  • Bowel obstruction
  • Dumping syndrome, leading to flushing, diarrhea, light-headedness, nausea, or vomiting
  • Hernia
  • Gallstones
  • Malnutrition
  • Low blood sugar (hypoglycaemia)
  • Vomiting
  • Ulcers
  • Acid reflux
  • The need for a revision or second surgery or procedure
  • Death (rare)

What is the outcome of Bariatric surgery?

Bariatric surgeries can provide long-term weight loss. However, the weight you lose depends on the type of surgery you have undergone and your lifestyle changes. Apart from weight loss, gastric bypass surgery may resolve or improve conditions often related to being overweight, including:

  • Heart disease
  • High blood pressure
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH)
  • Osteoarthritis (joint pain)
  • Gastroesophageal reflux disease (GERD)
  • Gastric bypass surgery also improves your ability to perform routine daily activities, which could help improve your quality of life.

What is the role of diet in bariatric surgery?

Behavior changes and lifestyle changes are the significant factors on which the success of bariatric surgery depends. The patient should rigorously follow the diet plan and lifestyle modification suggested by their doctor.

  • Diet Before Surgery: Your doctor may recommend weight loss before surgery as it helps in reducing excess fats around the liver and the abdomen region, reducing the chance of any complications. If you do not hit the suggested weight goal, the doctor might choose to delay the procedure.
  • Diet plan before surgery: Diet plan varies from patient to patient and depends on weight loss surgery. Cut down on high sugar beverages and avoid binge eating high carbohydrate foods and saturated fats. Take daily recommended multivitamin supplements,
    • Diet Plan after surgery: The diet plan post-surgery may go on for several stages as suggested by the dietician and doctor.
    • Stage 1- Liquid diet: In the initial days, the diet plan will only focus on liquids. The liquid diets may include skimmed milk, soup, broth, unsweetened juices, decaffeinated coffee or tea, sugar-free gelatin, etc.
    • Stage 2-Pureed diet: At this stage of the diet plan, pureed food will be included. Food can be blended into a puree-like consistency. It is recommended to have seedless fruits like bananas, pineapple, melons, etc., and avoid fibrous vegetables and spicy food. The dietician may also suggest pureed vegetables such as spinach, tomato, carrots, and green beans.
    • Stage 3-Soft diet: At this phase, the doctor will recommend you to start with food that is soft and easily chewable, like boiled eggs, scrambled eggs, cottage cheese, whitefish.
    • Stage 4-Stabilization: At this stage, solid food can be introduced. This stage usually starts only after two months. It is recommended to break the food into small pieces and chew well. It is preferable to introduce the solid food slowly so that stomach tolerance can be noted. Food that can be included at this stage is popcorn, fried food, crunchy food, dried food, tough meat, bread products.

How to take care of your food habits post-op diet?

Post-surgery, you may have to follow certain guidelines throughout life and adapt to specific lifestyle changes. It is always preferable to prepare your meals at home and carry them along to avoid consuming unhealthy food.

Below are some of the guidelines you will have to follow lifelong after the procedure.

  • Drink and eat slowly and pace yourself at each meal
  • Portion control is important
  • Pay attention to your body if it shows any signs of problem or discomfort
  • Cut down food rich in saturated fats
  • During meals, avoid intake of beverages, especially sweetened ones
  • Stay hydrated
  • Chew food properly and break it down into smaller pieces

What lifestyle changes to adapt after Bariatric surgery?

Avoid exercising immediately after surgery. Simple activities like simple yoga, stretching, deep breathing exercises are recommended.

Some tips:

  • Frequent and small meals: Eating large meals can develop problems. Eating smaller meals can be a challenge.
  • Commit to good nutrition: Ask a dietitian to help you create a plan to get you all the nutrients you need.
  • Exercise regularly: Keep yourself involved in physical activities like yoga, gym, etc., as these can help you stay active.

How to deal with loose skin?

  • Fat-burning exercises: Once your doctor approves, you may plan an exercise program best suited for you with the help of your physiotherapist. You can also start doing walking, running, cycling once your body is healed.
  • Diet: Avoid food that helps in muscle gain. Focus on food items like whole grains, berries, cashews, nuts, etc.
  • Opt for surgical procedures: There are different surgical options available that remove the excessive skin like facelift, breast lift, tummy tucks, etc. Discuss with your doctor in case you want to undergo surgical procedure.

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