Manipal Hospitals

What is Weight Loss Surgery?

Weight loss surgery aims at helping you lose weight in a healthier way. Weight loss surgery changes the internal hormonal environment in a favourable way so that the body stores less fat and utilizes more. There is a marked reduction in hunger, increase in energy levels and the preference for foods that lead to weight gain is automatically reduced. It changes the weight “set point” to a lower, healthier level. After that the body physiology takes over and the person starts losing weight automatically. It is, therefore, the only effective and durable option to treat severe obesity when a person has not been able to lose enough weight using the other methods.

There are two commonly followed methods of operations; one is called Restrictive Surgery and the other is called Malabsorptive Surgery. In Restrictive Surgery the stomach is made smaller, which decreases hunger hormones and improves satiety. In Malabsorptive Surgery, in addition to making the stomach smaller, a part of the small intestine is bypassed, which gives additional benefit in controlling diabetes, high cholesterol etc. Both these operations have a favourable effect on the person’s metabolism.

Different types of weight loss surgeries-

There are a number of surgeries available for weight loss. Some of them are purely Restrictive and some are a combination of Restrictive and Malabsorptive surgeries. The various types of surgeries are

  • Lap Band -
  • An adjustable silicon "band" is placed around the beginning of the stomach to create a small pouch (typically 30-50 ml) to provide an early feeling of fullness. This band is gradually released into the rest of the intestine. This restrictive procedure provides moderate amount of weight loss (50% of excess weight loss) and is reversible. The band should be adjusted in the initial days after surgery to prevent any complications. It is normal for some people to regain some of the lost weight after a few years. The advantage is that it can be reversed by removing the band by another surgery.

  • Lap Sleeve Gastrectomy -
  • This kind of weight loss surgery involves removal of a large portion of the stomach which induces the remaining stomach to form a narrow tube of 100-150 ml. This leads to a marked reduction in hunger and fullness after a small meal. It has been shown to provide good weight loss (60% or more of excess body weight) with minimal side-effects. It also causes remarkable improvement in many obesity related diseases like diabetes, high BP, respiratory problems etc. Vitamin and mineral supplements may be required after the operation depending upon your condition and lab results.

  • Lap Gastric Bypass -
  • Also called Lap Roux-en-Y Gastric Bypass, it is the "Gold Standard" and has withstood the test of time. In this procedure a small (30-ml) pouch of the stomach is created and joined to the intestine, bypassing a variable length of the intestine. Thus it restricts the capacity of the stomach AND bypasses the digestive tract. This procedure results in good weight loss (60% - 70% of excess body weight) but is associated with more nutritional problems. Hence a close follow-up with your doctor is required and you may be required to take vitamin and mineral supplements for a long period of time.

  • Lap Biliopancreatic diversion (BPD-DS) -
  • This procedure is called Bilio-pancreatic diversion with duodenal switch. It provides the maximum weight lossbut is associated with the highest number of problems after the operation, many of them being nutritional. Supplements are required life-long and close follow-up is essential. It is also a difficult procedure to perform. Hence it is reserved for extremely obese individuals. It may sometimes be performed in two stages to reduce the risk.

  • Lap Mini Gastric Bypass -
  • This procedure is a variation of the standard gastric bypass. It is easier to perform and has been shown to give good weight loss. However its long-term effects and problems have not yet been ascertained. Therefore, this procedure does not form a part of the standard Bariatric Surgery procedures.

  • Balloon -
  • Also called Intragastric Balloon Placement, in this procedure a silicone balloon is placed inside the stomach and filled with 1-1.5 litres of saline water resulting in reduction of hunger and early feeling of fullness. The balloon can be left inside for one year after which it is either removed or a new one is placed. This is not a permanent solution as removal of the balloon usually results in the appetite coming back to normal. As a result weight is also gained again. It is usually used in individuals who have a prohibitively high risk for surgery. Once some weight is lost and the patient becomes fit for surgery, a definitive procedure is performed.

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