Bariatric surgery: what it is, types, advantages and risks

Bariatric surgery is a set of surgical techniques used to treat excess weight, where the digestive system is altered in order to reduce the amount of food that enters the body and to modify the natural digestion process, facilitating the loss of weight and improving or curing diseases associated with obesity.

There are several surgical techniques which can be restrictive or restrictive and malabsortive at the same time. Restrictive techniques will only reduce the amount of food you eat because the volume of the stomach is reduced. In the case of restrictive and malabsortive techniques, in addition to decreasing the size of the stomach, the intestine is also modified to reduce the absorption of nutrients, thus decreasing the calories that enter the body.

Being a type of invasive surgery, bariatric surgery is only indicated when the person has already tried to lose weight using other methods without obtaining any results, or when excess weight puts the life of the individual in danger.

Who can be a candidate for this surgery
Bariatric surgery is indicated in people with grade II obesity who have not been able to obtain weight loss results, after several months, through nutritional treatment and regular physical activity.

To find out if an individual is a candidate or not for this surgery, the surgeon indicates a series of medical evaluations, as well as a rigorous control with a multidisciplinary team comprised of a nutritionist, psychologist, endocrine, among others, and is only carried out when all these specialists indicate that individual is prepared for the procedure.

This surgery is indicated in people between the ages of 16 and 65, being indicated according to the American Association of Metabolic and Bariatric Surgery (ASMBS) in individuals with:

BMI equal to or greater than 50 kg / m²;
BMI equal to or greater than 40 kg / m², without associated comorbidities;
BMI equal to or greater than 35 kg / m² and the presence of 1 or more associated comorbidities such as hypertension, hyperlipidemia, obstructive sleep apnea, hypoventilation syndrome, fatty liver, asthma, gastroesophageal reflux, urinary incontinence, debilitating arthritis, diabetes, metabolic syndrome , among other.
Likewise, the ASMBS indicates some cases in which bariatric surgery is contraindicated such as substance abuse or suffering from a poorly controlled psychiatric illness, suffering from bulimia nervosa, use of alcoholic beverages, uncontrolled heart or lung diseases, portal hypertension with varicose veins esophageal, inflammatory diseases of the upper digestive tract or suffer from cancer Cushing syndrome.

Main advantages
In addition to significant weight loss, bariatric surgery also improves diseases associated with obesity, improving or curing diseases such as:

Arterial hypertension;
Heart failure;
Respiratory insufficiency;
High cholesterol.
This surgery also provides improvements at a social and psychological level, reducing the risk of depression and helping to increase self-esteem, social interaction and physical mobility.

Types of bariatric surgery
The type of surgery to be performed is chosen by the surgeon taking into account the medical conditions of each individual. These surgery can be performed through a normal cut in the abdomen or by videolaparoscopy, the latter being the most used technique, because only a few small holes are made during the surgery to introduce the medical instruments. The types of bariatric surgery are:
1.Gastric band
This is the type of restrictive and less invasive bariatric surgery, it consists of placing a silicone band with an inflatable ring around the stomach, reducing its size and at the same time the amount of food that the individual ingests, thus reducing the calories that enter the body.

Usually, this type of surgery has fewer health risks and the recovery time is faster, however, its results are less satisfactory since once the band is removed, the size of the stomach returns to normal.
2.Gastric bypass
The gastric bypass, also called, Roux Y gastric bypass, is an invasive surgery where a restrictive and malabsortive technique is used, because the doctor removes a large part of the stomach, leaving only a small portion of about 30 mL capacity, which connects the second portion of the small intestine called jejunum, reducing not only the amount of food ingested but also decreasing the surface of absorption of nutrients.

This type of surgery has excellent results, allowing you to lose up to 70% of the initial weight, however, it has more risks and its recovery is slower. In addition to this, when creating nutrient malabsorption, it requires rigorous control with a nutritionist to supplement the vitamins and minerals that may be affected, as well as monitor the weight loss process very cautiously.
3.Gastric sleeve
The gastric sleeve, also called vertical gastrectomy, is a type of restrictive bariatric surgery where, unlike gastric bypass, the natural connection of the stomach to the intestine is maintained but a part of the stomach is removed, this in order to reduce its size and in turn the amount of food that is ingested, thus favoring weight loss.

This surgery has fewer risks than bypass, but the results are less satisfactory, allowing you to lose about 40% of the initial weight, being very similar to the gastric band.
4.Biliopancreatic bypass
This surgery is the least frequent, applying both a restrictive and malabsortive surgical technique, a gastric sleeve is performed first, leaving the stomach in the form of a tube and a large part of the small intestine is removed, reducing the absorption of nutrients and therefore the calories that enter the body.

However, although a large part of the small intestine is removed, bile continues to be released in the first portion of the small intestine, which is then connected to the final portion of the small intestine, so as not to interrupt the flow of bile.

This technique, like gastric bypass, has excellent results, however, it can cause malnutrition and vitamin deficiency, so it is important to have a rigorous control with a nutritionist.
Possible risks of surgery
The risks of bariatric surgery are associated with the severity of the diseases presented by the individual, so the main complications are:

Pulmonary embolism, which is the blockage of a blood vessel in the lung, causing severe pain and difficulty breathing;
Internal bleeding in the region where the surgery was performed;
The formation of a fistula, which is an abnormal connection between two organs, originating mainly where resection was performed at the intestinal level;
Vomiting, diarrhea and bloody stools.
Usually, these complications usually arise during the hospital stay and are quickly resolved by medical staff. However, depending on the severity of the symptoms, a new operation may be necessary to correct the problem.

In addition, it is common that after bariatric surgery patients have nutritional complications such as anemia, folic acid deficiency, calcium and vitamin B12. In addition, severe malnutrition can also occur, in case regular control with the nutritionist is not maintained.

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