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| Patient after having a bariatric surgery |
Such a procedure aims at reducing the size of the stomach which is achieved by using a gastric band, removing a part of the stomach or redirecting the small intestines to a small pouch inside the stomach.
According to the US National Institutes of Health, one must undergo bariatric surgery only if their body mass index (BMI) is 40 and above though it is also recommended to people who have a BMI of 35 but also suffer from other medical conditions like diabetes. There are a number of procedures for bariatric surgery and they are grouped in three categories.
Different Procedures that Constitute Bariatric Surgery
Predominantly malabsorptive procedures
These procedures reduce the size of the stomach but its effectiveness is also dependent on creating a physiological condition of malabsorbtion.
Biliopancreatic diversion (BPD)
Also known as Scopinaro procedure, BPD is not one of the common bariatric procedures. A portion of the stomach is resected and a smaller stomach is created after which the small intestine’s distal part is made to bypass the jejunum and duodenum to connect with the pouch. However a significant number of patients experience nutritional deficiency and malabsorption which is why they have to consume more dietary minerals and vitamins than the average population.
Without adequate supplementation, they are likely to suffer from a range of deficiency diseases like osteoporosis and anemia. The gall bladder is sometimes removed by the concerned surgeon so that the patient does not have to suffer from gall stones, which is a side effect of rapid weight loss.
Predominantly restrictive procedures
These procedures are solely restrictive as they decrease oral intake and limit gastric volume thus producing early gratification and leaving the alimentary canal in continuity.
Vertical banded gastroplasty
Also known as stomach stapling or Mason procedure, this procedure permanently staples a part of the stomach so that a smaller pre-stomach pouch can be created. This pouch then serves as the new stomach.
Adjustable gastric band
The size of the stomach can also be reduced by using a silicone band. Also known as a lap band, this procedure can be performed laparoscopically and is considered to be very safe.
The small gastric pouch and narrow outlet achieved by this bariatric surgery leads to the restriction of nutrient intake which leads to weight loss.
Sleeve gastrectomy
Also known as gastric sleeve, this procedure reduces the stomach to fifteen percent of its original size by surgically removing a large part of the stomach. Surgical sutures or staples are then used to attach the open edges. This irreversible procedure is also performed laparoscopically.
Intragastric balloon
In this bariatric surgery, a deflated balloon is placed inside the stomach and then filled up to reduce space inside. It is known to cause significant weight loss in only six months in most patients though the procedure is not approved by the FDA. However, obese people in Canada, Australia, India, Mexico and most European and South American countries can consider this as a viable option for weight loss.
Gastric plication
This procedure is a variation of the more popular sleeve gastrectomy and it reduces the volume of the stomach so that small quantities of food can offer the same kind of gratification. However it does not make use of staples and sutures like sleeve gastrectomy and is thus considered less complicated.
Mixed procedures
Mixed bariatric procedures make use of both predominantly malabsorptive procedures and predominantly restrictive procedures simultaneously.
Gastric bypass surgery
Here, a stapler device is used to create a small stomach pouch that is connected to the distal small intestine after which the upper part of the intestine is attached in a y-shape. It is the most commonly performed surgery for weight loss in the United States. However the roux en-y procedure does lead to malabsorption and dumping syndrome which most patients cannot deal with unless they adhere to a very strict diet.
Sleeve gastrectomy with duodenal switch
In this procedure, the stomach is tubulized with a volume of only 150 milliliter which ensures the patient cannot take in too much food. It is an irreversible surgery and disconnects the stomach from the duodenum to connect it to the distal part of the small intestine. The upper part is then attached to the duodenum ten centimeters from the colon.
Implantable gastric stimulation
In this bariatric surgery, a device like the heart pacemaker is placed inside the stomach. The electrical leads stimulate the outer surface of the stomach that helps to modify the functioning of the enteric nervous system making the stomach feel fuller than usual.
Diet after Bariatric Surgery
Right after bariatric surgery, the patient is restricted to only a clear liquid diet – diluted fruit juices, clear broth and sugar-free gelatin sweet dishes, till the gastrointestinal tract has healed significantly. The next stage requires the patient to eat only a pureed or blended sugar-free diet for a fortnight. During this time the person can consume cream of wheat, skimmed milk, protein drinks, margarine, pureed fruit, cream soup and mashed potatoes.
Patients cannot eat excessively after bariatric surgery as the reduced capacity of the stomach causes a sense of nausea and vomiting. Sometimes, the doctor may prescribe multivitamin pills to compensate for the sudden drop in nutrient intake. While a high protein diet is recommended, patients must refrain from consuming fats and alcohol after a bariatric surgery.
Adverse Effects of Bariatric Surgery
Weight loss surgeries often lead to certain deficiencies. Gastric dumping syndrome, incisional hernia, infections and pneumonia are among the common adverse effects. Due to lessened calcium absorption, metabolic bone disease may manifest itself as secondary hyperparathyroidism and ostopenia that could cause the patient to easily suffer fractures.
Gall stones have also been linked with rapid weight loss and the patient's kidneys may suffer from adverse effects of the surgery as well. A deficiency of micronutrients such as vitamin B12, iron, thiamine, fat soluble vitamins and folate may lead to seizures and other health problems.
Financing a Bariatric Surgery
While some insurance companies do cover the cost of bariatric surgery, patients have to often witness them cringing as the procedure is rather expensive. To get insurance, a person must provide the company with his weight-loss history and a letter of appeal so that they consider financing it.
In case, an insurance company refuses to pay, the patient should appeal again as most insurance companies give their clients an opportunity to appeal a denial. In case the letter of appeal does not work either, the patient can try approaching an attorney to prove the necessity of the surgery.
If a patient has no insurance, he could approach one of the many financial institutions that offer to pay for healthcare expenses like deductibles, co-payments and procedures left out by insurance. Some bariatric surgery centers also tie up with finance companies that offer assistance to patients who have no insurance but need financial help for their surgical procedure. If all else fails, a patient can consider taking out a home equity loan to finance their operation.
References:
1. BSIG, "Bariatric Surgery: A Detailed Overview". Retreived 13 Feb 2013. Web. BariatricGuide.
2. Medline Plus: Weight Loss Surgery - http://www.nlm.nih.gov/medlineplus/weightlosssurgery.html
3. Wikipedia: Bariatric Surgery - http://en.wikipedia.org/wiki/Bariatric_surgery
4. News Medical: What is Bariartic Surgery - http://www.news-medical.net/health/Bariatric-Surgery-What-is-Bariatric-Surgery.aspx
5. Ezine Articles: Financing a Bariatric Surgery - http://ezinearticles.com/?Financing-a-Bariatric-Surgery&id=68703
6. Albgomi, Bandar. "Gastric Sleeve Surgery - Sleeve Gastrectomy". Retreived 14 Mar 2012. Web. BSIG. http://www.bariatricguide.org/what-is-gastric-sleeve-surgery-or-sleeve-gastrectomy/.
