Bariatric Surgery In India
Restrictive Procedures : - The Lap Gastric band
Restrictive weight loss surgery works by reducing the amount of food consumed at one time. The theory is simple; due to the restriction created, you feel satiated with small amounts of food and because of a smaller outlet, food stays in the stomach for a longer time. The net result is - a reduction in daily caloric intake without a feeling of deprivation.
Procedure: - Entails laparoscopic implantation of a Silastic band around the stomach just below the gastro-esophageal junction to section off a small portion called as stomach pouch creating an hour-glass effect. A small outlet, about the size of a pencil eraser, is left at the bottom of the stomach pouch.
Effects : - The hour glass configuration only constricts the upper stomach thus acting as a pure restrictive operation. Since the outlet is small, food stays in the pouch longer and one also feels satiated for a longer time.
In a cooperative and compliant patient, the reduced stomach capacity, along with behavioral changes, can result in consistently lower caloric intake and consistent weight loss. Patients who see the best results from a restrictive procedure are those who learn to eat slowly, eat less, and avoid drinking too many caloric fluids, particularly carbonated beverages. If the patient fails to follow these guidelines, they can stretch the stomach pouch and/or the stoma outlet and defeat the purpose of the surgery. The effectiveness of a restrictive procedure is reduced by constant snacking or by drinking high-calorie, high-fat liquids.
Possible Complications : -
Band Infection and migration
Slippage and dilatation
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Malabsorptive procedures: Roux -En- Y Gastric Bypass
Procedures that alter digestion are known as malabsorptive procedures. Malabsorptive techniques reduce the length of intestine that comes in contact with food so that the body absorbs fewer calories. According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is completely stapled shut and divided from the stomach pouch. It is not completely removed. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, called the Roux limb, thus eliminating the duodenum and a small portion of the jejunum from the absorptive circuit. The omitted segment is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be adjusted to produce lower or higher levels of malabsorption.
Risks : - The duodenum being bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia.
A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or
A condition known as "dumping syndrome" can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
Metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones.
All the above listed deficiencies can be easily managed through a proper diet and vitamin and calcium supplements. It is mandatory for patients undergoing gastric bypass to consume a multivitamin and calcium supplement daily.
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