“Weight Loss Surgery is NOT a Cosmetic Surgery”
As per the National Institute of Health consensus conference, surgery is the only effective treatment for the long term and sustained weight loss resulting in improvement and/or resolution of co-morbid conditions, improving their self esteem and quality of life as well as increase longevity.
The most common question among people is “What is Obesity Surgery? Is it same as the lposuction?”
No! Liposuction is a surface surgery done to remove the extra unwanted fat from different parts of the body. Basicualy, this is a surgery a surgery for body sculpturing and not weight loss, whereas obesity or bariatric surgery gives an option for treating the diseases. It is evolved into three categories:
- Restrictive procedures,g: Sleeve gastrectomy, gastric band
- Malabsorptive procedures,g: Bilio-pancreatic diversion with or without duodenal switch
- Combined procedures,g: Roux-en-Y-gastric bypass (RYGB)
Therefore, the selection of the procedure needs to be individualized based on the age, presene or absence of the co morbidities, BMI, patient’s preference and compliance, experience of the surgeons, etc. The most crucial in selecting the right procedure for an individual is the experience of the bariatric surgeon.
Anatomy of the Digestive System
Starting from the top we will explain the anatomy of the digestive system to understand how the operation works.
Mouth
Entry point for food, teeth and tongue chew food and move it to the back of the throat for swallowing. The enzyme called as amylase starts digestion of starches and carbohydrates or sugars.
Esophagus
Carries food to the stomach and it has no digestive function.
Stomach
Holds food and mixes it with acid and saliva and it has no absorptive function.
Pylorus
The valve controls the emptying of the stomach and helps to prevent the dumping syndrome.
Small bowels
This tube of 5 meters in length lies in between the pylorus and large bowel. Around 95% of digestion is carried out here and it is the most important part of the digestive system. It is divided into three parts:
- Duodenum: Two feet long, bile from the liver and pancreatic enzymes or the digestive juices enters this segment.
- Jejunum: It is the middle portion of the small bowel.
- Ileum: It is the lower portion.
In both the jejunum and ileum sections, the proteins, carbohydrates and fats are absorbed as well as the minerals and vitamins. While calcium and iron are absorbed in the duodenum.
Large bowel
It starts at the end of the small bowel and main function is to absorb the water and hold the stools. The nutrients are not absorbed here. The appendix joins the bowel at its beginning.
Liver
The nutrients absorbed from the small bowel go to the liver via the portal veins. It secretes the bile necessary for fat digestion.
Pancreas
It secretes the enzymes which are required to digest the proteins, carbohydrates and fats.
How Digestion Works?
Digestion starts in the mouth with saliva’s amylase. The food then travels to the stomach where it is held, mixed with acid. It will start breaking down here. The stomach empyting is regulated by the pylorus. The process of digestion and absorption will happen in the small bowel when the food is acted upon by the bile from the liver and pancreatic enzymes. Water is absorbed in the colon and the waste is excreted through the rectum.
Weight Loss Surgery Procedures
Restrictive and Malabsorptive Procedures
There are two basic mechanisms of weight loss surgery:
- Restrictive procedures decreases the food intake by creating a small upper stomach pouch to limit the food intake.
- Malabsorptive procedures alter the digestion thereby causes the food to be properly digested and completely absorbed.
There are several procedures combining the restrictive and the malabsorptive mechanisms of weight loss surgery.
How Effective is Bariatric Surgery?
“The only way you can truly get more out of life for yourself is to give part of yourself away.”
The actual weight a patient will lose post operation depends on several factors as such:
- Patient’s age
- Overall condition of patient’s health
- Weight before surgery
- Ability to exercise
- Surgical procedure
- Commitment to maintain dietary guidelines and other follow-up care
- Motivation of patient and cooperation of family, association and friends
As per a recent study, the following criteria have been established for successful bariatric surgery, “The ability to achieve and maintain loss of at least 50% of the excess body weight without having any significant adverse effects”.
The clinical studies show that following the surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months post procedure. Patients may also lose around 30 to 50% of their excess weight during the first six months and around 77% of the excess weight as early as 12 months post surgery. Most patients with type II diabetes while showing less overall excess weight loss have showed excellent resolution of their diabetic condition, to the point of having little to no need for continuing their medication.
A comprehensive clinical review of the bariatric surgery data demonstrated that the patients who underwent a bariatric surgical procedure has experienced complete resolution or improvement of their co-morbid conditions such as hyperlipidemia, diabetes, obstructive sleep apnea, hypertension, etc.
Our Team of Specialists
Dr. (Prof.) Tej Krishan Thusoo- Director
Dr. Paritosh S. Gupta- Sr. Consultant
Dr. Mayank Manjul- Consultant