Many morbidly obese people have trouble losing weight or maintaining weight loss with conventional methods, and resort to morbid obesity surgery. Types of bariatric surgery options include restrictive and malabsorptive techniques, which help promote weight loss and improve obesity-related conditions in these people.
Bariatric Surgery Options for the Obese (Morbid Obesity Surgery)
Morbid obesity surgery includes restrictive and malabsorptive procedures. Such bariatric surgery promotes weight loss & improves obesity-related conditions.
Definition of Morbid Obesity
The World Health Organization (WHO) defines morbid obesity as having a BMI (Body Mass Index) of greater than 40kg/m2 or between 35 and 40kg/m2 where the patient presents with any obesity-associated conditions, such as diabetes, hypertension, cardiovascular disease, stroke, and cancer. Morbid obesity significantly increases the risk for these other life-threatening conditions associated with obesity.
Morbid Obesity Treatment
For any person with obesity, the first way to tackle weight loss is through behavioral modification and lifestyle changes in terms of diet and exercise. Many obese people find it difficult to maintain short-term weight loss using these measures and go on to be treated with pharmacological drug therapy.
However, available weight loss drugs for obesity treatment only result in a maximum of 10% weight loss when used in addition to diet and exercise. In addition, many patients with morbid obesity fail to achieve long-term weight loss through these means, and may, therefore, undergo obesity surgical treatment in order to help promote weight loss.
Morbid Obesity Surgery
The type of surgery used to help people with morbid obesity loses weight is called bariatric surgery. Obesity bariatric surgery reduces the intake of calories and nutrients by modifying the gastrointestinal tract, thus promoting weight loss. There are a number of different bariatric surgery procedures that can be undertaken in order to do this.
Restrictive Obesity Bariatric Surgery as a Morbid Obesity Surgery Procedure
Restrictive obesity bariatric surgery works by creating a small gastric reservoir in the stomach with a narrow outlet to delay emptying. This type of procedure reduces the amount of food the stomach can hold but allows digestion to continue as normal. As a result, this type of morbid obesity surgery reduces the intake of food and creates a feeling of fullness.
Restrictive Bariatric Surgery Procedures Include the Following:
Laparoscopic Gastric Banding
Laparoscopic gastric banding (LAGB) is when a specially made hollow band is placed around the upper end of the stomach. This creates a small pouch at the top of the stomach and a narrow passage into the remainder of the stomach.
The band can be tightened or loosened over time, to increase or decrease the size of the passage into the lower stomach region. This is also known as Swedish Gastric Band (SAGB) since the procedure was developed in Sweden in 1985.
Vertical Banded Gastroplasty
Vertical Banded Gastroplasty (VBG), also known as “stomach stapling,” is when a line of staples are inserted vertically at the top of the stomach for about six centimeters in order to make a small pouch. A soft band or ring is then placed at the bottom of the pouch in order to create a narrow opening and restrict the food from moving to the lower part of the stomach.
Malabsorptive Obesity Bariatric Surgery as a Morbid Obesity Surgical Procedure
Malabsorptive obesity bariatric surgery shortens the digestive tract to reduce the number of calories and nutrients absorbed by the body. Commonly used malabsorptive obesity surgical procedures include various gastric bypass procedures in combination with gastric reduction procedures.
By combining both malabsorptive and restrictive techniques, this type of morbid obesity surgery can aid in promoting significantly improved weight loss compared to using restrictive bariatric surgery procedures alone.
Malabsorptive Procedures
Some of the commonly used malabsorptive procedures used are as follows:
Biliopancreatic Diversion
Biliopancreatic Diversion (BPD) involves the removal of around two-thirds of the stomach. The part of the stomach that is removed is the lower half, leaving a small pouch at the top of the stomach.
The patient also undergoes a long intestinal bypass, whereby most of the small intestine is bypassed in order to further reduce absorption of nutrients, calories and also fat. In order to do this, the lower part of the small intestine is cut from the upper part and joined to the stomach pouch.
Roux-En-Y Gastric Bypass
Gastric Roux-En-Y Bypass is when a small stomach pouch is created at the top of the stomach in order to restrict food intake. A Y-shaped section of the small intestine is then attached to the pouch in order for food to bypass the lower stomach, the duodenum (the first part of the small intestine), and the first segment of the jejunum (the second part of the small intestine). As such, the gastric bypass significantly reduces the absorption of calories and nutrients.
Due to the increasing prevalence of obesity around the world, morbid obesity surgery procedures are increasingly being used. As more patients undergo morbid obesity surgery in an effort to promote weight loss, they will benefit by improving their health significantly, since bariatric surgery in the morbidly obese has been shown to be associated with significant improvements in obesity-related co-morbid conditions.
Sources
- Obesity Surgery Society of Australia & New Zealand website
- Victorian Government Department of Human Services, “Surgery for Morbid Obesity“
- WHO, “Obesity and Overweight“, 2018
- University of Southern California Department of Surgery, Defining Morbid Obesity
- Roux-En-Y Image via Wikimedia Commons
