TYPES OF BARIATRIC SURGERY YOU SHOULD KNOW

Who is an eligible candidate for bariatric surgery?

Even if you are struggling to lose weight through traditional means, it does not mean that you can automatically opt for bariatric surgery. Much like other medical procedures, some qualifications make a good candidate for undergoing weight loss surgery.

In terms of age, bariatric surgery can be done on people from 16 to 70 years old, though their eligibility is still on a case-to-case basis.

People under the age of 20 can undergo weight loss surgery. However, the said age group might not opt for such invasive procedures as they can choose to lose weight through monitored diet and physical activity for a start. For those who want to opt for surgery, it is best to wait until after puberty, as adolescents still go through many body changes during this period. For optimal weight loss results, it is advisable that they work closely with a team of medical experts like dietitians and lifestyle coaches to minimize the possibility of regaining weight.

On the contrary, there are additional precautions to consider when performing bariatric surgery on people over the age of 65. Older people tend to have issues when it comes to mobility and their general health, as they have been carrying their weight for years and might suffer obese-related medical condition. Usually, people of older age choose to undergo weight loss surgery to prolong their life and prevent deteriorating health. However, in some cases, the damages caused by their existing medical conditions are already irreversible. The patient’s medical fitness is something closely monitored before doing the procedure to people of a certain age. Cardiology and lung assessments are done to discover any possible risks that can interfere with the operation. With that said, bariatric surgery is less likely to cause complications as any risk factor can be corrected before the operation.

Aside from age, of course, your current body weight is the biggest factor for undergoing bariatric surgery. As mentioned earlier, your BMI can be an early indicator if you need to undergo medical weight loss. Body Mass Index (BMI) is a weight-to-height ratio, derived by dividing your weight in kilograms by the square of your height in meters. The value then categorizes a person from underweight to obese. Again, a BMI of 25 to 29.9 is considered Obese Type I, while a BMI over 30 is categorized as Obese Type II. A BMI of over 40 is already treated as morbidly obese. Moreover, if you have a high BMI along with other weight-related complications like high blood pressure or diabetes, you are a likely candidate for bariatric surgery.

What are the different types of bariatric surgery?

Medical weight loss surgery can be either of two categories: restrictive or malabsorptive. Restrictive bariatric surgery shrinks down the size of your stomach. As a result, it slows down your digestion and helps you eat less food. On the other hand, malabsorptive bariatric surgery makes your stomach smaller as well as removing a part of your digestive tract. It alters how much food you can consume, making it harder for your body to absorb calories.

Two of the most popular weight loss surgeries in Malaysia are sleeve gastrectomy and gastric bypass.

Sleeve Gastrectomy

Sleeve gastrectomy, or gastric sleeve surgery, is a restrictive procedure where the bariatric surgeon removes approximately around 75% to 80% of the stomach. The remaining portions are joined together into a banana-shaped stomach, referred to as the “sleeve”. After the operation, your stomach is reduced to 10% of its original size.

As the stomach is now smaller, it can only handle a small amount of food at a specific time. Also, it slows down your digestion, making you feel full for a longer period. Furthermore, the operation has an impact on your appetite. The surgery also removes a part of the stomach that produces the hormone ghrelin. Ghrelin, aptly called the “hunger hormone”, stimulates appetite and promotes fat storage through increasing food intake. Lower levels of the hormone reduce cravings and feelings of hunger.

A sleeve gastrectomy usually takes about 1 hour, under general anaesthesia. The surgeon will create several quarter to half-inch incisions in the abdomen. They will insert a laparoscope, an instrument with a tiny camera, through these cuts. Other medical instruments are then inserted to reduce the size of the stomach. The whole surgery is a relatively simpler procedure compared to other invasive bariatric surgeries.

The surgery is said to help in losing at least 50% of your excess weight within 18 to 24 months post-surgery. In some cases, they even lose 60% to 70% of their body fat. Of course, those results yield if you commit to a diet and exercise plan recommended by your surgeon. Shifting to healthier lifestyle choices will help you keep the weight off longer. Even if your stomach size is smaller, it is still possible to regain weight, especially if you:

• Eat large amounts of food
• Eat too many unhealthy foods
• Continue to have little to no exercise or physical activity

Much like other invasive medical surgeries, sleeve gastrectomy also comes with potential risks and complications. Some notable side effects of the procedure include:

• Blood clots
• Gallstones (risk increases with rapid or substantial weight loss)
• Hernia or protruding internal organs
• Internal bleeding or profuse bleeding of the surgical wound
• Gastric leakage
• Stenosis or obstruction of the stomach
• Perforation or developing a hole in the stomach or intestines
• Skin separation
• Stricture or narrowing of the urethra
• Vitamin or iron deficiency
• Heartburn

Gastric Bypass

Gastric bypass surgery, also known as Roux-en-Y gastric bypass, makes use of both restrictive and malabsorptive techniques. The surgery involves the bariatric surgeon dividing the stomach into two sections, an upper and lower section. The upper section is sealed off from the lower half, creating a small egg-shaped pouch. A portion of the small intestines is then cut and attached to the upper portion of the stomach, creating a Y configuration, hence the name.

The small pouch on top of the stomach can only hold a limited amount of food. As a result, it limits the amount of food you can consume for a certain period.

Gastric bypass also restricts the absorption of calories and nutrients. The procedure creates a shortcut where the food you eat travels. After the surgery, the food bypasses a part of the stomach and small intestines during digestion. The food moves directly from the upper pouch to the attached part of the intestines. With that said, the main stomach continues to produce digestive juices that flow to the small intestine. Skipping parts of the digestive tract allows the body to absorb fewer calories.

Moreover, much like sleeve gastrectomy, gastric bypass changes your gut hormones, which makes you feel full for longer. It also contributes to appetite suppression and the reversal of obesity-caused metabolic syndrome.

For the first six months, you can lose 30% to 50% of your excess weight, then go on to shed 77% of excess weight upon 12 months after the gastric bypass surgery. Some studies also state that the procedure can lead to a 50% to 60% weight loss even 10 to 14 years after surgery.

Patients with a higher initial Body Mass Index tend to lose more of their total body weight with the procedure. Those with a lower BMI also find success with the surgery, losing a good amount of excess weight. They are also more likely to come close to their ideal body weight.

Again, gastric bypass surgery may lead to some complications and health issues. Some of these long-term risks include:

• Breakage
• Dumping syndrome
• Gallstones (risk increases with rapid or substantial weight loss)
• Hernia or protruding internal organs
• Internal bleeding or profuse bleeding of the surgical wound
• Gastric leakage
• Perforation or developing a hole in the stomach or intestines
• Pouch obstruction or bowel obstruction
• Protein or calorie malnutrition
• Pulmonary and cardiac problems
• Skin separation
• Spleen or other organ injuries
• Ulcers
• Stricture or narrowing of the urethra
• Vitamin or iron deficiency
• Vomiting

Aside from these, there are more general side effects caused by bariatric surgery. Whether it is sleeve gastrectomy or gastric bypass, restrictive or malabsorptive, you may experience these issues, especially post-operation:

• Acid reflux
• Anaesthesia-related risks
• Chronic nausea and vomiting
• Narrowing of the oesophagus
• Inability to eat certain foods
• Infections
• Obstruction of the stomach
• Weight gain or failure to lose weight

Can I undergo bariatrics without having to do surgery?

Allurion Elipse Balloon

Credits to: Allurion Technologies

The Allurion Elipse Balloon is the latest technology in non-surgical weight loss procedures. It is the world’s first swallowable weight loss balloon. Unlike other gastric balloons in the market, Allurion Elipse do not require endoscopy, surgery, or anaesthesia. So, how does it work?

The balloon comes in a capsule form, with a thin catheter attached. The capsule allows you to swallow the balloon with a glass of water. Again, no endoscope or anaesthesia is needed. Clinical studies show that 99.9% of people succeeded in swallowing the capsule. If you have a hard time doing so, your medical specialist will be there to guide you.

An X-ray is done upon swallowing the balloon to make sure that it is placed properly inside the stomach. It is then filled with 550ml of buffered water, or until it is the size of a grapefruit. A second X-ray is administered to see if the balloon is properly filled. Again, the placement will be under the supervision of a certified medical specialist. The whole placement process only takes 15 minutes. It is also an outpatient procedure, meaning that you can go home upon doctor’s clearance, with little to no downtime.

Allurion Elipse Balloon will last in the stomach for four months and helps you to:

• Reduce your food intake by taking up space inside the stomach within that period
• Curbs your appetite to eat excessively
• Makes you feel full even with smaller portions of food
• In the presence of the balloon inside, the stomach delays gastric emptying, which allows the food to remain in the stomach, making you feel full longer

After four months, a time-activated valve opens, allowing the balloon to deflate by itself. The remnant of the balloon passes through the gastrointestinal (GI) tract and is naturally excreted out of the body as motion. Allurion Elipse does not need an endoscope to take out the balloon. However, if you choose to have the balloon removed before the four-month period ends, then an endoscopy is required to perform the procedure.

Allurion Elipse is one of the newer non-endoscopic gastric balloons out there. With that said, over 50,000 Allurion Elipse Balloons have been successfully placed worldwide. The balloon is clinically proven to help lose an average of 10-15% of total body weight within four months. The results may vary depending on the diet and exercise regimen you take during and after the balloon is placed. As established, there are weight loss programs available that offer the placement of the Allurion Elipse Balloon, alongside a diet and lifestyle regimen from experts to sustain your weight loss even after the balloon has passed.

There are some possible side-effects upon placing the Allurion Elipse Balloon. Some of these include nausea, abdominal cramping, and occasional vomiting. In most cases, these are temporary and well-controlled with the commonly used medications prescribed.

Traditional Endoscopic Balloon

Credits to Spatz3 Adjustable Balloon

Endoscopic balloons are gastric balloons where you can adjust their volume, increasing or decreasing depending on your condition. As the name suggests, it uses an endoscope for its placement and removal.

Before placing the balloon, you will be given detailed instructions on how to prepare yourself for the procedure. It includes possible restrictions on what food and drink you can take and medication you need to take ahead of time. Usually, you will be asked to avoid eating or drinking at least 8 hours before the placement procedure. They may also ask to run various tests beforehand to make sure there are no risks that can hinder the balloon placement.

For the procedure, the doctor will place an endoscope, a flexible tube with an attached camera, into the back of the throat. The tool is used to recognize any existing problems in the stomach like inflammation or ulcer, which can affect the balloon. You will be under conscious sedation throughout the process, making you aware of your surroundings but minimizing discomfort.

When there are no problems seen in the area, the doctor will proceed to place the gastric balloon. The inflated balloon is attached to a thin catheter. It is placed in the stomach, again with the help of an endoscope. Once placed, the balloon is filled with 650 to 750 millilitres of air or 400 to 700 millilitres of sterilized water. As mentioned, the content of the balloon can be gradually decreased to avoid any discomfort or increase to help lessen your food intake. However, take note that an endoscope will be used every time the balloon is filled or emptied. The whole placement procedure commonly takes around 20 minutes to one hour.

Endoscopic balloons can last inside the stomach for up to 12 months. Within that period, you can lose up to 16-25 kg. Of course, these results only foster when you adhere to a diet and exercise plan.

After 12 months, the balloon will be removed, again with the help of an endoscope. As preparation for balloon removal, you may be asked to go on a three-day liquid diet and then fast from midnight to the night before the removal procedure.

The placement of endoscopic balloons is not as invasive as bariatric surgery. With that said, the use of an endoscope inside the body still poses a couple of risks and side effects. Even a tedious mistake in handling an endoscope may lead to significant complications. Some possible risks of using an endoscope include infections, allergies, or, at worst, damage to the throat and stomach. While using the tool is generally safe, as it is commonly used in many medical procedures, the use of anaesthesia can impose risk to people with pre-existing medical conditions. For instance, people with obesity, high blood pressure, and diabetes may experience side effects after being under sedation.

Those are some alternative routes you can take in your weight loss journey. If you have exhausted all traditional ways of losing weight- to no avail- then there’s nothing wrong with trying a medical approach to weight loss. Just make sure to do your research and consult a bariatric doctor, specifically, so you can find the best solution out there for your condition. If you are worried about risks to your health, there are procedures out there that yield great results with minimal issues. With the right team of experts and medical devices, you have nothing to worry about. Besides, doing nothing can pose more harm to your health than any of these procedures. So, take your first step today!