Bariatric surgery has proven to be a real solution to obesity and other obesity-related diseases. The surgeries are especially handy in the event of the ineffectiveness of other weight-loss alternatives including dieting and physical exercise. Bariatric surgeries reduce body weight through restriction and malabsorption. Restriction reduces the amount of food that the stomach can store hence limiting the calories taken in. Malabsorption either shortens or bypasses the Ileum to reduce the amount of calories absorbed into the body. In exploring bariatric surgery, this paper will look at a brief history of bariatric surgery; the available methods of bariatric surgeries; factors to consider when choosing the appropriate bariatric surgery; post-surgery interventions and the side effects of the surgeries.
Weight-loss or bariatric surgeries help people to lose weight and limit health risks that are related to obesity. These surgeries are technological alternatives to other methods of reducing obesity that have proved ineffective in treating extreme cases of the condition. Bariatric surgeries reduce body weight through restriction and malabsorption. Restriction reduces the amount of food that the stomach can store hence limiting the calories taken in. Malabsorption either shortens or bypasses the Ileum to reduce the amount of calories absorbed into the body. There are four types of Bariatric surgeries including duodenal switch and biliopancreatic distraction, roux-en-Y gastric bypass, Sleeve gastrectomy, and Laparoscopic adjustable gastric band. The choice of the type of Bariatric surgery depends on the severity of obesity, the Body Mass Index(BMI), effectiveness of non-surgery methods of reducing weight, and the risks likely to be encountered. Given that obesity and weight loss are a problem, and other methods of weight loss have proven ineffective, especially in providing durable weight loss results, bariatric surgery is indeed a lifesaver. Bariatric surgery is a peculiar field, given the potential a single surgery has in limiting if not curing a number of medical diseases such as arthritis, diabetes, liver disease, venous stasis diseases, high cholesterol, chronic headaches, sleep apnea, and hypertension. Over the last ten years, fast recovery and minimal intrusive methods have led to the uptake of bariatric surgery. Even with distinction of the weight loss operations as either restrictive or malabsorptive, there has been an evolution in the procedures undertaken. Advances in technology and research have relegated some of the procedures including jejunocolic bypass, vertical banded gastroplasty, biliopancreatic diversion, and jejunoileal bypass to legacy status for better procedures (Moshiri et al. 40). However, even with the adoption of new procedures, there are factors to consider before choosing any singular procedure. Moreover, there are post-surgery interventions and side effects that candidates must consider before undertaking any of the procedures.
Obesity is increasingly becoming a problem worldwide. So much is the condition a problem that some are referring to it as an epidemic (Buchwald and Danette 1605; Buchwald and Williams 1157). Combined, overweight, obesity, and morbid obesity affect more than 1.7 billion people in the world (Buchwald and Williams 1157). Medical professionals, nutritionists and most health departments in the world have conducted campaigns on the dangers of overweight and obesity, and ways of preventing the conditions including dieting and regular exercise. However, the nature of work today and the availability of junk food have made regular exercise and dieting a problem leading to innumerable number of deaths and development of medical conditions including hypertension as well as cardiovascular diseases. With the failure of the other interventions for combating overweight and obesity (dieting and exercise), there is need for other effective measures to arrest mortality by overweight and obesity. Buchwald and Williams enthuse, “bariatric surgery today is the only effective therapy for morbid obesity” (1157). This is especially after the recognition of bariatric surgery as a metabolic surgery (Buchwald and Danette 1605).
Perhaps even the more need for bariatric surgery comes from the fact that obesity has an association with many chronic health problems (Lee and Weu 751). Yet the effects of obesity do not stop there; the condition also adversely increases morbidity and reduces the quality of life and life expectancy (Lee and Weu 751). Estimates indicate that morbid obesity currently afflicts more than 20 percent of the obese population. While other weight loss alternatives are available, bariatric surgery remains the most efficient alternative for continued weight loss for this population (Lee and Weu 751). Moreover, patients with chronic diseases associated with morbid diabetes have shown complete recovery or improvement after undergoing bariatric surgery, an indication that the procedure is not only effective, but also works faster than other weight loss alternatives. Even more is that the procedure has pointedly reduced general deaths from obesity in addition to having significant survival advantage. Perhaps more notable is the fact that “The application of laparoscopic techniques to bariatric surgery in the past decade has reduced peri-operative morbidity and has contributed to a remarkable
increase in interest in the surgical treatment of morbid obesity” (Lee and Weu 751).
Gastrointestinal surgery also denotes bariatric surgery and in essence, is a process aimed at altering the digestive process (Hubbard and William 257). In their working, bariatric procedures can be classified as restrictive, malabsorptive and a combination of restrictive and malabsorptive. The restrictive procedure works by limiting the amount of food taken through the creation of a narrow passage from the upper into the lower part of the stomach (Hubbard and William 257). The procedure effectively limits the amount of food held by the stomach in addition to slowing food passage through the stomach (Hubbard and William 257). On the other hand, malabsorptive procedures involve the small intestines, most of which are left out of the digestive tracts, in effect limiting the amount of calories and nutrients absorbed by the body (Anderson et al. 2). Although effective, the procedure is no longer a recommendation given the nutritional deficiencies (extreme) that result after it. A combination of the two options (restrictive and malabsorptive) employs restriction and a partial bypass of the ileum (Hubbard and William 257).
Methods and Materials
In exploring bariatric surgery, this paper will conduct an analysis of journal articles with the aim of synthesizing the information gathered from the articles into one comprehensive paper. The literature review part of the paper will specifically look at what authors say of bariatric surgery, with an aim of getting a general overview of the procedure and its effectiveness. The other parts of the paper (discussion) will synthesize information from the journal articles, particularly in relation to the different types of bariatric procedures available, factors for consideration before undertaking the procedures, the post-surgery interventions and any complications that may occur post-procedure. To get information on the topic, internet searches through databases such as proquest was conducted. The search involved searching key words such as “history of bariatric surgery,” “types of bariatric surgery,” “factors to consider before undergoing bariatric surgery,” and “complications after bariatric surgery.”
As aforementioned, bariatric procedures are restrictive, malabsorptive or a combination of restrictive and malabsorptive procedures. For restrictive procedures, adjustable gastric banding and vertical banded gastroplasty fall in this category (Hubbard and William 258). Adjustable gastric banding (AGB) involves the placement of a hollow silicone rubber band around the stomach, at a point near it upper end, in effect creating a small pocket and a slender passage into the other part of the stomach (Hubbard and William 258). After the band has been put in place, it is then filled with a salt solution through a tube connecting it to an access point made under the skin. Through the tube, it is possible to adjust the band (tighten or loosen), which changes the size of the passage through increase or decrease of the amount of salt solution (Hubbard and William 258).
Vertical banded gastroplasty used to be the most popular procedure. It involved using a band and staples in the creation of a small stomach pocket. This gave the feeling of satiety after eating only a small amount of food. The method, however, is obsolete and is no longer used today (Hubbard and William 258). The appeal of restrictive procedures is that they are easier to perform and are much safer than malabsorptive procedures. Moreover, given that they employ laparoscopy, only small incisions are made, causing less tissue damage, less operation time and shorter hospital stay in comparison with open procedures (Hubbard and William 258). Even more is that restrictive procedures are reversible, and mostly have few nutritional deficiencies. However, even with these, restrictive procedures do not encourage faster weight loss, and patients cannot maintain the weight loss over a long period.
Apart from the restrictive procedures is a combination of both restrictive and malabsorptive procedures. The combined procedure is the most common procedure today, restricting both the intake of food and the amount of calories absorbed by the body. Of the combined procedures, Roux-en-Y gastric bypass (RGP) is the most common (Garb et al. 1447; Hubbard and William 258). In its current form, RGP is an improvement of the procedure developed in 1960s by doctors Mason and Ito, the tow having observed rapid weight loss among ulcer patients after the partial removal of their stomachs (ulcer patients). The procedure’s modification came with the introduction of a Roux-en-Y limb of the intestine instead of the loop bypass with a larger portion of the stomach. The modification was because of the bile influx that came as a result of the loop set up, warranting the introduction of a Roux-en-Y with a limb of the intestine connected to a small stomach pocket preventing bile from going into the upper part of the stomach and the esophagus (Hubbard and William 258). Through the procedure, the first segment of the small intestines and the rest of the stomach are left out. The bypassed section of the small intestine is responsible for the absorption of calcium and iron, the section responsible for the absorption of proteins and other micronutrients, however, remain intact.
Bypassing the section of the intestines responsible for the absorption of calcium and iron can result in the development of anemia and osteoporosis. For this reason, patients who have undergone such a procedure must remain on lifelong mineral supplements. Additionally, the bypass can also cause vitamin B 1 and B12, which also requires daily multivitamin supplements as a measure against nutritional complications. The working of the procedure is such that there is a change in the behavior of the patient after the procedure. The bulk of patients who have undergone the procedure experience reduction in hunger in addition to feeling satisfied immediately after eating. The changes in the eating habits emanate from changes in several hormones and the neural signs communicating with the hunger centers in the brain.
Biliopancreatic diversion (BPD) is another type of combined procedure. It is an intricate procedure involving the removal of the lower portion of the stomach, connecting the small stomach pocket remaining directly to the last section of the small intestines. This in effect bypasses the duodenum and the jejunum (Hubbard and William 259). The procedure leads to fast weight loss, although it has number of associated risks, particularly nutritional deficiencies. Thus, the combined procedure helps individuals in losing weight quickly with a continued weight loss for close to 2 years following the procedure. Roux-en-Y effectively continues in maintaining weight loss for up to 70 percent for more than 10 years (Hubbard and William 259). Even more is that the combined procedures help patients in improving the health problems associated with obesity including hypertension, diabetes, sleep apnea, and osteoarthritis.
The procedures are however more difficult to perform in comparison with restrictive surgeries, with an additional danger of long term nutritional deficiencies. Moreover, the procedures are likely to cause anemia among menstruating women, given that the body takes in less vitamin B12 and iron. The procedures also present the risk of patients developing bone diseases due to the lack of calcium and iron in the body from the bypassed sections responsible for the absorption the two minerals.
Factors Considered When Choosing Appropriate Surgery
The different types of bariatric surgeries have different outcomes and associated risks, in addition to permanence. Before choosing the right bariatric procedure, there are factors that need consideration. One of the factors is the expected weight loss outcome. Given that the procedures have different outcomes (gastric bypass 70 percent of excess weight; gastric banding 50 percent; and gastrectomy 60 percent), the patient must choose the most appropriate weight-loss goals. Achieving the goals are however dependent on the ability of the patients to make the necessarily lifestyle changes that come with the procedures, otherwise it is possible for the patients to regain the weight.
Another consideration is how fast the patient wants the weight loss. While some may want the loss fast as provided by gastric bypass, others may want a gradual procedure. Gastric banding provides a slow and steady weight loss of about one or two pounds per week, over a period of two years for the patient to achieve the expected weight (Lee and Weu 753).
Reversibility is another factor for consideration. While restrictive procedures such as banding are totally reversible others are not such as gastrectomy. Patients, therefore, must consider the possibility of needing a reversal of the procedure before undertaking it. Thus, although banding is reversible, patients will most certainly regain the excess weight. Moreover, many patients see banding as safe, given that it is possible to remove the band in case the patient develops any complications. It is impossible to reverse gastrectomy, even when the patient develops complications.
While the factors help in choosing the appropriate procedure, there are post-surgery interventions that patients must undertake. Most of the procedures require taking appropriate diet and physical exercise. According to Kalarchian and Marcus, however, many patients find this difficult and therefore require post-surgery psychological support (457). Thus, the patients require psychosocial support post-surgery, specifically suited toward diet, activity and other psychological factors (Kalarchian and Marcus 457). There are additionally follow up visits to the doctor to check on wound healing, weight loss among other interventions.
Although the procedures are safe, and assist patients in achieving their weight loss goals, there are side effects that come with the procedures. Apart from the need to take mineral and vitamin supplements, bypass patients are likely to experience sensitivity towards sugar. Patients, therefore, experience dizziness, abdominal pain and diarrhea after taking sugary food.
Obesity is a real problem across the world. While there are other methods to check obesity such as physical exercise and dieting, these require a lot of personal discipline, and often times fail in achieving the desired results. Obesity is a risk factor to other chronic diseases and medical conditions, in addition to mortality. In the proven ineffectiveness of these alternative methods, bariatric surgery provides an option to patients, with proven results. Patients, therefore, choose on the most appropriate procedure, which the doctors then perform. While some of the procedures are reversible, others are permanent, and patients must therefore make informed considerations before choosing on the type of procedure. In truth, bariatric surgery provides an option for patients and has been proven to help in not only obesity, but other conditions associated with obesity.
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