Bariatric Surgery Work: Procedures and Recovery
Bariatric surgery is a surgery performed with the intent to have significant and sustainable weight loss in obese patients who have tried other means of weight loss but couldn’t achieve substantial weight loss. This surgery changes the digestive system to achieve weight loss. Bariatric surgery is also called metabolic surgery.
Who needs Bariatric surgery?
Individuals who are obese to an extent that hampers their day-to-day life. Individuals with obesity and associated co-morbidities like diabetes, hypertension, heart disease, sleep apnoea, and metabolic syndrome are awaiting knee replacement. Individuals with a BMI >35 Individuals with BMI >30 with comorbidities like diabetes, hypertension, heart disease, sleep apnoea, metabolic syndrome
Types of Bariatric Surgery Procedures
- Gastric Bypass (Roux-en-Y Gastric Bypass): A small pouch is created at the top of the stomach and directly connected to the small intestine, bypassing part of the stomach and upper intestine. This reduces the amount of food you can eat and lowers calorie absorption.
- Sleeve Gastrectomy A large portion of the stomach is removed, leaving a smaller, banana-shaped “sleeve.” This reduces stomach capacity and triggers hormonal changes that help control appetite and blood sugar levels.
- Adjustable Gastric Band (Lap-Band): A band is placed near the top of the stomach to create a small pouch. The size of the opening between the pouch and the rest of the stomach can be adjusted, helping to control food intake.
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This complex surgery removes part of the stomach and reroutes a significant portion of the small intestine. It combines restrictive and malabsorptive techniques to promote weight loss.
- Bariatric Revision Surgery: For individuals who have had prior bariatric procedures, revision surgery may be needed to address complications, insufficient weight loss, or other issues.
Indications and Purposes of Bariatric Surgery
The purpose of bariatric surgery is to promote weight loss, improve or resolve obesity-related health problems, and enhance overall quality of life. Here are the main indications and purposes of bariatric surgery:
Indications
Severe Obesity
Bariatric surgery is typically recommended for those with a BMI of 40 or higher. It can also be considered for individuals with a BMI of 35 or higher if they have obesity-related severe health issues.
Obesity-Related Health Conditions
Bariatric surgery may benefit individuals with health conditions that improve with weight loss, including:
- Type 2 diabetes
- Hypertension (high blood pressure)
- Sleep apnea
- High cholesterol
- Non-alcoholic fatty liver disease
Failure of Non-Surgical Methods
Candidates for bariatric surgery usually have attempted weight loss through:
- Diet changes
- Exercise
- Behavioural modifications
If these methods haven’t worked, surgery may be an option.
Motivation and Commitment
Post-surgery success requires a commitment to:
- Healthy eating
- Regular exercise
- Follow-up appointments
Make sure you are ready to make these lifestyle changes!
Purposes
Weight Loss Benefits of Bariatric Surgery
- Effective Weight Loss: Bariatric surgery helps with lasting weight loss by reducing stomach size or changing the digestive process. This limits how much food you can eat or absorb, leading to gradual weight loss.
Improvement of Health Conditions
- Health Boost: It can significantly improve or resolve obesity-related issues like hypertension, type 2 diabetes, and sleep apnea, lowering your risk of health complications.
Better Quality of Life
- Quality of Life: Successful weight loss can improve mobility, reduce joint pain, boost self-esteem, and enhance overall well-being.
Long-Term Weight Management
- Long-Term Success: Bariatric surgery helps maintain weight loss better than non-surgical methods. However, you still need to commit to a healthy lifestyle with dietary changes and regular exercise.
Lower Mortality Risk
- Lower Risk: Studies show bariatric surgery reduces mortality risk in severely obese individuals significantly when related health conditions are improved.
Steps Involved in Bariatric Surgery
During a bariatric surgery procedure, several specific steps are taken to achieve the desired weight loss and metabolic changes. The exact details may vary depending on the type of surgery being performed, but a general overview of what happens during bariatric surgery:
Anesthesia
You will receive anesthesia to ensure you’re comfortable and pain-free throughout the procedure.
Incisions
Small incisions are made in the abdomen to give the surgeon access to the surgical area. In many cases, minimally invasive techniques (laparoscopic surgery) are used, involving tiny instruments and a camera.
Access to the Stomach
The surgeon uses the incisions to reach the stomach and digestive tract.
Surgical Technique
Different types of bariatric surgery use different techniques:
- Gastric Bypass (Roux-en-Y): A small pouch is created at the top of the stomach and connected to a lower part of the small intestine, bypassing a section of both the stomach and small intestine.
- Sleeve Gastrectomy: A large portion of the stomach is removed, leaving a smaller, banana-shaped “sleeve.”
- Gastric Banding (Lap-Band): A band is placed around the top of the stomach to create a small pouch.
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS): A portion of the stomach is removed, and a larger part of the small intestine is bypassed.
Closure and Healing
The incisions are carefully closed with sutures or staples, and the healing process begins.
Recovery and Monitoring
After the surgery, you’ll be moved to a recovery area where medical staff will monitor your vital signs and ensure you wake up safely from the anesthesia.
Hospital Stay
Depending on the type of surgery and your health, you may stay in the hospital for a few days to recover and receive post-operative care.
Diet Progression
You will start with clear liquids, gradually move to soft foods, and eventually return to regular foods based on the guidance from your healthcare team.
Follow-up Care
Regular follow-up appointments will be scheduled to monitor your progress, adjust medications, and provide advice on diet and lifestyle changes.
Who Performs Bariatric Surgery?
Bariatric or metabolic surgery is performed by a surgeon who specializes in treating obesity and related conditions. These surgeons have advanced training to ensure the procedure is both safe and effective.
Bariatric surgeons typically have a background in general surgery, along with additional expertise in handling complex obesity cases. They work closely with a multidisciplinary team, including dietitians, psychologists, nurses, and other specialists, to provide comprehensive care before, during, and after surgery.
How to Prepare for Bariatric Surgery?
- Consultation and Evaluation: Meet with a bariatric surgeon to discuss surgery options. Undergo physical exams, imaging, and blood tests to assess health.
- Education and Counseling: Attend informational sessions about surgery and recovery. Meet with a dietitian and mental health professional for guidance.
- Pre-Operative Requirements: Follow dietary guidelines and complete necessary tests like blood work, EKG, and pulmonary tests.
- Lifestyle Changes: Adopt a healthy diet, exercise regularly, and quit smoking to reduce Bariatric surgery risks.
- Medical Management: Manage chronic conditions like diabetes and hypertension with your healthcare provider.
- Support System: Build a support system of family and friends to assist during recovery.
- Pre-Operative Diet: Follow a specific low-calorie or liquid diet as instructed by your healthcare team.
- Psychological Preparation: Address emotional factors through counseling or support groups.
- Medications: Consult your doctor about medication adjustments before surgery.
- Logistics: Plan your hospital stay, arrange transportation, and prepare for home recovery.
- Post-Operative Preparation: Stock up on protein supplements, vitamins, and medications. Clear your schedule for recovery time.
- Final Consultation: Have a final meeting with your surgeon to address any last-minute questions before surgery.
Recovery After Bariatric Surgery
The recovery process after bariatric surgery is a crucial phase that involves adjusting to your new digestive system, adopting a modified diet, and gradually resuming physical activity. Recovery times can change depending on the type of surgery, individual health, and adherence to post-operative guidelines.
Here’s an overview of what to expect during the recovery period
Immediate Post-Op (Hospital Stay):
- Stay in the hospital for monitoring and recovery.
- Start moving around soon to prevent blood clots.
- Pain management medications will be provided.
Week 1-2:
- Transition from clear liquids to pureed/soft foods as per your surgeon’s guidelines.
- Sip fluids slowly, avoid carbonated drinks.
- Attend follow-up appointments and take prescribed medications.
Week 3-4:
- Introduce soft, protein-rich solid foods.
- Focus on small, frequent meals and chew thoroughly.
- Start light physical activity like short walks.
Month 2-3:
- Progress to a variety of foods and increase physical activity intensity.
- Monitor weight loss and health improvements, and discuss with your healthcare team.
Long-Term Recovery:
- Keep regular follow-up appointments.
- Maintain a balanced diet with portion control and hydration.
- Stay active and address emotional challenges with counseling or support groups.
Lifestyle Changes After Bariatric Surgery
Undergoing bariatric surgery necessitates significant lifestyle changes to ensure successful weight loss, improved health, and long-term well-being. These changes are designed to support your body’s new digestive system and promote healthy eating habits. Here are the key lifestyle changes you’ll need to make after bariatric surgery:
Eating Habits:
- Portion Control: Eat small, controlled portions.
- Slow Eating: Chew thoroughly and eat slowly.
- Nutrient-rich Foods: Focus on protein, vegetables, fruits, and whole grains.
- Hydration: Drink fluids between meals, not during.
Nutritional Guidelines:
- Balanced Diet: Include essential nutrients and vitamins.
- Supplements: Take prescribed vitamins to avoid deficiencies.
- Avoid Empty Calories: Limit sugary and processed foods.
Meal Planning:
- Regular Meals: Stick to three meals and plan snacks.
- High-Quality Protein: Eat lean proteins for muscle and metabolism.
Physical Activity:
- Regular Exercise: Engage in walking, swimming, or strength training.
- Gradual Progression: Increase exercise intensity slowly.
Emotional & Psychological Health:
- Counseling & Support: Seek professional help or join support groups.
- Healthy Coping: Find non-food stress management strategies.
Behavioral Changes:
- Self-Monitoring: Track food intake.
- Goal Setting: Set realistic weight loss and fitness goals.
Follow-Up Care:
- Medical Appointments: Attend regular check-ups.
- Blood Work: Have routine tests to monitor health.
Social Support:
- Family & Friends: Share your journey with loved ones.
- Support Groups: Connect with others in bariatric surgery groups.
Mindful Choices:
- Mindful Eating: Eat when hungry, avoid emotional eating.
- Healthy Cooking: Learn to cook nutritious meals.
