Weight Loss Surgery

Weight-loss surgery (also called bariatric surgery) includes a variety of procedures performed on people who are severely obese. These are operation on the gastrointestinal tract that is responsible for intake and digestion of food. Weight loss is achieved by reducing the size of the stomach through removal of a portion of the stomach or by re-routing the small intestine to a smaller stomach pouch.

Weight loss surgery works in multiple ways

  1. Reduction in the size of stomach limits the amount of food you can take in. Thus the calories consumed are reduced significantly.
  2. Rerouting of the small intestine to the smaller stomach pouch restrict the amount of food you can digest. This leads to further reduction in the calories available to the body.
  3. In addition, these operations bring about certain changes to the hunger and satiety hormones which lead to reduced in consumption of food and satiety with smaller quantities of food.

As a person puts on weight, the excess accumulated fat gets stored under the skin (subcutaneous fat) and around the internal organs (visceral fat). The subcutaneous fat is obvious in the form of a protruding belly or heavy hips. But it is the excess visceral fat that is harmful as it is associated with increased risk of diabetes, cardiovascular disease and other obesity-related problems.
Liposuction involves sucking out fat from under the skin (subcutaneous fat) from a particular part of the body. Liposuction is not a weight loss surgery, but rather a body sculpting (cosmetic) procedure that merely changes the shape of the body. Liposuction cannot have any effect on the visceral or harmful fat and does not result in any long-term weight loss. In fact, after liposuction the sucked out fat eventually returns within a few months to a year, and is redistributed to other areas of the body. Although liposuction might seem attractive, it does not result in improved health or durable weight loss.
Weight loss surgery, on the other hand, is not a cosmetic procedure. It causes reduction in weight by promoting loss of fat from all over the body including the subcutaneous and visceral fat. Thus, weight loss surgery produces results in significant and sustainable weight loss that produce overall health benefits and improves the quality of life.

There are several benefits of weight loss, which include

  • Reduction in high cholesterol
  • Reduction in risk of liver disease
  • Improvement or resolution of diabetes
  • Improvement or resolution of high blood pressure
  • Improvement or resolution in obstructive sleep apnoea
  • Improvement in ovulation and fertility
  • Improvement in menstrual disorders
  • Improvement in osteoarthritis and joint pains
  • Improvement in gastroesophageal reflux disease
  • As weight loss surgery has been shown to be the only way of achieving significant weight loss and maintaining it over a long term period, individuals undergoing this form of surgery enjoy these benefits.

    It is important to appreciate that weight loss surgery is major surgery and does carry certain risks. These risks vary according to your age, degree of obesity and other illnesses you may have. The risk of death within the first 30 days after surgery is estimated to occur in less than 0.5% (or 1 in every 200 patients) having this operation. This number is calculated on national and international averages on the base of large number of operated cases.
    Other complications, listed below, may happen in up to 5% of patients.

    Complications that can occur soon after surgery

  • Blood clots in the legs or the lungs: To prevent blood clots from forming you will be given special stockings and an injection to thin the blood. During the surgery you will also wear special boots to keep the blood in the legs flowing. You need to continue to wear the stockings for few weeks after your operation. Getting out of bed and walking as soon as is possible after surgery will also reduce the risk of clots in the legs.
  • Bleeding: There is a small risk of internal bleeding from part of the stomach that has been closed with staples. You will be monitored carefully for signs of bleeding. If occurs, it can be often managed with medicines and occasionally it may require transfusions. In a rare situation you may need an endoscopy or even a second operation to stop the bleeding.
  • Dysmotility: Very occasionally the new reduced stomach may produce frequent spasms and may not tolerate food and even liquids. This is a rare and unpredictable event that may require temporary tube feeding.
  • Leaks from staple lines: A leakage from the staple line occurs rarely because of a failure of the natural healing process. If this happens, your hospital stay will be longer. Sometimes, this may happen after you go home. It is important to report any unusual symptoms after going home to your doctor. If appropriate he may decide to get a CT scan done to assess if there is a leak. Sometimes the leak will heal without further surgery. In the worst-case scenario you may require a second operation to control the leakage.
  • Wound infection: This is rare but may happen at the site of one of the incisions. It can usually be treated with a course of antibiotics and dressings.
  • Long-term problems after weight loss surgery

    Although uncommon, depending on the type of weight loss surgery, certain long-term problems can occur. They include:

  • Hernias at the site of one of the incisions
  • Internal hernias that may produce intestinal obstruction requiring a re-operation.
  • Narrowing (stricture) at the site of internal joins, which can make eating and drinking more difficult. This may need to be stretched with an endoscopic procedure
  • Hair loss in the first six months. This is a temporary side effect of the rapid weight loss and it will re-grow.
  • Gallstones
  • Dumping syndrome, which causes vomiting, reflux and diarrhoea soon after eating and is
    caused by the stomach contents moving too rapidly through the small intestine.
  • Patients may develop deficiencies of certain nutrients over long term. Patients having
    weight loss surgery are required to regularly take iron, multivitamins, calcium and vitamin D
    as prescribed as also undergo a regular follow up with their doctors to detect and treat
    deficiencies of the elements if they arise.
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