Bariatric Surgery: Types, Symptoms, Risks and Recovery

There are four types of bariatric surgery, each with its own advantages and disadvantages. The following are different types of bariatric surgery:

Roux-en-Y Gastric Bypass (RGB):

RGB is one of the oldest and most performed bariatric surgeries. 

Advantages of RGB:

• Significant weight loss: Patients can lose excess weight within the first year after surgery.

• Effective for diabetes: Many patients experience rapid improvement or remission of type 2 diabetes after the surgery.

• Restricts food intake: The small stomach pouch limits the amount of consumable food, leading to early satiety.

• Reduces hunger hormones: The bypassed part of the intestine lower’s ghrelin production, reducing hunger.

Disadvantages of RGB:

• Complex surgery: The RGB procedure involves rearranging the gastrointestinal tract, making it more invasive than other surgeries.

• Malabsorption: The bypassed portion of the intestine reduces the absorption of certain nutrients, leading to the potential for various deficiencies.

• Dumping syndrome: Some patients may experience dumping syndrome, which causes nausea, diarrhea, and weakness after eating certain foods high in sugar or fat.

Sleeve gastrectomy:

In this procedure, the surgeon removes a large stomach area, leaving behind a narrow, tube-shaped stomach resembling a banana or sleeve.

Advantages:

• Remarkable weight loss: Like RGB, patients can achieve substantial weight loss within the first year.

• Reduced hunger hormones: Removing a part of the stomach lowers ghrelin production, reducing appetite.

• No intestinal rerouting: The procedure does not cause malabsorption or dumping syndrome.

Disadvantages:

• Nonreversible: Unlike gastric banding, sleeve gastrectomy permanently removes a part of the stomach.

• Potential for leaks: There is a risk of leaks along the staple line, although it's relatively low.
  

Laparoscopic Adjustable Gastric Banding (LAGB):

Also known as the Lap Band procedure, this surgery involves the placement of a silicone band and inflatable balloon around the upper part of the stomach, composing a small pouch on the upper part of the stomach.

Advantages:

• Adjustable and reversible: The band can be adjusted or removed through a less invasive procedure.

• Low risk of nutrient deficiencies: Since there is no intestinal rerouting, nutrient absorption is not affected.

• Short hospital stay: Recovery time is generally faster than more complex surgeries.

Disadvantages:

• Slower weight loss: Weight loss may be slower compared to other surgeries.

• Band-related complications: Some patients may experience band slippage, erosion, or other difficulties.

• Frequent follow-ups: Regular adjustments and monitoring are required to maintain effectiveness.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

This procedure combines both restrictive and malabsorptive elements.

Advantages:

• Highest weight loss potential: BPD/DS results in the most weight loss among bariatric procedures.

• Effective for severe obesity and diabetes: It is particularly effective for patients with a very high BMI or severe diabetes.

Disadvantages:

• Complex and high risk: BPD/DS is a more complex procedure with higher nutritional deficiencies and complications risks.

• Permanent changes: The surgery is not easily reversible due to extensive intestinal rerouting.

• Lifelong supplementation: Patients require lifelong vitamin and mineral supplementation due to malabsorption.

Gastric Balloon:

It is a non-surgical procedure. 

Advantages:

• Non-surgical: It is a non-invasive procedure, meaning no incisions are required.

• Temporary: The surgeon generally removes this balloon after six months, and the procedure is reversible.

• Short hospital stay: Patients can often go home the same day or the next day.

• No intestinal rerouting: Since the procedure does not involve surgery on the stomach or intestines, there is no risk of malabsorption or nutrient deficiencies.

Disadvantages:

• Limited weight loss: The weight loss with a gastric balloon is typically less than other surgical options.

• Temporary solution: After the removal of the balloon, patients must maintain lifestyle changes to sustain weight loss.

• Side effects: Some patients may experience nausea, vomiting, or discomfort during the first few days after balloon placement.

• Not suitable for all: The gastric balloon may not suit people with certain medical conditions or those requiring significant weight loss.

How is bariatric surgery done?

Let us understand the basic steps involved in each type of bariatric surgery: 

1. Roux-en-Y Gastric Bypass (RGB):

Surgeons create a small pouch at the beginning of your stomach by stapling it off from the rest. It's like a mini stomach. Then, surgeons cut the small intestine and attach one end to this pouch, making a "Y" shape. That means food now takes a shortcut and bypasses some stomach and upper intestine. This way, you eat less, and your body absorbs fewer calories.

2. Sleeve Gastrectomy:

In this one, surgeons remove a big chunk of your stomach, leaving behind a slim tube-shaped stomach, like a banana. So, now your stomach can't hold as much food, and you feel full faster, leading to more weight loss.

3. Laparoscopic Adjustable Gastric Banding (LAGB):

Bariatric surgeons put a particular band with an inflatable balloon around the upper part of your stomach, creating a small pouch. Picture it as a belt for your tummy. The cool thing is they can adjust this band to make it tighter or looser. So, you control the passage size between the pouch and the rest of your stomach. It helps you eat less and feel satisfied with smaller meals.

4. Biliopancreatic diversion with duodenal switch (BPD/DS):

In this procedure, bariatric surgeons start with a sleeve gastrectomy, making your stomach smaller. Then, they divide your small intestine into two parts. One part connects to your new stomach, letting food travel down. The other part gets rerouted to join the lower part of the intestine. So, fewer calories and nutrients get absorbed, and you lose more weight!

5. Gastric Balloon:

In this non-surgical procedure, Bariatric surgeons insert a deflated balloon into your stomach through a tube with a camera. Once it's in, they fill it with a sterile solution. It's like blowing up a balloon, but this one stays inside your stomach for about six months. That takes up space, making you feel complete with smaller portions. After six months, they remove this balloon, and you maintain good habits.

Let us delve into the indications and contraindications of bariatric surgery in detail.

Indications for Bariatric Surgery:

Healthcare professionals usually recommend bariatric surgery for people who meet specific criteria related to their weight and health conditions. The following are the main indications for bariatric surgery:

• BMI criteria: Doctors consider bariatric surgery for individuals with a BMI of 37 or higher (severe obesity) or a BMI greater than 32 (obesity), along with significant obesity-related health problems. In some circumstances, doctors may suggest this procedure in people with BMI greater than 27 (overweight) if they have uncontrolled type 2 diabetes or other significant health issues linked to obesity.

• Obesity-related health conditions: Health conditions such as diabetes type 2, high BP, sleep apnea, high cholesterol level, joint pain, or heart disease that have not improved with other weight loss techniques may benefit from bariatric surgery.

• Previous weight loss attempts: bariatric surgery may be helpful in a person who has tried various weight loss approaches like diets, exercise, and medications without success.

• Psychological evaluation: Candidates for bariatric surgery undergo a psychological assessment to ensure they can cope with the emotional challenges of the procedure and lifestyle changes afterward.

• Commitment to lifestyle changes: Successful bariatric surgery outcomes rely on the patient's willingness to adopt healthier habits, including dietary changes, regular exercise, and long-term follow-up with healthcare professionals.

Contraindications for bariatric surgery:

Certain factors may make bariatric surgery unsuitable or unsafe for some individuals. Contraindications may include:

• Severe mental health conditions: People with severe mental health issues that could interfere with post-surgery guidelines or coping with challenges may not be good candidates for surgery.

• Active substance abuse: Individuals with ongoing substance abuse problems might not be suitable for bariatric procedures due to serious complications and noncompliance with post-surgery care.

• Untreated eating disorders: Those with untreated eating disorders, like binge eating disorder or anorexia nervosa, are generally not eligible for bariatric surgery.

• Medical conditions that increase surgical risk: Certain medical conditions, such as severe heart or lung disorders, uncontrolled high blood pressure, or liver disease, may increase the risk of surgery and make the procedure unsuitable.

• Inability to understand risks and benefits: People who need help comprehending the potential risks and benefits of the surgery or providing informed consent may not be suitable candidates.

• Unwillingness to comply with post-surgery requirements: Patients unwilling or unable to make necessary lifestyle changes, including dietary modifications and regular follow-ups, might not be relevant for bariatric procedures.

Bariatric surgery is generally safe but has some risks, like any other surgery. The following are some potential risks:

• Surgical risks:

Studies show that bariatric surgery has a low risk of complications. However, there's always a chance of infection, bleeding, or reactions to anesthesia. But, with proper surgical techniques and postoperative care, these risks are usually well managed.

A study published in the New England Journal of Medicine surveyed over 4,000 bariatric surgery patients and found that 17.3% had complications within 30 days of surgery. Most of these were mild or moderate, like surgical site infections and bleeding.

• Nutritional deficiencies:

Some bariatric procedures can lead to nutritional deficiencies due to reduced food intake or absorption issues. It means you may need extra vitamins and minerals.

In a study published in Obesity Surgery, they checked 500 gastric bypass patients. One year after surgery, vitamin B12 deficiency was in 34.8% of patients, and 18.7% had an iron deficiency.

• Dumping syndrome:

After certain bariatric surgeries, like gastric bypass, some people experience dumping syndrome. It is when food moves too quickly from the stomach to the small intestine. Symptoms can include nausea, vomiting, diarrhea, dizziness, and sweating after eating certain foods.

According to another study published in Surgical Endoscopy, 76.5% of gastric bypass patients experienced dumping syndrome during the first six months following surgery. Still, the good news is that it gradually decreased over time.

• Bowel obstruction and Hernia:

In some cases, intestinal obstruction or hernias can happen after bariatric surgery. Blocks can result from internal scarring or adhesions, while hernias may form at the incision sites.

One study in Obesity Surgery found that 3.8% of patients had internal hernias after laparoscopic Roux-en-Y gastric bypass. While rare, it required surgical intervention to correct.

• Gallstones:

Prompt weight loss after a bariatric procedure may increase the risk of gallstones. Changes in the gallbladder's function can lead to stone formation.

According to a study in the Archives of Surgery, 33% of patients developed gallstones within six months after gastric bypass. The good news is that gallstone-related complications were relatively uncommon.

Recovering after bariatric surgery can vary depending on the type of surgery you had and your overall health. Most people stay in the hospital for a day or two after the surgery, where the doctors closely monitor them.

Once you return home, it is time to rest and heal. For the first few weeks, you'll be on a liquid diet, but as you progress, you'll slowly move to soft foods and then regular foods.

Now, the recovery period can come with some ups and downs. Let me tell you about some common things you might experience:

• Pain: After the surgery, you might feel some pain, but it's usually manageable with medications. You might also feel sore around your incisions, which is normal.
• Nausea and Vomiting: Feeling nauseous or throwing up after bariatric surgery is common. Your stomach and digestive system have undergone some changes, and adjusting takes time. But don't worry; this should get better in a few days. If it doesn't improve, talk to your doctor.
• Constipation: Changes in your stomach and digestive system can cause constipation. But don't fret; you can manage it with diet and meds. Just let your doctor know if you're having any trouble.
• Fatigue: Feeling tired and drained is natural after surgery. So, take it easy, get plenty of rest, and avoid strenuous activities for some days.

Now, you might notice a few other changes too. Swallowing may be tricky initially because your stomach is smaller now, and your esophagus must stretch to accommodate food. But don't worry; this should improve with time.

Additionally, you might experience some emotional changes too. Bariatric surgery is a big deal, and it's normal to feel all kinds of emotions-happiness, relief, motivation, or even some anxiety and stress. But trust me; these feelings will settle down over time.

Just remember to be patient during your recovery. Healing and adjusting to these changes takes time. The following are a few tips to help you along the way:

• Drink plenty of water and other liquids to stay hydrated and prevent constipation.
• Follow the diet plan your doctor gave you. It is crucial for your healing process.
• Take your medications as prescribed to manage pain and other side effects.
• Get plenty of rest, as your body needs it to recover.
• Don't push yourself too hard if you're tired or sore. Listen to your body and take it easy.

With proper care and attention, you'll be on your way to a smooth and successful recovery and your new healthier and happier life.

Bariatric surgery has a good prognosis for patients. In the short term, you can expect to lose significant weight, improving your health and lowering the risk of long-term conditions, such as cardiovascular diseases, type 2 diabetes, and stroke. In the long term, you can maintain this weight loss and enjoy better health and quality of life.

Studies back this up:

One study found that people who had bariatric surgery lost around 65% of their extra weight over five years. That's way more than those who tried non-surgical methods. Another study discovered that bariatric surgery reduced the risk of death from all causes by 40% compared to those who didn't have the surgery. A third study revealed that bariatric surgery reduced the likelihood of type 2 diabetes development by 50% compared to non-surgical treatments. Sure, there are risks with surgery, like infection and bleeding. But the benefits usually outweigh the risks. You should speak with your doctor about bariatric surgery's pros and cons and prepare to make some lifestyle changes to maintain weight loss after surgery.

The following are some helpful tips for a successful outcome:

• Follow your doctor's instructions carefully for proper healing and to avoid complications.
• Make healthy changes to your lifestyle. Eat well, exercise, and get enough rest.
• Be patient; your body needs time to adjust to the changes.

With proper care, you can achieve a successful outcome after bariatric surgery. 

Medanta offers top-tier medical expertise, experienced bariatric surgeons, comprehensive care, advanced facilities, and patient-centric services, making it a highly recommended choice for bariatric surgery.

• Pioneering bariatric experts: At Medanta The Medicity, we take pride in our team of pioneering bariatric experts. Our accomplished surgeons possess extensive experience and expertise in various bariatric procedures, ensuring personalized and exceptional care for each patient.

• Tailored treatment plans: We believe every patient is unique, and their weight loss journey should be too. Our approach involves crafting individualized treatment plans, considering your needs and goals to achieve the best possible outcomes.

• Advancing surgical techniques: Embracing the latest advancements in surgical technology, Medanta offers cutting-edge techniques, such as minimally invasive laparoscopic procedures, robotic surgery, etc promoting faster recovery and minimized discomfort.

• Holistic patient support: Beyond the operating room, our holistic approach encompasses a multidisciplinary team of professionals. Our dedicated dieticians, nutritionists, psychologists, and support staff work together, ensuring comprehensive care throughout your weight loss journey.

• World-class infrastructure: At Medanta, we've invested in world-class infrastructure and advanced facilities. Our advanced operating theaters and specialized postoperative units ensure a comfortable and seamless experience.

• Remarkable success stories: We take pride in our incredible success stories, where patients have achieved sustainable weight loss and experienced life-changing transformations. Our commitment to excellence is evident in the results we deliver.

• Compassionate patient care: Compassion is at the core of our patient care, from the initial consultation to postoperative care. Medanta prioritizes your well-being and creates a stress-free environment.

• International standards of care: Our commitment to delivering international standards of care ensures that you receive top-tier medical services comparable to the best healthcare institutions worldwide.

• Comprehensive Postoperative guidance: Your journey doesn't end with surgery; it is a stepping stone to a healthier life. Medanta provides comprehensive postoperative support, including follow-up consultations, dietary guidance, and counseling, empowering you toward lasting success.

• Embark on your health transformation: Choosing Medanta for bariatric surgery means embarking on a transformative health journey. We invite you to experience excellence and compassionate care as we walk alongside you toward a healthier, happier life.

What is bariatric surgery?

The bariatric surgical procedure helps people lose weight who have severe obesity.

Who is a candidate for bariatric surgery?

Candidates for bariatric surgery are people having a body mass index (BMI) of 37 or higher or a BMI of 32 with obesity-related health problems.

What are the different types of bariatric surgery?

There are several types of bariatric surgery, including gastric bypass, sleeve gastrectomy, adjustable gastric banding, and biliopancreatic diversion with a duodenal switch.

How does gastric bypass work?

The gastric bypass procedure involves the creation of a small pouch in the stomach and bypassing part of the small intestine to limit food consumption and nutrient absorption.

What happens during a sleeve gastrectomy?

The sleeve gastrectomy procedure involves removing a larger part of the stomach to create a smaller, sleeves-shaped stomach, reducing food intake and hunger.

How does an adjustable gastric band work?

An adjustable gastric band is positioned around the upper part of the stomach to create a smaller pouch, restricting food intake.

What are the potential risks factors of bariatric surgery?

Risks of bariatric surgery include infection, bleeding, anesthesia-related complications, and long-term nutritional deficiencies.

How long is the recovery period after bariatric surgery?

Recovery time varies, but most people stay in the hospital for 2-3 days and can resume normal activities within a few weeks.

Can bariatric surgery cure obesity-related health conditions?

Bariatric surgery can often improve or resolve various conditions, such as diabetes, high blood pressure, obstructive sleep apnea, and heart disease.

Following bariatric surgery, how much weight loss can I expect?

Weight loss varies, but patients often lose 50-80% of their excess body weight within a year after surgery.

What type of lifestyle changes after bariatric surgery is imperative?

Adopting a healthy diet, regular exercise, and long-term follow-up are essential for successful weight loss and maintenance.

How soon after bariatric surgery can I return to work?

Most people can return to work within 1-2 weeks after surgery, depending on their type of job and recovery progress.

Can I become pregnant after bariatric surgery?

Yes, but it is generally recommended to wait 12-18 months after surgery to become pregnant to allow for stable weight loss and adequate nutrition.

Will I have loose skin after weight loss?

Excess skin is common after significant weight loss. Depending on the amount of loose skin, your surgeon may recommend additional surgical procedures to remove it. Less than 5% patients typically need removal of excess skin. 

What dietary changes will I need to make after bariatric surgery?

You will initially be on a liquid diet and gradually transition to soft and then solid foods. You should emphasize portion control and nutrient-dense foods.

Can I still enjoy my favorite foods after bariatric surgery?

While your doctor may suggest avoiding some foods, you can enjoy a variety of foods in smaller portions, focusing on nutrient-dense choices.

Will I need to take supplements after bariatric surgery?

Due to reduced food intake and nutrient absorption, your healthcare provider may prescribe various supplements like multivitamins, calcium, vitamin B12, and iron.

How can I manage dumping syndrome after gastric bypass surgery?

Dumping syndrome can manage by avoiding high-sugar and high-fat foods, eating smaller, frequent meals, and staying hydrated.

Can bariatric surgery be reversed?

Some procedures, like adjustable gastric banding, can be reversible. However, other surgeries like sleeve gastrectomy are generally not reversible.

How long will it take for me to reach my target weight after bariatric surgery?

The timeline for reaching your target weight varies, but most people continue losing weight for 12-18 months after the procedure.

Will I experience hair loss after bariatric surgery?

Some patients may experience temporary hair loss due to changes in nutrient intake, but it usually resolves on its own.

Is there a risk of regaining weight after bariatric surgery?

Weight regain can occur if lifestyle changes are not maintained. Regular follow-ups and adhering to a healthy lifestyle are essential to prevent this.

Can bariatric surgery improve fertility in women with obesity?

Weight loss after bariatric surgery can improve fertility and increase the chances of successful pregnancy in women with obesity.

Can bariatric surgery be performed on adolescents?

Healthcare providers may suggest bariatric surgery for adolescents with severe obesity and significant health problems after careful evaluation and consultation.

Does insurance cover bariatric surgery?

Some insurance plans may cover bariatric surgery, but coverage varies. Inquire your queries with an insurance provider to understand your specific coverage.

Will I need to attend counseling before bariatric surgery?

Counseling or psychological evaluation is often part of the pre-surgery process to assess readiness for the procedure and discuss potential challenges.

Can I drink alcohol after bariatric surgery?

Alcohol consumption is usually discouraged in the early postoperative period. Afterward, doctors may advise moderation and cautious drinking because of reduced tolerance.

How soon after bariatric surgery can I exercise?

Light physical activity can begin shortly after surgery, but you should avoid high-impact exercises for 4 weeks until you fully recover.

Can bariatric surgery affect my mental health?

Bariatric surgery can positively affect mental health, improving self-esteem and quality of life. However, some patients may experience emotional challenges.

Can I undergo bariatric surgery if I have a history of heart disease?

Patients with heart disease may still be candidates for bariatric surgery after a thorough evaluation and clearance from their cardiologist.

Will I need to stop smoking before bariatric surgery?

Smoking increases the risk of complications, and quitting smoking is strongly advised before undergoing bariatric surgery.

How long will I need to take medications after bariatric surgery?

Medication needs may change after surgery, and your medical team will adjust your prescriptions accordingly.

Is there an age limit for bariatric surgery?

Age alone is not a determining factor for bariatric surgery candidacy. The decision depends on overall health and individual evaluation.

Can bariatric surgery cure sleep apnea?

Bariatric surgery can significantly improve sleep apnea symptoms and may lead to complete resolution in some cases.

Will I have to follow a special diet for the rest of my life after bariatric surgery?

After surgery, dietary changes will be necessary, but they will evolve to accommodate your changing needs.

Can bariatric surgery help with joint pain and arthritis?

Weight loss after bariatric surgery can alleviate joint pain and improve arthritis symptoms, as there is a reduction in joint pressure.

How long will it take to see results after bariatric surgery?

Initial weight loss usually occurs in the first few weeks, but noticeable results may be visible within a few months.

Will I need to be on a special diet before surgery?

Pre surgery diets may vary, but doctors may advise patients to follow a specific diet to reduce liver size and enhance surgical safety.

Can I drink carbonated beverages after bariatric surgery?

Carbonated beverages are generally discouraged, as they can cause discomfort and may affect stomach size.

Can bariatric surgery affect my ability to absorb medications?

Certain medications may be affected by changes in the digestive system. Your medical team will adjust your medications accordingly.

Can bariatric surgery treat polycystic ovary syndrome (PCOS)?

Weight loss after bariatric surgery may improve PCOS symptoms and hormonal balance.

After losing weight, do I need plastic surgery to remove excess skin?

Healthcare professionals may advise plastic surgery in few patients to remove excess skin and improve body contours depending on the amount of loose skin.

Can bariatric surgery treat gastroesophageal reflux disease (GERD)?

In some cases, bariatric surgery can improve GERD symptoms and reduce the need for medication.

Can bariatric surgery help with fertility in men with obesity?

Yes, weight loss after bariatric surgery can improve fertility in men with obesity.

How can I prevent hair loss after surgery?

Hair loss after surgery is usually temporary and can be managed with adequate protein intake and supplements, as your doctor advises.