There are many types of bariatric surgeries. The five standard bariatric operations as per the Obesity & Metabolic Surgery Society of India (OSSI) and IFSO are-
Laparoscopic Adjustable Gastric Banding
Laparoscopic Sleeve Gastrectomy
Laparoscopic Roux-en y gastric bypass
Laparoscopic One Anastomosis Gastric Bypass (OAGB/MGB)
Laparoscopic Duodenal Switch
Additionally, there are modifications of standard operations, newer operations and endoscopic bariatric procedures. It can all be very confusing to understand which operation may work the best for you.
Before we start discussing the procedures, I must re-emphasize that bariatric surgery is not the end of the treatment. It is actually the beginning of a lifelong journey. Patients who embrace a healthier lifestbariatric surgeryyle after their surgery, tend to do much better in the long term. I have been into practice for almost 15 years now and have seen a range of bariatric operations climbing up the popularity charts and then falling out of favour. However, what does strike me is that there are patients who do well with just any kind of procedure and those who may not do so well with even the strongest of procedures. Of course, not everything is dependent on the patient or the doctor. Sometimes, the disease may be too aggressive and may take over our efforts. Having said that, lets discuss the nuances of the standard procedures in a little more detail.
Laparoscopic Adjustable Gastric Banding surgery– In this procedure an adjustable silicon band is applied over the upper part of the stomach. This divides the stomach in a smaller upper pouch and a larger lower pouch. It restricts the amount of food that a person can take and thus leads to weight loss. It does not make any permanent change to any of the organs in the gastro-intestinal tract and is reversible. This operation was very popular about 15 years ago but many patients especially in India did not get good results in terms of weight loss. It has gone out of favour now and is not routinely advised to patients.
Laparoscopic Sleeve Gastrectomy– Sleeve gastrectomy is the most commonly performed bariatric surgery operation all across the world. The sleeve has maintained its superiority for over a decade now. In this operation the stomach is divide vertically and outer two-thirds is removed. This leaves behind a narrow tubular sleeve like stomach. It leads to wight loss by restriction of food intake, early satiety, decreased hunger and neuro-hormonal changes. In the long term, acid reflux and weight regain can be issues after a sleeve gastrectomy. Weight loss results are good and if coupled with lifestyle modification it leads to good long-term outcomes. It also leads to significant improvement in obesity associated diseases like type 2 diabetes, high blood pressure, dyslipidemia etc.
Patients with pre-existing acid reflux disease must not undergo this procedure as it may increase after the surgery. In the long term, iron and Vit B 12 deficiencies can occur and supplementation may be needed off and on.
Laparoscopic Roux-en y gastric bypass surgery– (RYGB)- Gastric bypass is considered as the gold standard bariatric operation. It is being performed for over 40 years now and has great weight loss outcomes along with improvement in associated diseases, especially type 2 diabetes. In this procedure a small pouch of the stomach is created and the small intestine is re-routed and attached to the pouch in a Y shaped fashion. It leads to weight loss by restriction of food intake, early satiety, decreased appetite, neuro-hormonal changes, bile acid interactions, mal-absorption etc. Patients who undergo any bypass procedure need to commit to lifelong nutritional supplementation.
Laparoscopic One Anastomosis Gastric Bypass (OAGB/MGB)- This operation is a variation of a gastric bypass and has become increasingly popular in India in the last few years. In this operation there is a longer stomach pouch and the small intestine is attached to the pouch in a loop manner. This procedure entails a longer bypass as compared to RYGB and hence the requirement of nutritional supplements in higher. Attention must also be paid to protein supplementation especially in India where more than 30% of the population is vegetarian. There are also some concerns about biliary reflux after this operation.
Laparoscopic Duodenal Switch– This procedure entails a sleeve gastrectomy alongwith a large bypass of the small intestine. This operation is highly mal-absorptive and the requirement of nutritional supplements is very high. This procedure is usually not recommended in the Indian setting as most patients are not able to cope up with the very high protein requirement and requirement of other supplements.
To summarize, we call a procedure effective when it leads to good weight loss results and also significant improvement in obesity associated co-morbidities. The stronger the procedure, more is the effectivity. However, it must also be kept in mind that stronger procedures also lead to more nutritional deficiencies. Hence a balance needs to be struck when it comes to weight loss outcomes and nutritional deficiencies. The most effective procedure for you will be the one that you can cope up with in the long term. Ultimately, as I said earlier, bariatric surgery is just the beginning of your weight loss journey. Those who embrace lifestyle modification on a consistent basis, stand to get the best results.
Dr. Aparna Govil Bhasker
About Dr. Aparna Govil Bhasker
Dr. Aparna Govil Bhasker is an accomplished and renowned Bariatric Surgeon and Laparoscopic Surgeon.
Dr. Aparna Govil Bhasker is an accomplished Bariatric Surgeon and Laparoscopic GI Surgeon. Extremely passionate about her field of specialization. She completed her MBBS and MS in General Surgery in 2006, from Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. Set up in 1967 by none other than the first health minister of India, Ms. Sushila Nayar, MGIMS is deeply rooted in Gandhian ethics. Read more