What is Bariatric Surgery?

9th March 2020
Bariatric surgery is one of the possible treatments for morbid obesity. This is especially suited for patients who don't obtain results through dietary changes. 

Obesity is a chronic disease that generates as a result of the interaction of genetic and environmental factors. The imbalance between energy intake and expenditure produces a digestive accumulation of body fat. This determines a series of comorbidities and associated pathologies. The branch of surgery that’s responsible for the treatment of obesity is bariatric surgery.

Bariatric surgery: what does it entail?

Bariatric surgery consists of a set of surgical procedures that are used to achieve weight loss in obese patients. Patients should only refer to it when medical-dietary treatments fail.

We must bear in mind that the famous liposuctions don’t fall within this type of surgery. Bariatric surgery includes surgery techniques of the digestive system and aims to achieve weight loss in the most physiological way possible. 

Bariatric surgery techniques

For the concretion of this kind of intervention, there are several types of techniques:

  • Restrictive: they take action at the level of our functioning stomach, producing a gastric restriction. The intragastric balloon and the adjustable gastric band are examples of this.
  • Malabsorptive techniques: produce intestinal malabsorption, so the patient will absorb fewer nutrients and lose weight. As an example, there’s the biliopancreatic diversion or duodenal crossing.
  • Mixed techniques: join the two types of techniques. The main example of it is the gastric bypass.

Restrictive techniques

The most famous is the intragastric balloon. A balloon is inserted into the stomach endoscopically and inflated to reduce the filling capacity of the stomach; thus, ensuring that the patient satiates earlier. However, since it has to be removed in six months, it has a serious rebound effect.

Another important technique is the adjustable gastric band. With this technique, they make a small incision in the abdomen with the assistance of a camcorder. Inside, they introduce the silicon band through the laparoscopic route and wrap it around the stomach at the level of the lower curvature to reduce its capacity.

Malabsorptive techniques

Biliopancreatic diversion is one of the most important techniques. It consists of performing a horizontal gastrectomy- partial section of the stomach- to create a reservoir that can contain half a liter of liquid.

Likewise, an incision of the duodenum takes place a the post-pyloric level. Finally, the intestinal loop joins a terminal portion of the small intestine; only fifty centimeters will remain to permit the absorption of food. In a regular person, there can be up to six meters.

There are three types of bariatric techniques.
Image: laguiadelasvitaminas.com

Another technique is the duodenal crossover, in which a gastrectomy is performed in a section of a portion of the stomach. They do it vertically instead of horizontally, as in the previous example. In this case, a biliopancreatic diversion takes place before, but at the level of the distal intestine; closer to the large intestine.

The duodenum, where the pancreatic and bile enzymes we need for digestion are poured, takes the terminal ileum. Additionally, the intestinal loop, which is where the food goes, joins this anastomosis, so it’ll have about 50-100 centimeters where the patient can digest and absorb food. It’s more physiological than the previous one, in which you only try to decrease the absorption.

These surgeries reduce the amount of food that a person can absorb.
Image: opcionmedica.es

Mixed techniques

In this case, one of the most popular ones in Spain, which demonstrates greater profitability, is the gastric bypass. It consists of creating a small reservoir at the level of the smaller curvature attached to the esophagus.

This way, the food passes directly to the intestinal transit without passing through the stomach, which will pour its gastric juices into the intestine. Therefore, the food will digest in the small intestine and the patient will satiate much more easily.

Gastric bypass is one of the most popular techniques.
Before and after a gastric bypass.

Conclusion

These surgical techniques are certainly useful to achieve definitive and physiological weight loss. We must take into account that they are only performed in people with morbid obesity; after dietary and pharmacological treatments have had no effect.

All surgeries carry a series of risks, but in this case, the benefits outweigh them since they improve the quality of life of these people. Moreover, it reduces the incidence of cardiovascular diseases, improves cholesterol levels, blood pressure, and the control of diabetes.

With this article, the goal is to publicize the main techniques of bariatric surgery that are available. Although it may seem somewhat complex, remember that this is the knowledge that the digestive surgeon should have, not us. Nonetheless, it’s always good to be properly informed if we’re going to undergo an operation in order to lose weight.

  • Karmali, S., Johnson Stoklossa, C., Sharma, A., Stadnyk, J., Christiansen, S., Cottreau, D., & Birch, D. W. (2010). Bariatric surgery: a primer. Canadian Family Physician Medecin de Famille Canadien, 56(9), 873–879. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20841586
  • Bariatric Surgery Procedures | ASMBS. (n.d.). Retrieved April 18, 2019, from https://asmbs.org/patients/bariatric-surgery-procedures
  • Pories, W. J. (2008). Bariatric Surgery: Risks and Rewards. The Journal of Clinical Endocrinology and Metabolism, 93(11 Suppl 1), S89. https://doi.org/10.1210/JC.2008-1641