Bariatric Archives

Bariatric August 4, 2022

How To Prepare Yourself for Bariatric Surgery

Introduction

Bariatric surgery can be an extremely positive experience for your body. As you know, bariatric surgery involves getting you a smaller stomach through surgery toward your weight-loss goal. Most people who have this type of surgery feel better afterwards. It’s also one of the most successful weight-loss surgeries available today. If you’re considering undergoing Bariatric surgery, you should probably get ready as your hospital team will also have many questions for you. So ensure you have all the answers beforehand so there are no last-minute hiccups during your surgery.

What is Bariatric Surgery?

Obesity is a leading risk factor for diabetes and heart disease. There is no treatment for obesity that is predictive and consistent with results except for bariatric surgery. Bariatric surgery is a medical procedure used to help people with obesity lose weight by reducing the size of the stomach and the intestines. Such reduction and resizing of the stomach can help the patient feel full after eating smaller portions of food. This ensures fewer calories go into the body, thus enabling losing weight much faster.

Who should go for Bariatric Surgery?

Bariatric surgery may be suitable –

For a person who is morbidly obese (meaning the said patient is very overweight and at high risk of developing other health problems, such as diabetes or heart disease). Bariatric surgery candidates are generally either overweight than 500 pounds or obese with a Body Mass Index (BMI) of 40 or higher.

To someone who is unable to reduce weight through exercise and diet control.
In cases where it is safe, look at the patient’s medical condition.
Where the obesity-related health issues are life-threatening and need immediate addressing

One should also be ready to commit to the lifestyle change that comes with Bariatric surgery.

Advantages and Disadvantages of Bariatric Surgery

There are many benefits to undergoing bariatric surgery. First, you will likely feel better about yourself. You’ll also have more confidence and feel more in control of your life. And Bariatric surgery can help you lose weight much faster than dieting alone. Bariatric surgery can also help you avoid other weight-loss methods that may be unsafe or ineffective. That’s because Bariatric surgery is the only type of weight-loss surgery proven to work long-term. You may be wondering if there are any disadvantages to undergoing bariatric surgery. However, studies show very few disadvantages to this surgery.

Like any other surgical procedure, Bariatric surgery too has associated risks. The related risks or side effects could be infection, vomiting, stomach obstruction, inability to eat a specific food, failing to lose weight, and risks related to anaesthesia or acid reflux.

How and Why is Bariatric Surgery Performed?

Weight reduction is generally obtained through two types of Bariatric surgery — Restrictive and Malabsorptive — each with its advantages and disadvantages or a combination of both. In Restrictive surgery, the surgeon removes a section of your stomach larger than the average amount. This will reduce the amount of food you can eat at one time. In Malabsorptive surgery, the surgeon removes some of your small intestine — which means one will not be able to eat food with high sugar content, such as bread, fruit and sugar-sweetened beverages. These bariatric surgeries are slightly different and are generally chosen based on the person’s lifestyle.

Restrictive Surgery aims at reducing the intake of food by reducing the size of the stomach
Malabsorptive Surgery aims at reducing the absorption of nutrients by the body by resizing the small intestine.

The various types of Bariatric Surgeries include-

Sleeve gastrectomy is a surgery where the portion of a stomach is removed along a greater curvature. The remaining portion of the stomach is a banana-shaped stomach.
Gastric Bypass Surgery- It is also known as Roux-en-Y. Here a portion of a stomach is created like a small pouch and directly connected to the small intestine.
Intragastric Air Balloon- A saline-filled silicone balloon is placed in the stomach through the endoscopic route.
Endoscopic Gastroplasty- Using an endoscope, the suturing device sutures the stomach reducing its shape and size to that of a tube.
Metabolic Surgery – This surgery specifically addresses diabetes and metabolic dysfunctions, which have stopped responding to any lifestyle or medication changes as opposed to obesity per se.
Biliopancreatic diversion– Also known as Duodenal Switch, this is a type of surgery where the food bypasses some part of the small intestine. This can be considered both a malabsorptive and restrictive type of surgery.

Preparation and Procedure of Bariatric Surgery

Before surgery, you should probably be completely ready for the change. It is a holistic approach and assessment by an inter-professional team of stakeholders. There will be a nutritional evaluation, psychological evaluation, a weight loss plan, and medical clearance from the concerned departments, including the anaesthetic one.

Start by researching the procedure carefully. Ask your doctor if they have had this surgery before and the expected recovery time. Make sure you talk to your doctor about the benefits and risks of the procedure.
Keep your expectations realistic – you will not wake up lean the day after surgery.
Rally for all kinds of support; you cannot do this surgery alone. Have someone from your family come in as your caregiver. Join an online support group.
Review your resources – medical assistance, nutrition guidance, exercise regime.
Identify and understand the risks of food cravings and addictions and seek medical help before the surgery.
Be ready for lifestyle changes in your daily life, such as taking it easy at work or not drinking liquids for 12 hours before bed.

Before surgery, you will have a pre-op appointment where you can ask your doctor any questions about the procedure, the procedure itself and what you will experience during your surgery. During this appointment, you and your doctor can review your diet and medications, if any. You may also want to ask about what you should do in the days before your surgery and what you can do to get yourself ready for surgery. And if you are undergoing pre-op testing, such as a blood test or an EKG, ensure you have all the results when you arrive at the hospital. Finally, if you have any pre-operative medications, bring them with you.

Procedure of Bariatric Surgery

Bariatric Surgery could be either an Open Surgery or Laparoscopic Surgery. Most of the weight loss surgeries are done laparoscopically unless the patient is highly obese, has undergone any stomach surgery previously, or has other health complications.

Depending upon the need of the patient the surgeon will perform either Restrictive or Malabsoptive Surgery. The surgery will be done under general anesthesia.

With Bariatric surgery, you can bypass the struggle of weight loss journeys not yielding results. The patient will get hospitalised for a day or two. In that time, the surgeon will make several small incisions in the abdomen and then insert a port so that the patient can get medication and fluids intravenously. Post-surgery, the patient will probably be free to go home. However, the patient may need to take it easy for a few days.

Comply With Your Post-Op Diet and Restrict your Food Choices

Post your Bariatric surgery, and your diet will be restricted once you return home. You will be able to eat only a tiny amount of food and nothing high in sugar. Your diet will consist of either clear liquids or thick, bland blended food. You will only be able to drink fluids with a straw or a cup with a lid. You will not be able to cook or eat anything that has sugar added to it. You must follow these rules the entire time you are on a post-op diet. If you need to eat something that has sugar, you are allowed to have fruit or honey. However, these are the only foods you can eat on your post-op diet. It is important to note that you will be allowed to eat only minimal food. Eating smaller portions throughout the day is better than eating a large meal in one sitting.

Stay Safe and Keep Track of When to Return to Normal Life

It is important to keep yourself safe during your recovery. Make sure you do not fall, get hurt, or go near any dangerous activity. It is also vital to track when it is safe to return to work or school. You should also ensure enough rest, especially during the first few weeks after surgery. It is also important that you drink plenty of fluids.

FAQs

1. Do we have to lose weight before bariatric surgery?

Answer – Yes, Some patients are asked to lose 10 percent of their weight before their weight loss surgery to avoid complications.

2. How long is the preparation for bariatric surgery?

Answer – The entire process from preparation to surgery involves an inter-professional team of stakeholders who will evaluate the patient on multiple aspects, which can be up to six months.

3. What is the preparation for bariatric surgery?

Answer – The preparation is a holistic approach and assessment by an inter-professional team of stakeholders. There will be a nutritional evaluation, psychological evaluation, a weight loss plan, and medical clearance from the concerned departments, including the anesthetic one.

4. Who cannot undergo bariatric surgery?

Answer – Those with BMI below 35 cannot undergo bariatric surgery.

5. What foods to avoid after bariatric surgery?

Answer – All forms of red meat, high fat, and greasy food, spicy and seasoned food, processed food, alcohol, sugars, and sweets.

6. What are the risks of bariatric surgery?

Answer – The risks are infection, blood clots, failure to lose weight, chronic nausea and vomiting, acid reflux, allergy to certain foods, etc.

Bariatric December 15, 2021

Obesity And Its Treatment

Most people enjoy their leisure time binge-watching movies and shows, this sedentary behavior has contributed to the development of obesity. Obesity is viewed by many individuals as a moral failing rather than a disease.

According to the World Health Organisation (2016), there are around 2 billion adults overweight, of those 650 million are considered to be affected by obesity.

What is obesity?

Obesity is a complicated condition characterized by an excess of body fat. Obesity isn’t just a cosmetic problem. It’s a medical condition that puts you at risk for various diseases and health problems like heart disease, diabetes, high blood pressure, and some cancers.

It is typically caused by a mix of genetic, physiological, and environmental factors, as well as nutritional, physical activity, and exercise choices.
The good news is that even minor weight loss can assist or prevent obesity-related health issues. A healthier diet, more physical exercise, and behavioral adjustments can all help you lose weight. Prescription medications and weight-loss treatments can also be used to treat obesity.

So, how can you treat obesity?

Overweight and obesity are commonly treated with a combination of a healthier diet, increased physical activity, and other lifestyle changes. Some people may benefit from weight-management programs to lose weight or avoid regaining it. Some obese people are unable to either lose enough weight to improve their health or maintain their weight loss. In such cases, further treatments such as weight-loss medicines, weight-loss gadgets, or bariatric surgery may be considered.

Regular physical activity and a healthy eating plan

Following a healthy eating plan with fewer calories is typically the first step in reducing overweight and obesity. People who are overweight or obese should begin regular physical activity as soon as they start a healthy eating plan. Physical activity can assist you in burning calories more quickly. Physical activity can help you stay in shape and maintain a healthy weight.

Making a habit change

Start with small changes and include positive habits in your lifestyle. Your weight loss starter kit must have – a concrete healthy eating plan, dedication to follow, regular workout, and proper sleep.

The following suggestions may assist you in considering ways to lose weight, increase your exercise, and enhance your long-term health.

– Expect setbacks since they are unavoidable: If you experience a setback, such as overeating during a family or company gathering, try to refocus and get back on track as soon as possible. Only eat in your dining room or kitchen when seated at a table. Avoid trigger areas where sweets may be offered. Track your progress with online food or physical activity trackers which help you manually track your progress.

– Make a plan: Having precise objectives can assist you in staying on track. Rather than “be more active” set a goal to walk 15 to 30 minutes before work or at lunch on Monday and Friday. If you skip a stroll on Monday, make up for it the next day.

– Seek help: Seek help from family, friends, or medical experts if you need it. You can seek assistance in person, via email or text, or over the phone. You can also become a member of a support group. Health specialists with specialized training can assist you in making lifestyle changes.

Programs to help you lose weight

Some people benefit from a structured weight-loss program. In a weight-loss program, professional weight-loss specialists will create a customized strategy for you and assist you in sticking to it. The plan includes a lower-calorie diet, increased physical activity, and tools to help you adjust and sustain your behaviors. You can work with the specialists in individual or group sessions on-site (that is, face-to-face). To support your plan, the specialists may contact you frequently by phone or via the internet. Smartphones, pedometers, and accelerometers can all help you keep track of how well you’re sticking to your diet and exercise plan.

Medicines for weight loss

Your doctor may prescribe drugs to manage overweight and obesity if healthy eating and physical exercise habits aren’t enough. While taking weight-loss medications, you should endeavor to keep to your healthy eating plan and maintain regular physical activity.

Bariatric surgery

Bariatric surgery refers to a variety of procedures that alter your digestive system to help you lose weight. If you’re severely obese and haven’t been able to shed enough pounds to improve your health or avoid regaining the weight you’ve lost with conventional therapies, bariatric surgery may be a possibility. If you have major health problems associated with obesity, such as type 2 diabetes or sleep apnea, bariatric surgery may be an option at a lower degree of obesity. Many medical disorders connected to obesity, particularly type 2 diabetes, can be improved by bariatric surgery.

Obesity has the potential to reduce one’s overall quality of life. It’s possible that you won’t be able to participate in physical activities that you used to like. Long-term weight reduction success requires being motivated to decrease weight. Various variables motivate different people, therefore it’s crucial to figure out what motivates you particularly. Remember to be flexible with yourself and to enjoy your small victories as you lose weight. Also, don’t be scared to seek assistance when necessary.

Bariatric December 11, 2020

Patient Guide To Bariatric Surgery: Safest Approach And Recovery After Surgery

There’s no doubt that when one starts thinking about weight loss surgery, he or she is looking way ahead to the results, pain, and life after the surgery. It is important to accept that any surgery, in general, will have some kind of pain associated and patients should accept it as a part of the process. And especially after bariatric surgery, it’s very common for any patient to experience stomach pain. Weight loss surgery is considered major surgery and, to varying degrees, it is usual to experience a range of symptoms. These may include nausea, heartburn, GERD, uncontrollable vomiting, sleeplessness, surgical pain, fatigue, light-headedness, gas pain, pain in the left shoulder, and emotional ups and downs in the early days and weeks after surgery. Up to 30% of patients experience some sort of abdominal pain after undergoing bariatric surgery. Mostly, the abdominal pain is due to the body, particularly the stomach, coping up with the surgery, and can be encountered, if one accidentally overeats. Apart from pain, patients also suffer from other abdominal symptoms, depending upon their history and the surgery procedure. Post-bariatric surgery, one will have a feeling of fullness, after eating much less food, as compared to an ordinary person. The feeling of fullness after the surgery is much like a nauseating feeling, feeling after over-eating, otherwise. One will be able to cope up with this pain, gradually as they self-adjust their meal portions to much lesser quantities.

On the other hand, it is just not about the pain and accompanying symptoms of bariatric surgery, one must also be well aware of certain risk factors associated with the surgery. And, it goes without saying that as with any major abdominal surgery, there are risks associated with bariatric surgery too and surgery should not be considered unless you and your surgeon evaluate all other possible options. An ideal approach to weight-loss surgery requires proper discussion and careful consideration of all the associated risk factors (Short-term/ Long-term). But, surgery with proper aftercare and adequate lifestyle changes can bring astounding long-term results for health and weight.

The safest form of a Weight-loss Surgery

We all know that obesity is a major health problem worldwide, and various forms of surgeries aim to shrink the stomach and affect nutrition absorption to help the patient lose weight. Bariatric surgery is considered to be the most substantial and constant weight loss solution for obese patients. But patients should consider this surgery only after exploring all other options for weight loss like dieting, exercise, and drug treatments. Currently, there are 4 standard surgeries for weight loss and they are as follows

Gastric bypass: This surgery is restrictive/malabsorptive and involves two procedures. A small pouch is created by stapling the stomach and then the small intestine is cut and the lower part is attached to the pouch, bypassing a major part of the stomach.

Gastric sleeve or sleeve gastrectomy: This is a restrictive laparoscopic surgery in which about 75% to 85% of the stomach is removed and only a small portion is stapled. This reduces the quantity of food intake and does not affect the absorption of nutrients.

Adjustable gastric banding: This again is a restrictive surgery in which the surgeon places an inflatable band over the top portion of the stomach which divides the stomach into two sections, creating a small pouch on top of the main stomach, connected to it by a small channel. This slows down the passage of food that goes into the main stomach eventually reducing the overall intake.

Biliopancreatic diversion with duodenal switch: This is a restrictive/malabsorptive surgery performed in two standard steps. Firstly, a sleeve gastrectomy is performed in which most of the stomach is removed and is connected to the pouch to the end of the small intestine bypassing most of it.

Each type of bariatric surgery comes with its positives and negatives. Some offer rapid initial weight loss, some are minimally invasive, and few might require minimum post-operative care. Just like the pros, there are also certain cons related to these surgeries like nutritional deficiencies, permanent and irreversible results, and slow weight loss rate in some cases. It is completely dependent on the surgeon to suggest the type of surgery basis a detailed evaluation of the patient’s BMI, health parameters, and personal needs. But, regardless of the approach, every type of bariatric surgery result in significant weight loss.

What to expect after weight loss surgery?

Usually, one can expect a significant weight loss (up to 60%) after the surgery. Also, a significant improvement is observed in other conditions such as your blood sugar levels, high blood lipid levels or sleep disorders, which are related to higher body weight. This indirectly impacts the quality of life and enhances it. But, don’t think that these improvements will be permanent. You will be required to follow certain healthy lifestyle recommendations after surgery to avoid regaining the lost weight. Eating small and frequent meals becomes an essential part of the recovery phase as eating large meals can create problems for the small-sized stomach. Ask a dietitian to help you create a plan that will get you all the nutrients you need and top it up with a good workout regime that focuses on managing weight and improving muscle growth that can help you in a quicker return to a healthier lifestyle. Remember to stay in touch with your medical team and to attend all follow-up appointments that are scheduled as part of your recovery. Also, keep a personal check on your progress and don’t hesitate to contact your primary care doctor if any medical concerns arise.

Bariatric November 24, 2020

Possible Side Effects Of Bariatric Surgery

The study says, India, with 41 million obese people, ranks third after the US and China in having the highest number of overweight people in the world. Together, India and China represent 15% of the world’s obese population which leads to the rise of the weight loss industry in the country like never before. And, so as the number of weight loss surgery. Obesity can be considered a modern-day epidemic that’s slowly spreading all over the world that includes the young as well as the old. However, the problem with obese people is not just about the excessive fat but the condition that invites a lot of life-threatening diseases like diabetes, stroke, blood pressure, etc. The common treatment for obesity includes losing weight through healthy eating, regular exercising and being more active but who have extreme obesity are advised treatment options like weight loss device, weight loss medicines, or weight loss surgery.

Weight loss surgery is one of the fastest-growing segments of the surgical discipline. Gastric bypass and other weight-loss surgeries — known collectively as bariatric surgery — involve making changes to your digestive tract that aids in losing weight. However, bariatric surgery is not for everyone who is extremely overweight as it has some risks and complications. You may need to meet some medical guidelines and have an extensive screening process to qualify for bariatric surgery. Let’s dig in a dip to understand the risks and side effects associated.

Risks and side effects of Bariatric Surgery

Risks and side effects are part of any surgery or treatment. As evident with any major surgery, bariatric surgery is no exception and this procedure too has its own set of risks and side effects in the short- and long-term. Up to 40% of patients suffer from side-effects post-bariatric surgery. However, serious complications are seen in <5% of patients.

The most usual risks associated with bariatric surgery include:

Constipation
Too much internal bleeding
Infection
Blood clot formation
Trouble in breathing
Gastrointestinal Leaks, after surgery, there is a small chance that food could leak out into your stomach
In rare cases, Death

Longer-term risks and complications of bariatric surgery include:

Obstruction of bowels, a gastrointestinal condition in which digested material is prevented from passing normally through the bowel.
Stone in the gall bladder
Hernia
Low blood sugar
Low nutrition
Ulcer formation
Vomiting and Nausea
GERD or Acid reflux occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach
Dumping syndrome- It is a group of symptoms, such as diarrhea, nausea, and feeling light-headed or tired after a meal, that is caused by rapid gastric emptying. Rapid gastric emptying is a condition in which food moves too quickly from your stomach to your duodenum.

Unavoidable conditions, emergencies, or under some special circumstances, weight loss surgery or bariatric surgery could only be the treatment option. Though some complications are inevitable, with proper guidance from the doctor one will be able to overcome the challenges post-surgery.

Recovering from the surgery will be the next important step for the ones undergone the surgery. Below are some important tips to note for a speedy recovery.

Recovery from the bariatric surgery

Recovery in the hospital: After undergoing bariatric surgery, the patients have to spend around 2 to 5 days in the hospital, or longer if complications develop. If the surgery was laparoscopic, you can expect a shorter stay at the hospital. It is normal to experience any tiredness, GI symptoms such as nausea, vomiting, flatulence, loss of hunger, etc. in the immediate days to weeks after surgery. You may feel pain at the surgery site for a few days, but if it is unbearable, you may consult your surgeon, who may prescribe an IV analgesic or an oral pain-killer when you resume taking food through your mouth. Performing simple activities such as walking or even frequently altering position in bed can aid in circulation, seeding the recovery process and prevent any complications. Deep breathing and coughing exercises will also aid in preventing any lung infections.

Recovery at home: Your discharge from the hospital will be decided by your doctor based on your health progress. You will be needed to follow a certain diet and activity restrictions at home after discharge. After you get home, don’t rush into performing all activities at once. Proceed gradually. Also, keep up all follow-up appointments with your doctor regularly.

However, it is possible to not lose enough weight or to regain weight after undergoing any weight loss surgery, even when the procedure works correctly. This weight gain, after the surgery, can happen if you fail to follow the doctor’s recommended lifestyle changes, such as consuming a healthy diet, following regular physical activities and having good sleep.

Bariatric November 24, 2020

What Is Bariatric Surgery And Its Types?

You’ve probably heard this term ‘Obesity’ a lot of times in your life. Obesity is recognized as a significant public health hazard, as it increases the risks for multiple diseases such as type 2 diabetes and other cardiovascular diseases. Obesity is a complex disease involving an excessive amount of body fat that increases the risk of other diseases and health problems, such as diabetes, heart disease, high blood pressure and certain cancers. Today, more than one-third of the world’s population has been affected by this complex, multifactorial, and largely preventable disease. If these secular trends continue, by 2030 an estimated 38% of the world’s adult population will be overweight and another 20% will be obese. This epidemic of overweight presents a major challenge to chronic disease prevention and health across the life course around the world.

Increasing ease of life, owing to minimize physical labour and automated transportation, a sedentary lifestyle, and liberal access to calorie-dense food has turned a once-rare disease of the affluent into one of the most common diseases of this century. Luckily, overweight and obesity, as well as their related non-communicable diseases, are largely preventable. Common treatments for this disease include losing weight through being more physically active, healthy eating, and making other changes to your habits. But, for the people who have extreme obesity and haven’t been able to lose enough weight are advised other treatment options like weight-loss medicines, weight-loss devices, or weight loss surgery (bariatric surgery). Let us dig in deep to understand more about bariatric surgery and its types.

What is bariatric surgery?

Bariatric surgery is a kind of surgical procedure that aids in weight loss by altering your digestive tract. This surgery leads to weight loss by reducing the quantity of food your stomach can hold, causing you to feel full in a lesser quantity of food uptake. Generally, it is performed when lifestyle changes like diet or exercise plan fail to work or your excess body weight is causing serious complications. Some bariatric surgery procedures restrict your food consumption, while others reduce the capacity of your body to absorb nutrients from your meals and a different kind of surgery can work in both ways.

Types of bariatric surgery

The type of surgery that may be best to help a person lose weight depends on several factors. One should discuss with their doctor what kind of surgery might be best for them. Gastric Bypass, Sleeve Gastrectomy, Adjustable Gastric Band and Biliopancreatic Diversion with Duodenal Switch are the most frequently performed bariatric surgery types. Each type is associated with its own merits and limitations.

Gastric Bypass or Roux-en-Y Procedure: This surgery is typically a non-reversible procedure and functions by reducing the capacity of food you can eat in a single meal as well as decreasing the absorption of nutrients. In this procedure, the surgeon incises across the top portion of your stomach, separating it from the remaining part. The resulting portion will be approximately like the size of a walnut and will be able to hold just a small quantity of the food as compared to the usual capacity. Then, your surgeon will incise the top portion of the small intestine and joins it directly onto the separated pouch of the stomach. Thus, the food directly enters this portion of the small intestine from the stomach, bypassing the majority of your stomach and a part of the small intestine. This procedure leads to a significant weight loss of 60% to 80% and bears a >50% excess weight loss maintenance. This procedure also raises expenditure of energy and leads to favourable alterations in gut hormones, which suppresses hunger, decreases appetite and improves satisfaction.

Sleeve Gastrectomy: This procedure removes around 80% of your stomach, leaving behind just a tubular pouch, which cannot hold much food. The advantages of sleeve gastrectomy include faster and major weight loss of >50%, similar to Roux-en-Y, does not need re-routing of food, associated with a shorter hospital stay and leads to favourable alterations in gut hormones, which suppresses hunger, decreases appetite and improves satisfaction. However, it causes long-term Vitamin deficiencies and possesses a higher complication rate at short-term vs. AGB procedure.

Adjustable Gastric Band or AGB: It is often referred to as simply “The band”. This procedure involves the placement of an inflatable band around the stomach’s upper part, forming a small pouch above the band, leaving the rest of the stomach’s portion below. In simpler terms, it works by decreasing hunger, aiding the patient to decrease calorie consumption. It leads to an excess weight loss of 40 to 50%. It does not need cutting of the stomach or any intestinal rerouting. It needs a hospital stay of just 24 hours or even less and the procedure is also reversible and adjustable. It possesses the lowest early complications’ rate and also the lowest death rate amongst bariatric surgery procedures. The risk of Vitamin and mineral deficiencies is also minimal.

However, the speed of achieving excess weight loss is lower than the rest and most of the patients fail to lose at least 50%. It needs the placement of a foreign object causing object erosion or other band-related adverse effects. It also needs strict diet plan adherence post-surgery and you need to attend follow-up with surgeon without fail. It is associated with the highest re-operation rate.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This procedure is a two-part surgery. Firstly, a creation of tubular stomach pouch as in sleeve gastrectomy and secondly, connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing the majority of the intestine. This surgery leads to a greater excess weight loss of 60-70% at 5 years. It permits patients to eat a normal diet in due course of time. It decreases fat absorption by approx. 70% and leads to favourable alterations in gut hormones, decreasing appetite and raises satisfaction. This procedure is termed to be most effective in diabetes patients. However, this technique possesses higher rates of complication and risk for death. It needs a prolonged hospital stay and causes protein, vitamin and mineral deficiencies. Also, strict adherence is required in post-operative diet restrictions and follow-up doctor visits.

Each of the surgery types has pros and cons and various patient factors affect which procedure is chosen including body mass index, eating habits, other health issues and previous stomach surgeries. The patient should discuss the most suitable option with the surgeon by considering the benefits and risks of each type of surgery. However, bariatric surgeries may not be suitable for everyone and so they are only performed if there is a serious health threat to the patient due to their excessive weight.