Surgery: Archives

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.

Heart Attack December 7, 2020

STENTS: TYPES, PROCEDURE & BENEFITS

What is a Stent?

A stent resembles a tiny tube, which is used to treat diseases where the blood vessels get clogged due to the accumulation of fat, cholesterol and even calcium. Normally, these blood vessels are involved in supplying blood to the rest of the body from the heart, including the heart muscles. The majority of the stents are composed out of wire mesh and are permanent. Some stents used for bigger blood vessels are also composed of fabric and are termed as stent-grafts.

A different class of stents is manufactured from materials that get dissolved or absorbed over time in the body. Stents are implanted within the affected blood vessels, which prevents them from getting blocked. Stents are also available in a drug-coated variant, where they are coated with drugs that slowly get released in the bloodstream. These drugs prevent the blood vessels from getting blocked.

Why a stent is required?

In case fats present in the body get collected inside an artery, it can decrease the flow of blood to your heart itself and can lead to chest pain and eventually cause heart disease. Also, the accumulated contents in the vessel lumen (referred to as plaque) can lead to the formation of a blood clot, which upon rupturing, can block the vessel and disrupt the normal blood flow to the heart and can lead to a heart attack due to the death of the tissues which are deprived of blood. Stents reduce your subsequent risk of heart vessel disease and can be used even for treating an ongoing heart attack.

What are the different types of stents?

There are two primary types of stents: 1) Bare Metal Stents (BMS) 2) Drug-eluting Stents (DES). BMS gives support to the blood vessel to aid in preventing its blockage post angioplasty. On the other hand, A DES is a BMS coated with a unique drug coating added for reducing the risk of re-blocking of arteries. In a DES, the drug gradually gets released from the drug coating overtime preventing the reformation of blockages during the maximal risk period, wherein a block can be formed. In a DES, the stent is coated with a special polymer, which contains and preserves the drug during the stent placement procedure. As soon as the stent is placed, it aids in controlling the release of the drug into the blood vessel walls. In this way, the polymer helps in an equally distributed drug release from the stent. The polymer for DES is designed to permit a consistent and controlled drug release from the surface of the stent into the walls of the artery. There are two types of drug-eluting stents:

Permanent Polymer DES: In this type of stent, the polymer stays on the stent permanently, even after all the drug has been released.
Bioabsorbable Polymer Drug-Eluting Stent: In this type of stent, the polymer degrades shortly with the release of the drug. This helps better healing by eliminating long-term polymer exposure.

The doctor may prefer a BMS or a DES based on the unique needs of each patient. Each type of stents has its inherent advantages and drawbacks which should be discussed well in advance with the doctor. A DES cannot be used in you in the following cases:

1) You are allergic to the drug, the polymer or metals (stainless steel, platinum, chromium, cobalt, etc.) used in the stent.

2) You cannot tolerate anti-clotting or anti-platelet drugs.

3) You have a blockage that does not permit proper stent placement.

4) Your doctor feels you are not suitable for stent placement for a particular reason. Still, stent placement is associated with complications like any other invasive procedure.

Process of stent implantation

Your doctor will first make a small cut in a blood vessel located in your abdomen, arm, or neck to insert a stent in your body.
He/she then inserts a small tube known as a catheter through the vessel to the artery which is clogged. The tube contains a tiny balloon at its end, that your doctor will inflate in your clogged artery. This process will widen your artery and restore the blood flow through the deprived portion. The stent will then be placed inside the artery and the rest of the contents (balloon and catheter) will be taken out. The placed stent will keep the artery open to keep the usual blood flow. The entire process is estimated to last only an hour but mostly, you will be required to stay in the hospital for a night for observation of any adverse events.
Risks may include:

1) Hemorrhage at the spot of tube insertion.

2) Blood vessel damage at the time of insertion.

3) Infection.

4) Arrhythmia i.e.Improper beating of the heart, whether irregular, too fast or too slow.

5) On rare occasions (1-2%), people who are implanted with a stent, develop a clot at the stent placement site, further elevating the risk of occurrence of a heart attack (myocardial infarction) or stroke. This risk is maximum during the first couple of months of post-procedure. Hence, your doctor will recommend you to take aspirin or any other blood thinners to prevent clot formation.

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What are dissolving stents and what are their benefits?

Traditional metal stents have been associated with several drawbacks for a long time. A metallic stent needs to be placed permanently in the blood vessel for the prevention of re-narrowing or post dilating a clogged artery with a balloon. However, the permanent presence of a metal stent forms a core for forming a clot of blood within the stent which could be fatal for the patient. The principle behind a dissolving or a bioresorbable stent is to overcome the drawbacks of metallic stents. It prevents re-occurrence of narrowing during the period of maximum risk and ultimately gets dissolved withdrawing the risk of formation of any blood clot.

Are stents effective in the long term in reducing the chance of another heart attack?

Yes, certain stents (DES) can reduce the chances of future heart attacks to some extent but regular medicine intake and lifestyle modifications are the most vital components in reducing the risk of a heart attack even after stent implantation.

How long does a stent last?

A stent is a tube-like structure and normally metallic. It is designed to maintain the lumen of the blood vessel. Coronary arteries are the blood vessels that carry blood to the heart muscle. Stents are placed through a procedure in which a catheter is placed in the artery present in the abdomen and guided up to the heart. An angioplasty where the narrowed artery due to blockage is dilated via a balloon dilation normally happens before the stent placement.

Some patients with stents implanted 30 years ago are performing normally even now. However, stents can also develop blockages. Lately, drug-eluting stents have been used largely in patients to prevent the development of blockages after stent placement. These stents are coated with drugs to lessen the risk of formation of blockages. Patients who already get stents implanted carry the risk of blockages at different locations in different arteries. Aspirin therapy and control of cholesterol and triglycerides through diet, medicine or both do appear to decrease risk.

Harms/Risks of Stenting

You may get an allergic reaction
Angioplasty can lead to hemorrhage, blood vessel damage, or even heart damage, or arrhythmia.
Rarely, some potential complications such as heart attack, stroke, or renal failure can also occur.
A scar tissue formation can happen inside your stent post stenting procedure necessitating another procedure for removing it.
Stenting also carries a risk of blood clot formation which needs medicines for prevention.
It cannot ultimately cure your CAD. You have to continue managing your contributing risk factors for CAD such as hypertension, overweight, diabetes, or high cholesterol to prevent a future event.

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Living with Stent

Saves your life and alleviates damage to your heart muscles at the time of heart attack by replenishing blood flow to your heart.
Immediately relieves/decreases symptoms of heart disease.
Reduces the risk of heart attack or stroke in the future.
Stent placement may diminish your requirement of a CABG (Coronary Artery Bypass Grafting).
Stenting is comparatively much less invasive versus CABG and also has a much short-lived recovery period.

Knee Replacement November 26, 2020

Osteoarthritis: Symptoms, Causes & Treatment

The knee is the human body’s largest joint and its healthy maintenance is required to perform most of the everyday activities, easily. The knee joint is formed by the thighbone’s (femur’s) lower portion, the shinbone’s (tibia’s) upper portion, and the cap of the knee referred to as the patella. The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The C-shaped wedges present between the thighbone and the shinbone are known as menisci. They function as the natural “shock absorbers” protecting the joint. The thigh and shinbones are held together by large ligaments, lending stability to the joint whereas the long thigh muscles make the knee strong. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane secretes a liquid that moistens the cartilage, minimizing friction to almost zero in the case of a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

Although there are more than 100 types of Arthritis, the three most common types are Osteoarthritis, Rheumatoid arthritis and Post-traumatic arthritis. In this article, we will majorly focus on Osteoarthritis.

What is Osteoarthritis (OA)?

Osteoarthritis is an age-related “wear and tear” type of arthritis. It generally affects persons aged 50 years or more, but may also affect younger individuals. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. Osteoarthritis (OA) of the knee happens when the cartilage, the cushion between the knee joints deteriorates. This can cause pain, stiffness and swelling. Appropriate treatment can help relieve discomfort and slow the damage. It can also improve your quality of life facilitating you to better keep up with your day-to-day activities.

What are the causes of Osteoarthritis?

Age: The risk of developing OA increases as someone gets older because bones, muscles and joints are also aging.
Joint injury
Using the same joints over and over in a job or sport can result in OA.
Obesity: Extra weight puts more stress on joint and fats cells to promote inflammation.
Weak muscles: Joints can get out of the right position when there’s not enough support.
Hereditary: People with family members having OA can also suffer from OA.
Women are more likely to develop OA than men.

What are the signs & symptoms of OA?

Joint stiffness and soreness
Grating sensation
Bone spurs
Loss of flexibility
Pain or aching in the joint during activity
Limited range of motion that may go away after movement
Clicking or cracking sound when a joint bends
Swelling around a joint.

How to Diagnose Osteoarthritis?

Osteoarthritis of the major joints is most effectively diagnosed through a combination of medical history, physical examination, and various lab tests including imaging studies such as X-ray. A physician can diagnose most of the cases but in some cases, he may refer you to an Orthopedic surgeon, physiatrist for further evaluation.

Medical History

Medical histories can often be the most useful tool for physicians in diagnosing osteoarthritis. The doctor will look for a family history of the disease as well as the presence of various risk factors to indicate the need for further testing.

Physical Examination

A physical examination will usually follow the medical history as the physician looks for physical signs of the disease. These include signs like swelling and tenderness of the joints, loss of movement in specific joints, or visible joint damage such as bony growths in the surrounding area. The patient may also be asked to perform a variety of physical tasks so the physician can evaluate the range of motion and general joint mobility.

What are the treatment options for Osteoarthritis?

General Management

Patients with osteoarthritis of the hand may benefit from assistive devices and instruction on techniques for joint protection; splinting (a rigid or flexible device that maintains in position a displaced or movable part) is beneficial for those with symptomatic osteoarthritis.

Patients with mild to moderate osteoarthritis of the knee or hip should participate in a regular exercise program (e.g. a supervised walking program, hydrotherapy (water cure) classes) and, if overweight, should follow a healthy and balanced diet. The use of assistive devices can improve functional status.

Medical Management

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs are ibuprofen and diclofenac; painkillers.
Topical therapies – Topical NSAIDs are applied to unbroken skin where it hurts in the form of gels, creams, sprays, or plasters.
Intra-articular injections – A term used to define a shot delivered directly into a joint with the primary aim of relieving pain.

Surgical Measures

Total hip and knee replacements provide excellent symptomatic and functional improvement when the involvement of that joint severely restricts walking or causes pain at rest, particularly at night. Total Knee Replacement is one of the most common surgeries in the world with a large majority of patients going on to lead rich, happy and healthy lives. It requires a surgery of 1-2 hours followed by a hospital stay of 2-3 days.

The knee is the human body’s largest joint and is made up of the lower end of the thighbone, the upper end of the shinbone and the kneecap. A knee replacement includes replacing some or all of the component surfaces of the knee joint with artificial implants. A knee replacement is performed to repair the damaged weight-bearing surfaces of the knee joint caused due to inflammatory diseases or injury. The damage over time leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Depending on the severity of the disease your doctor will suggest the best line of treatment to treat Osteoarthritis.

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.