Bariatric Surgery

There are two major types of bariatric surgery:

1. Restrictive operations. Reduce food intake by narrowing the passage between the upper and lower parts of the stomach. Adjustable gastric banding, in which the passage is narrowed with a hollow band of silicone rubber, is an example of a restrictive operation.

2. Restrictive/malabsorptive operations. Also called combined operations, these alter the small intestine so that less of it is involved in the digestive process. A Roux-en-Y gastric bypass, in which a small stomach pouch is created and attached to a Y-shaped section of the small intestine, is an example of a combined operation. This procedure allows food to bypass the lower stomach, the duodenum and the first portion of the jejunum.

These surgeries can help obese patients lose significant amounts of weight. However, they present certain health risks such as nutritional deficiencies, infection, blood clots and pneumonia. In some cases, bariatric surgery has led to death. However, death or infection occurs relatively rarely, according to the American Obesity Association.

Patients who have successful bariatric surgery will gradually return to a healthful diet after a period of time. There is no guarantee that patients will keep off the weight they have lost. The best way to increase the likelihood of maintaining weight loss is to eat a healthful diet, exercise regularly and make other physician-recommended lifestyle changes.

Bariatric surgery promotes weight loss through one of two methods: by restricting food intake or by interrupting the digestive process.

The digestive process begins as soon as a person swallows food. Once the food enters the digestive tract, digestive juices and enzymes begin digestion, and calories and nutrients are absorbed in the small intestine. The food moves down the esophagus and into the stomach, where acid continues to digest the food. In the average person, the stomach can hold about 3 pints of food at one time.

As food is digested, it moves to the first part of the small intestine (known as the duodenum), where bile and pancreatic juices promote digestion and absorption of nutrients including the minerals iron and calcium. Most of the remaining calories and nutrients are absorbed in the final two segments of the small intestine (jejunum and ileum). Any leftover food particles move into the large intestine before they are eliminated from the body.

Prior to the surgery, patients are encouraged to follow all preparatory steps recommended by their physician. These may include modifications to diet, engaging in an exercise program and limiting or stopping use of nicotine products.

Following surgery, patients will have a short hospital stay. The length of the stay will depend on the type of surgery performed and the patient’s recovery. Patients will be placed on a special diet for several months that begins with liquids and progresses through pureed foods and soft foods before returning to regular foods.

Patients will initially find that they need to eat very small meals throughout the day, although the stomach will stretch a small amount over time. However, the amount of food a patient can eat is permanently restricted following surgery.

For the first six months following surgery, patients often find that they may vomit or feel pain under the breastbone if they eat too much or eat too quickly. Patients may experience other symptoms during this period as well, including:

Body aches
Feeling of tiredness similar to flu
Feeling cold
Dry skin
Hair thinning or hair loss
Mood changes

Patients may lose as much as 50 to 60 percent of excess weight within the first two years of surgery. However, there is no guarantee that patients will keep the weight off over the long term. Bariatric surgery patients are urged to eat a healthy diet, exercise regularly and make other physician-prescribed lifestyle changes that can increase their chances of maintaining a healthy body weight.