Bariatric surgery – also known as gastroplasty, obesity surgery or stomach reduction surgery – is a medical intervention that can be performed on people with a high BMI who have been diagnosed with grade III or II obesity associated with two comorbidities. It is usually indicated for those who are unable to lose weight through pharmacological treatment and dietary re-education and suffer from diseases associated with excess weight. However, although it is called “bariatric surgery”, there are different types of so-called “stomach reduction” surgery. However, it is important to emphasize that the power of choice does not depend on the patient, since the bariatric surgery specialist will know how to assess the best technique to treat obesity, what the risks are and how the surgery will influence associated diseases, such as diabetes and hypertension, for example. Analyses to determine which type of intervention the patient should undergo take place well before surgery, on the basis of a consultation and with the help of complementary tests. Specific factors are taken into account. A person with a very high BMI, for example, should undergo the most invasive type of bariatric surgery, so that a greater percentage of weight and body fat loss occurs. On the other hand, if this patient is of advanced age, the physician may opt for a less invasive technique, which requires less recovery time and exaggerated nutritional losses.
1. Sleeve or Vertical Gastrectomy
The gastric sleeve is the type of bariatric surgery in which the stomach itself is reduced. Approximately 80% of the organ is removed. The remainder is converted into a tubular pouch that resembles the shape of a banana. Studies show that the Sleeve is as effective as the Gastric Bypass in terms of weight loss and is more recommended for patients with severe obesity and who do not have gastroesophageal reflux.
It is also a procedure that does not cause great nutritional deficiencies, since it does not involve intestinal diversion and provides a more gradual weight loss. It also does not have one of the disadvantages of the Bypass, which are the dupimg and the risk of internal hernia, since the intestine is not operated, but only the stomach. It is currently the most practiced bariatric surgery in the world.
2. Gastric Bypass
In spite of being a more complex operation, the Gastric Bypass is the second most performed surgery to treat morbid obesity. The stomach is divided and a small gastric pouch is created and connected to the intestine by means of a new intestinal loop. In this way, the volume of the organ is considerably reduced and an intestinal bypass is performed. The procedure restricts the amount of food that can be consumed (due to the reduction in the size of the stomach) and favorable changes in the intestinal hormones reduce appetite and increase satiety.
However, attention must be paid to dietary recommendations and vitamin/mineral supplementation throughout life. Surgery can lead to long-term vitamin/mineral deficiencies, especially deficiencies of vitamin B12, iron and calcium.
3. Duodenal Switch
Duodenal Switch surgery consists of two components and two phases. First, a smaller tubular stomach pouch is created by removing a portion of the stomach, much like the Sleeve. Next, a large portion of the small intestine is ablated. Like the other surgeries described above, the Duodenal Switch initially helps to reduce the amount of food consumed.
However, over time, this effect diminishes and patients may eventually consume “normal” amounts. The worst effects of the Duodenal Switch are diarrhea and nutritional deficiencies that can lead to caloric-protein malnutrition. It is rarely practiced today, precisely because of the need for very close patient follow-up.
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