Types of Bariatric Surgery for Weight Loss
Operations aimed at reducing body weight are called bariatric surgery. The result of these operations is either a significant reduction in the amount of food consumed or a limitation of its absorption in the intestinal tract. These include adjustable gastric banding, longitudinal tubular resection of the stomach (drain resection), gastric bypass surgery, biliopancreatic bypass surgery.
Los Angeles bariatric surgery comprises banding which is to install a special ring (gastric band) on the upper part of the stomach. The superimposed ring divides the stomach into two parts and gives the shape of an hourglass. Between a small and a large part of the stomach, a narrowing is about 1 cm in diameter. The upper part of the stomach has a volume of only 15–20 ml (that is, the amount of food that can completely fill it is just a tablespoon). Eaten food causes a very fast feeling of fullness. Thus, the total amount of food (calories consumed) decreases dramatically, and weight loss begins. The technique has been known since the beginning of the 90s.
Currently, in our clinic, the operation is performed without an incision, through several punctures (laparoscopic banding). The advantages include a high cosmetic effect, a less painful course of the postoperative period, there is no need to observe bed rest, fast postoperative rehabilitation. Among other methods, bandaging is the most physiological, least traumatic, and most importantly reversible (there is always the option to remove the bandage).
Read also: Weight Loss Tips
Sleeve resection of the stomach
Synonyms – DRAIN, sleeve gastrectomy, longitudinal, vertical
This is a bariatric surgery aimed at treating morbid obesity and its complications. The name (DRAIN) from the English word “sleeve” – a sleeve, is not an official name, but rather medical jargon. Due to its widespread use in practice, it should be borne in mind.
The operation consists of a longitudinal resection of the body and the bottom of the stomach in such a way that a long and thin “sleeve” with an inner diameter of about 1 cm is formed from the lesser curvature of the stomach. With sleeve gastrectomy, the lateral part of the stomach is removed, the important physiological valves of the stomach (cardiac sphincter and pylorus) are preserved, the stomach remains physiologically functional.
Longitudinal gastrectomy has been an integral part of biliopancreatic bypass surgery (BPS) and has been used to treat obesity for more than 10 years. At present, sleeve gastric resection, gastric banding and gastric (gastro) bypass surgery (GI) account for 95% of all bariatric surgeries.
Sleeve gastric resection has several advantages over bandaging and shunt interventions (GS and BPS). Unlike bandaging the stomach, after tubular resection in the body, there is no foreign material (silicone) left. Weight loss begins immediately after surgery, ends earlier than after bandaging and does not depend on additional manipulations with the regulated system and patient discipline, but is actually determined by the new anatomy of the stomach, gives stable weight loss with an efficiency of up to 80% excess weight (60% on average).
After bandaging, the result does not occur immediately, but as the system fills up (inflates), and in the future, it will depend significantly on how the patient’s bandage system and nutritional behaviour function. Over time, the gastric band, like any technique, can fail, require a repair or replacement.
After tubal resection, implants are not used. A patient who has undergone sleeve gastrectomy usually does not need a lifelong intake of those doses of vitamin and mineral supplements that are absolutely necessary after gastro shunting or biliopancreatic shunting. The likelihood of side metabolic effects (protein, vitamin, calcium deficiency) is also less. However, sleeve resection is technically more difficult than bandaging the stomach, so the risk of complications is higher.
The main role is played by the gastro reductive effect – that is, a decrease in the volume of the stomach. The initial volume of the stomach is about 1500 ml, after surgery, it decreases to 100-200 ml (10 times). Passing along a long and narrow sleeve, food overcomes significant resistance and, lingering, causes a persistent feeling of satiety with a small amount. A uniformly narrowed stomach is subjected to uniform pressure and cannot stretch in any one place, as happens after vertical gastroplasty. This operation also affects hormonal factors.