Obesity has become a worldwide epidemic in both advanced and developing nations across all age groups. Many people develop severe obesity and its incidence is increasing at a faster pace than simple obesity. People with severe obesity are more likely to develop metabolic complications.
In parallel to this, obesity surgery is also gaining popularity worldwide, which is directly related to its efficacy in sustained weight reduction and reversal of metabolic complications. It has become an effective treatment in people with severe obesity and in people with simple obesity that cannot reduce weight with diet, exercise and drug therapy. Obesity surgery is based on two principles; restrictive procedures, restricting the intake of food or calories and procedures that reduce absorption of food or calories.
1. Vertical banded gastroplasty: a small pouch is created from the stomach at its uppermost part that lies just below the esophagus, using a prosthetic band or mesh. It restricts the entry of food and weight loss occurs due to reduced intake of food or calories.
2. Laparoscopic adjustable gastric band: an inflatable band is placed at the upper part of stomach through laparoscopic surgery. This band is filled with saline and is calibrated to restrict food intake. Restriction of calories brings about weight control.
3. Sleeve gastrectomy: This is a restrictive surgery in which a sleeve of greater curvature is resected laparoscopically. This converts the stomach into a tube like the esophagus. The capacity of stomach reduces to about 100 ml. This also removes the fundus of stomach which secretes the hunger hormone called ghrelin, resulting in reduction of appetite.
4. Gastric bypass surgery: In this procedure a small pouch is created from upper part of stomach with a capacity of 15 to 20 ml. The small intestine is divided and its farther end is united with this pouch. The food that enters the stomach passes into the distal part of intestine thereby passing the upper intestine. This reduces the surface area over which nutrients are absorbed.
5. Biliopancreatic diversion and duodenal switch: This surgery results in reduced absorption of nutrients. In this procedure a part of stomach is resected. The intestine is divided and its distal part is connected to the upper half of stomach. The upper part of small intestine is united with small intestine closer to terminal ileum. In the duodenal switch operation this procedure is modified by doing sleeve resection of the stomach.
Dr. Uday Singh Dadhwal
(Specialist General Surgery)
Bahrain Specialist Hospital
Email: uday.dadhwal@bsh.com