What Are the Different Types of Bariatric Surgeries?
The long term complication in bariatric surgery depends on the type of surgery. The different types of bariatric surgeries are:
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Gastric Bypass Surgery: It is also called RNYGB(Roux-en-Y), a commonly done procedure in bariatric surgery. In this, a small sack or pouch is created from the stomach and is directly joined to the small intestine. When the food is swallowed, it immediately goes into the pouch and from there to the small intestine bypassing the stomach and a part of the small intestine, hence the name gastric bypass surgery.
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Sleeve Gastrectomy: This is a laparoscopic procedure where a major (80 percent) part of the stomach is removed, and only a small (20 percent) portion is left over. This small portion resembles that of a narrow thin tube which is in the shape of a banana. Limiting the stomach size decreases the amount of food intake, and thereby weight loss can be achieved.
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BPS/DS: Also called biliopancreatic diversion with duodenal switch. Though it is effective, it is rarely used as a surgical procedure for weight loss as it involves more risk. This procedure is done in two steps. In the first step, sleeve gastrectomy is performed, where only a small portion of the stomach is left. In the second step, a gastric bypass is performed. This surgery restricts food intake and also decreases the amount of nutrient absorption.
What Are the Complications of Bariatric Surgery?
Any procedure involves complications, and the bariatric procedure, too, involves complications. These are classified as short-term (immediately after surgery) and long-term (from 6 months to over years) complications.
Immediate Complications Include:
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Uncontrolled hemorrhage.
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Anesthetic reactions.
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Thrombus (blood clot) formation.
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Inflammation or infections at the surgical site.
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Vomiting and gag reflex.
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Incompetence for definite foods.
Long Term Complications Include:
1. Dumping Syndrome: This is a state in which the food that is eaten directly goes into the small intestine through the stomach. Usually, it takes some time for the swallowed food to move into the intestines from the stomach, but in dumping syndrome, food goes quickly into the small intestine from the stomach. The food contents quickly pass into the intestine without stopping in the stomach. Patients face the problems of diarrhea and stomach pain immediately (10-30 minutes) after eating food. Home remedies for preventing dumping syndrome involve eating small portions of food and limiting the fructose (sugar) intake. In severe cases, anti-diarrheal medication is advised. This helps in slowing down food movement from the stomach into the intestines.
2. Gallstone Formation: The risk of gallstone formation is higher in people who have undergone bariatric surgery than in normal people. This is because of the increased saturated levels of cholesterol and biliary mucin in the gallbladder. The formation of stones is evident after one year of post-bariatric surgery. Most of the cases are advised for cholecystectomy (surgical removal of the gallbladder). Patients who have undergone sleeve gastrectomy (46 percent) are less prone to cholecystectomy when compared to gastric bypass (71 percent).
3. Hernia: One of the potent complications that need to be looked after surgery is a hernia. The risk of hernia is more in bariatric patients because of the surgical incisions. An increased number of surgical incisions may weaken the fascia. When sutures are placed on the weakened fascia, it leads to tearing of the fascia and results in an incisional hernia. The risk of hernia can be reduced by laparoscopes. Laparoscopic devices can also develop hernia as they pass through the abdomen.
4. Malnutrition: This is a major risk in bariatric surgery patients. After bariatric surgery, food intake becomes very less, as a result, micro and macro nutrients availability becomes less, leading to malnutrition. A deficiency of the B complex group of vitamins is usually seen after the surgery. Some of the deficiencies include:
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Iron Deficiency: This arises because of the improper absorption of iron while iron-containing foods pass through the small intestine. This results in anemia (decreased red blood cell count).
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Vitamin B12 Deficiency: This leads to anemia and complications in the nervous system, such as numbness, weakness, and loss of muscle coordination leading to impaired walking.
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Vitamin B1 Deficiency: B1, also called Thiamine, deficiency of B1 leads to a disease called Beri-beri. There are three types of Beri-beri, dry, wet, and cerebral. Beri-beri presents with heart and neurological problems.
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Fat-Soluble Vitamins: A, D, E, and K are called fat-soluble vitamins. These vitamins are not properly absorbed into the digestive system because of the malabsorption of fat after bariatric surgery.
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Calcium and Vitamin D Deficiency: Duodenum and jejunum are bypassed during gastric bypass surgery, and these sites are very important for the absorption of calcium and vitamin D. Deficiency of these vitamins could lead to improper bone formation, leading to fragile bones. Bone fractures are one of the complications seen in bariatric patients. Zinc, copper magnesium deficiencies are also seen in bariatric patients.
5. Hypoglycemia: Low glucose is found in the blood due to decreased food intake. This results in dizziness, weakness of the patient.
6. Gastrointestinal Issues: Ulcer formation, abdominal pain, diarrhea, indigestion, and vomiting are the long-term complications associated with bariatric surgery.
7. Alcohol: Alcohol-associated problems are also seen in bariatric patients.
8. Death: In very few cases, death can also occur.
Conclusion:
Obesity is one of the leading health complications affecting people of all ages, and bariatric surgeries can successfully treat this. But dealing with the postoperative complications is very important. Hence post-operative follow-up is very important to check for complications. If needed, life-long follow-up is advised. The success of bariatric surgery depends on the type of surgery, lifestyle modifications, and dealing with the complications.
