Bariatric surgery otherwise known as weight loss surgery is a set of procedures done on individuals who are dangerously obese and is used as a last resort treatment especially when all other methods such as lifestyle changes have failed to significantly reduce weight.
The significant reduction of weight is brought by decreasing the stomach size through gastric band or the removal of a part of the stomach through a procedure called sleeve gastrectomy or, more technically a biliopancreatic diversion with duodenal switch. It can also be done through surgical removal or resection of part of the small intestine and redirecting it to a small stomach pouch, which is a procedure known as gastric bypass surgery.
The stomach serves as the temporary storage for food and even though there is partial digestion in this part, final digestion and absorption will occur at the later part of the gastrointestinal tract. The bariatric surgical procedures can therefore cause weight loss by three categories –
- Restricting the amount of food that the stomach can temporarily store
- To induce malabsorption of nutrients and;
- Procedures that combine both effects
Different Types of Bariatric Surgery and Specific Advantages and Disadvantages
There are generally four types of bariatric surgery including –
- Gastric Band
- Sleeve Gastrectomy
- Gastric Bypass
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass
Gastric Band Procedure
Gastric Band usually called – the band – makes use of an inflatable band placed on the upper part of the stomach. This inflatable band creates a small pouch of the stomach above the band and the remaining portions are located below the band.
What the Procedure can do:
With gastric band procedure, eating only a small amount of food will satisfy hunger and will help in inducing satiety or the feeling of fullness. Satiety will depend on the opening size between the pouch and the rest of the stomach.
Clinically, the impact of gastric band is to reduce the hunger because of promoting satiety. However, there is no malabsorption and digestion takes place as it would normally.
Sleeve Gastrectomy Procedure
What the Procedure can do:
The procedure allows resizing of the stomach to such a point that it can only hold a smaller volume than the normal stomach. Due to this, there is significant reduction of the amount of food and thus the caloric intake that the patient will consume.
Clinically, the impact of the procedure is on the hormones secreted by the stomach that affects several factors such as satiety, blood glucose or sugar and hunger control.
It is said that the sleeve is at par with the roux-en-Y gastric bypass especially when talking about weight loss and improvement or control of diabetes. The rate of complication is usually between the band and roux-en-Y gastric bypass.
Gastric Bypass Procedure
The roux-en-Y gastric bypass or commonly known as gastric bypass is believed to be the ‘gold standard’ among all approved weight loss surgical procedure. In fact, it is the most common bariatric procedure performed all across the globe.
What the Procedure can do:
The procedure works basically similar to most bariatric procedures in that the stomach becomes smaller and thus the volume of food intake would be significantly reduced. Redirecting the food largely from the stomach towards the intestines would inhibit hunger, promote satiety and reverse the primary reason of obesity hence achieve weight loss in the process.
However, since this is a more complex procedure than the band or sleeve, it has potentially higher complication rates and could even lead to chronic vitamin or mineral deficiencies specifically vitamin B12, folate, calcium and even iron. Therefore, this procedure must only be done if the benefits outweigh the risks
Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass
BPD/DS is a procedure where a portion of the stomach is removed to create a tubular stomach pouch and it is followed by bypassing a large portion of the small intestine.
What the Procedure can do:
Similar to the abovementioned procedures, the BPD/DS can reduce the amount of food intake however unlike the previous procedures the effect lessens and patients can eventually consume ‘near normal’ amount of food over time. Furthermore, a large portion of the small intestine is bypassed hence there is also decreased absorption of calories and nutrients specifically fat and proteins.
The procedure is believed to be the most effective treatment for obesity among all as it could also help control type 2 diabetes.
Nevertheless, it should be important to note that the procedure has the highest complication rate among other bariatric procedures and would require the patients to have longer hospital stay. Also, the patients would potentially develop vitamin or mineral deficiencies particularly fat soluble vitamins like vitamin D, iron, zinc and calcium.
General Comparison of the Procedures
Generally, patients can have higher success rate going for gastric bypass procedures than other bariatric operations. There are several advantages to each of the procedure but each comes with risks and disadvantages, as well.
Laparoscopic procedure will only require shorter hospital stay than procedures that require opening the abdomen. The former will only have multiple small incisions where the small video camera and surgical instruments are inserted. This procedure often produces less or no post-op pain at all compared to the more invasive procedures. Also, the patients can resume normal levels of activity quicker than the more complex procedures.
Surgeons are now opting to laparoscopic procedures in that it does not possess high risks. However, gastric bypass is still considered the ‘gold standard’ simply because the success rate of the procedure is significantly higher than the other aforementioned procedures.
How to Choose What Procedure Works Best
There are several factors to consider when choosing what procedure would work best including:
- Personal or surgeon’s preferences
- Current health status
- Cost of the procedure and whether or not it is covered by insurance
Therefore, choosing the specific surgical procedure that would work will require a lot of research, a lot of though and lengthy discussion with the attending physician.
What Qualities to Look for in a Surgeon?
Since bariatric procedures would mean entrusting health to a professional, it is only right that enough thought and research have been done before choosing the surgeon that would perform the procedure.
Here are qualities to look for in a bariatric surgeon –
- Certified by the Board of Surgery. A surgeon with certification will only mean that the surgeon has undergone extensive training and is at par with the current predefined standards. Your surgeon should be a fellow of the Royal Australian College Of Surgeons (FRACS) and a member of the Australian Society Of Plastic Surgeons
- Good or positive reputation. This means that the surgeon has performed several successful operations before and the patients can attest to that.
- Significant experience to the procedure. Otherwise, the procedure in itself will defeat the purpose of treating obesity. A surgeon who knows what he or she is doing will always perform with excellence since the future health and post-op status of the patients will depend on him or her.
- Explain which procedure works best in a particular situation. Transparency and responsibility are two most common traits that a bariatric surgeon must have. He or she must be able to explain what each procedure means and what it can do to the patients. Otherwise, the patients would blindly walk into the operating room without knowing what’s going to happen to them.
- Ask for second opinion. Just because the surgeon has decided for the best surgical approach, this does not mean there is no room for second opinions. Second opinions matter because this is the ultimate basis for comparison.
- Supportive measures after the procedure. Care after the procedure is another important criteria in choosing which doctor. This includes having knowledge of techniques for fast recovery and to heed all advice pertaining to diet maintenance after the procedures.
Patients have the right to choose the surgeon they are most comfortable with. Comfort is one factor that allows good rapport during recovery and establish the regimen perfect for the individual involved. Since the procedure is simply the first step, it requires that patients must adhere to post-op diet maintenance.
Weight loss surgery or bariatric procedures in Australia are not fully covered by Medicare and this would mean some out of pocket expenditures are to be expected by the patient.
However, if the patient has a Private Health Insurance – which is accessible to many Australians – the procedure can be done under its coverage.
Assuming that the patient has private insurance, patients will look at an estimate bariatric procedure cost of $1,700-$4,750 AUD, which is equivalent to $1,450-$4,550 USD.
Considering all the factors and cost mentioned above, it is extremely important that as a patient –knowledge and research – are primary factors of deciding whether you are a good candidate for bariatric surgical procedures. It is important to know about the advantage but the risks must not be ignored – at all cost. You must exhaust all resources available when looking for weight loss surgery or bariatric surgery in Sydney, Australia.