Examining the Pros and Cons of Bariatric Surgery

Experience a Journey Towards a Healthier You!

Weight loss surgery, also known as bariatric surgery, can be a transformative step towards a healthier and happier you. This procedure acts as a powerful ally in your weight loss journey, helping you achieve significant, lasting weight loss. As a result, the risk of developing serious health conditions like heart disease, diabetes, and even some cancers can be significantly reduced. Bariatric surgery allows you to unlock a future filled with increased energy, improved mobility, and a renewed sense of well-being. 

Moreover, here’s the good news: weight loss surgery has become much safer over time. Thanks to newer techniques, better training for surgeons, and quality control programs, the mortality risk associated with this surgery has gone way down, from around 1.5% to a much lower 0.3%. So, while it remains a major procedure, it can be a powerful tool to help people with obesity live longer, healthier lives. 

Consider the Option that Best Meets Your Requirements  

There are different procedures available for Bariatric surgery, and surgeons can choose the best option based on each patient’s, individual needs. 

  • Roux-en-Y Gastric Bypass: This two-pronged surgical approach tackles weight loss by both curbing appetite and reducing nutrient absorption. Staples are used to create a smaller stomach to limit the amount of food intake, and certain section of the small intestine is bypassed to limit the nutrients and calories absorbed.
  • Sleeve Gastrectomy: The method encompasses the stapling and removal of a portion of the stomach to reduce the size of the stomach to that of a small banana. It also influences weight loss by altering gut hormones that regulate appetite, taste, and blood sugar levels, contributing to feelings of fullness after consuming a smaller volume of food.?
  • Mini Gastric Bypass: In this surgery, the surgeon creates a long, sleeve-shaped pouch from the stomach. This pouch is then connected directly to the small intestine, forming a loop. 
  • Banded Gastric Bypass: By adding a band to a gastric bypass surgery, surgeons can precisely control the pouch and stoma sizes in this banded gastric bypass procedure. This standardization and adjustability can potentially improve weight loss outcomes in the long run. 
  • Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a two-part weight loss surgery. The first part involves reducing the stomach’s size through a procedure called sleeve gastrectomy. The second part reroutes the digestive system. This reduces the body’s ability to absorb fats and calories, leading to weight loss. 

Is Weight Loss Surgery Right for Me?  

Weight loss surgery isn’t for everyone. The question comes round to: 

Am I qualifying for bariatric surgery?  

Bariatric surgery is for patients with: 

  • BMI > 32.5 kg/m2 with obesity related co-morbidities 
  • BMI > 37.5 kg/m2 without co-morbidities 
  • BMI > 30 kg/m2 with life-threatening obesity-related disorders like uncontrolled diabetes, cardiovascular disease/cardiomyopathy, and severe obstructive sleep apnoea 
  • Bariatric Surgery to be considered only between the ages of 18 – 65 years 
  • Bariatric surgery may be considered in patients more than 65 years in the presence of severe obesity-related co-morbidities/disability 
  • Bariatric Surgery may be considered in patients < 18 years in special situations after paediatrician/endocrinology certification, or after attainment of puberty or completion of skeletal maturity

Obesity treatment encompasses a lot more than stated. A good lifestyle works wonders with a follow-up routine. Moreover, regularly consulting the multidisciplinary team to monitor progress is fundamental to addressing the underlying potential complications.  

Weighing the Pros and Cons of Bariatric Surgery  

Weight-loss surgery is an effective and more reliable alternative to lose 60-80% of your excess weight within a year of surgery. Significant weight loss after bariatric surgery positively impacts cardiac metabolism, workload, performance, and structure.?

Bariatric Surgery improved the quality of life for 95% of patients with an 89% reduction in 5-year mortality.   

  • Migraines 57% resolved 
  • Depression 55% resolved 
  • Pseudotumor cerebri 96% resolved 
  • Obstructive sleep apnea 74-98% resolved 
  • Dyslipidemia hypercholesterolemia 63% resolved 
  • Asthma 82% improved or resolved 
  • Cardiovascular disease 82% risk reduction 
  • Hypertension 52-92% resolved 
  • Non-alcoholic fatty liver disease 90% improved steatosis; 37% resolution of inflammation; 20% resolution of fibrosis 
  • GERD 72-98% resolved 
  • Metabolic syndrome 80% resolved 
  • Type II diabetes mellitus 83% resolved 
  • Stress urinary incontinence 44-88% resolved 
  • Polycystic ovarian syndrome 79% resolution of hirsuitism; 100% resolution of menstrual dysfunction 
  • Degenerative joint disease 41-76% resolved 
  • Venous stasis disease 95% resolved 

Understanding the risks associated is of equal importance. By and large, every surgery involves risks.  

Risks of Bariatric & Metabolic Surgery 

The more extensive the bypass operation, the greater the risk for complications and nutritional deficiencies. Patients with extensive bypasses of the normal digestive process require not only close monitoring but also may require the use of special foods and medications. Five to ten percent of patients who undergo weight-loss operations may require surgical/medical interventions to correct complications.

Rare complications of gastric bypass surgery include leak through staples or sutures, ulcers in the stomach or small intestine, and blood clots in the lungs or legs (it is hence important for all our patients to strictly adhere to the compression stockings and LMWH therapy as advised postoperatively), stretching of the pouch or oesophagus, persistent vomiting, and abdominal pain, inflammation of the gallbladder, and failure to lose weight. 

Many a patient undergoing bariatric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. A person’s risk of developing gallstones increases during rapid or substantial weight loss. 

A few studies have reported up to 30 percent of patients who have weight-loss surgery may develop nutritional deficiencies such as anaemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained – a close follow-up with our dietician is thus emphasized. 

Women of childbearing age should avoid pregnancy for 12-15 months until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus. Though some bariatric procedures can be reversed, patients should carefully consider all of the risks and benefits before electing to have this surgery. 

Patients with uncontrolled diabetes, retinopathy, neuropathy, and nephropathy are advised a very close monitoring of their blood sugar and other medications with regular follow-up. Patients who have been advised C-PAP/Bi-PAP must strictly adhere to the usage, or else it could even prove fatal.  

In short bariatric/metabolic surgery is not a magic pill but could work like magic if used and practised judiciously under supervision.

Post-Surgery Care and Management

Post-bariatric surgery, there are a few things to keep in mind to make it a success. Here’s what your post-bariatric surgery care must involve. 

  • Your surgeon and healthcare team will be there to watch over you, answer questions, and help avoid any problems. They’ll also track your weight loss to see how you’re doing. 
  • Having good people around you is important. Friends, family, or even a support group can be a big help after surgery. They can offer encouragement and understand what you’re going through. 
  • Food after surgery is a step-by-step process. Right after, for 15 days it’ll be non-aerated, sugar-free liquids like fat-free milk, buttermilk, soy milk, almond milk, strained soups, coconut water, etc. It’s like giving your stomach a little rest for a few weeks to heal up. Then, things will slowly move to soft foods for the next 15 days that are easy to chew and digest. Make sure to get plenty of protein during this time, like lean meats or dairy products. After a month the diet becomes normal, focusing on protein-based foods. 
  • Don’t forget to move your body! So, getting some exercise is a great way to manage the long-term effects of bariatric surgery, feel better overall, and keep the extra kgs away for good. 

Your Weight Shouldn’t Be the Barrier to the New ‘You’! 

Bariatric surgery, or weight loss surgery isn’t just about the numbers on the scale. It can be a major win for your overall well-being! 

Studies show that people who have weight loss surgery not only manage health problems better but also feel a lot better about themselves. They have more energy, and they feel more confident in their own skin. 

Of course, everyone’s reasons for wanting weight loss surgery are different. The important thing is to talk to your surgeon about all your options and concerns. They can help you decide if weight loss surgery is right for you and provide support before and after surgery. 

References: 

  1. https://asmbs.org/patients/is-metabolic-and-bariatric-surgery-right-for-you/ 
  1. Bariatric (Weight Loss) Surgery: Types & Requirements (clevelandclinic.org) 
  1. Medanta | Beyond Weight Loss: Understanding Bariatric Surgery and Its Life-changing Benefits 
  1. Bariatric surgery – Mayo Clinic 
  1. Bariatric Surgery: What You Need To Know – Forbes Health 
  1. Best Weight Loss Surgery in Delhi NCR, Weight Loss Treatment in india (atulpeters.com) 
  1. risks-and-complications-of-bariatric-surgery.ashx (clevelandclinic.org) 
  1. Effect of exercise training before and after bariatric surgery: A systematic review and meta?analysis – PMC (nih.gov) 
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538485/  
  1. https://www.niddk.nih.gov/health-information/digestive-diseases/dumping-syndrome  
  1. https://www.ncbi.nlm.nih.gov/books/NBK594253/  

Infertility in Women and Bariatric Surgery

Improving Infertility in Women with PCOS: The Impact of Bariatric Surgery on Reproductive Health

The relationship between PCOS, obesity and infertility has been documented for many years. Anovulation, miscarriage, impairment in follicle formation and altered activity are the known effects of these. These women also face difficulty in managing diabetes, pre-eclampsia, growth disorders, higher rates of caesarean delivery, higher maternal mortality, and increased children’s risk for metabolic disease in the future.

A considerable weight loss can increase the chances of spontaneous ovulation, which is why the solution – bariatric surgery. This surgery is known to improve both fertility and pregnancy in women with reproductive concerns, polycystic ovarian syndrome (PCOS), along with metabolic syndrome (MS).

Bariatric Surgery’s Positive Effect on Women

Bariatric surgery in reproductive-age women has been shown to decrease menstrual irregularities. Women suffering from hormonal imbalance show considerable improvement postoperatively, and chances of conceiving increase after this surgery. Sensitivity to leptin levels increases post-surgery, reflecting improved reproductive metabolic status. Many women (about 10%-25%) with subclinical hypothyroidism, haven also shown a significant improvement following surgical weight loss.

Women already take pregnancy into consideration when electing for bariatric surgery. Nowadays women undergoing surgery are aware of their own reproductive risks and a significant number of these women are thinking ahead.

Studies on Infertility in Women and Bariatric Surgery

Bariatric surgery has attracted the interest of many scholars with more individuals showing improved fertility post-weight loss treatment. An older study implied that a BMI drop greater than 5 kg/m2 was a significant predictor of fertility within 2.5 years of follow-up after surgery. There was also a trend of a reduced need for fertility treatment in women conceiving within 3 years of weight loss surgery compared to their need for fertility treatment prior to surgery. Reports also show previously anovulatory women conceiving post-operatively without ovulation induction agents.

Comparing Pregnancy Outcomes in Women Pre and Post-Bariatric Surgery

A study comparing pregnancy outcomes in women before and after weight loss surgery showed improvements in pregnancy-related hypertension and diabetes mellitus, and a significant drop in caesarean delivery rate too. Moreover, bariatric surgery did not result in increased rates of post-partum haemorrhage, infection, shoulder dystocia or foetal demise.

The benefits of bariatric surgery in women suffering from PCOS with metabolic syndrome are discussed extensively on various platforms, leading in favour of surgery in such cases. Nutritional and vitamin deficiencies in these women during that time frame of rapid weight loss can be dealt with supervised supplementation and regular follow-ups with the surgeon and obstetrician. There were no differences in maternal complications, foetal outcomes or delivery complications, making bariatric surgery a highly recommended solution and one of the best ways to lose weight in morbidly obese people.