Weight loss surgery in iran
- Type 2 diabetes
- Hypertension
- Heart disease
- Severe joint disease
- Back pain
- High blood cholesterol and fat
- Sleep apnea and other sleep problems
- Nonalcoholic fatty liver disease (NAFLD)
Types of Bariatric Surgery
Some types of bariatric surgery limit how much food you crave to eat, while other procedures work by reducing the body’s ability to absorb calories and nutrients, and some procedures do both. The surgery can be done as a laparotomy (open abdominal operation with a large incision) or a laparoscopy (minimally invasive camera-assisted abdominal operation with a small incision). Each type of surgery has its own advantages and potential drawbacks. Your bariatric surgeon will review your health history to determine which surgery is best for you.
Here’s a look at common types of bariatric surgery:
Sleeve Gastrectomy
The Laparoscopic Sleeve Gastrectomy, often called the “sleeve surgery”, is performed by removing approximately 80% of the stomach. The remaining stomach is the size and shape of a small banana. This smaller stomach can’t hold as much food as before. It also produces lower levels of the appetite-regulating hormone ghrelin, which may lessen your desire to eat.
The procedure:
The surgeon cuts across the top of your stomach, sealing it off from the rest of your stomach. The resulting pouch can hold only about an ounce of food.
How it Works
The new stomach holds less food and liquid, helping to reduce the amount of food (and calories) that are consumed. By removing the portion of the stomach that produces most of the “hunger hormone”, the surgery has an effect on the metabolism. It decreases hunger, increases fullness, and allows the body to reach and maintain a healthy weight as well as blood sugar control. The simple nature of the operation makes it very safe, without the potential complications brought by surgery on the small intestine.
Advantages
- Technically simple and shorter surgery time
- Can be performed on certain patients with high-risk medical conditions
- May be performed on patients with severe obesity as the first step
- Effective weight loss and improvement of obesity related conditions
- no rerouting of the intestines
- shorter hospitalization period than other types of procedures
Disadvantages
- Non-reversible procedure
- May worsen or cause onset reflux and heart burn
- Less impact on metabolism compared to bypass procedures
Roux-en-Y Gastric Bypass (RYGB)
This procedure is the most common method of gastric bypass. The Roux-en-Y Gastric Bypass has been performed for more than 50 years, and the laparoscopic approach has been introduced since 1993. It is one of the most common operations and is very effective in treating obesity and obesity related diseases. The name is a French term meaning “in the form of a Y”.
The Procedure
First, the stomach is divided into a smaller top portion (pouch) which is about the size of an egg. The larger part of the stomach is bypassed and no longer stores or digests food.
The small intestine is also divided, and the latter section is connected to the new stomach pouch to allow food to pass. The small intestine segment which empties the bypassed stomach is once again connected to the small intestine approximately 3-4 feet downstream, resulting in a bowel connection resembling the shape of the letter Y.
This way, the stomach acids and digestive enzymes from the bypassed stomach and the first portion of the small intestine mix with the food along the way.
How it Works
The gastric bypass works in several ways. Like many bariatric procedures, the newly created stomach pouch is smaller and is able to hold less food, which means fewer calories can be consumed. Additionally, the food does not come into contact with the first portion of the small intestine, and this results in decreased absorption. Most importantly, the modification of the food’s journey through the gastrointestinal tract has a profound effect to decrease hunger, increase fullness, and allow the body to reach and maintain a healthy weight. The impact of the surgery on hormones and metabolic health often results in improvement of type two diabetes even before weight loss. The operation also improves reflux (heart burn) rapidly. Along with following an appropriate diet, patients must avoid tobacco products and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen post operation.
Advantages
- Reliable and long-lasting weight loss
- Effective for remission of obesity-associated conditions
- Refined and standardized technique
Disadvantages
- Technically more complex when compared to sleeve gastrectomy or gastric banding
- Higher risk of vitamin and mineral deficiencies than sleeve gastrectomy or gastric banding
- There is a risk for small bowel complications and obstruction
- There is a risk of developing ulcers, especially with NSAID or tobacco usage
- May cause “dumping syndrome”, a feeling of sickness after eating or drinking, especially sweets
Adjustable Gastric Banding (AGB)
The Adjustable Gastric Band is a device made of silicone that is placed around the top part of the stomach to limit the amount of food a person can eat without cutting away any portion of it. It has been available in the United States since 2001. The impact of this type of surgery on obesity related diseases and long-term weight loss is less, compared to other procedures. Its use has therefore declined over the past decade.
The Procedure
This device is placed and secured around the top part of the stomach, creating a small pouch above the band. This procedure is usually performed laparoscopically.
How it Works
The feeling of fullness depends upon the size of the opening between the pouch and the rest of the stomach. The opening size can be adjusted with fluid injections through a port underneath the skin. Food goes through the stomach normally but is limited by the smaller opening of the band. It is less successful against type 2 diabetes and has less influence on the metabolism.
Advantages
- The lowest rate of early complications after surgery
- No division of the stomach or intestines
- Patients can go home on the day of the surgery
- The band can be removed if needed
- The lowest risk of vitamin and mineral deficiencies
Disadvantages
- The band may need several adjustments and monthly office visits during the first year
- Slower and less weight loss than with other surgical procedures
- There is a risk of band movement (slippage) or damage to the stomach over time (erosion)
- Needs a second operation in most cases (either to adjust or remove the band)
- Can result in swallowing problems and enlargement of the esophagus
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
The Biliopancreatic Diversion with Duodenal Switch, abbreviated as BPD-DS, is a two-part surgery in which the first step involves performing a procedure similar to a sleeve gastrectomy. The second part of the surgery involves connecting the end portion of the small intestine to the stomach, bypassing the majority of the first portion of the intestine.
The Procedure
Following the creation of the sleeve-like stomach, the first portion of the small intestine is separated from the stomach and the rest of the intestine. The remaining part of the small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through the sleeve pouch and into the latter part of the small intestine. The separated portion of the small intestine is once again connected to the small intestine downstream so that it can carry the digestive enzymes from the pancreas to the gestational tract.
How it Works
The smaller stomach, shaped like a banana, restricts patients to eat less food. The food stream bypasses roughly 75% of the small intestine. This results in a significant decrease in the absorption of calories and nutrients. Patients must take vitamins and mineral supplements after surgery. Even more than gastric bypass and sleeve gastrectomy, the BPD-DS affects intestinal hormones in a manner that reduces hunger, increases fullness and improves blood sugar control. The BPD-DS is considered to be the most effective approved metabolic operation for the treatment of type 2 diabetes.
Advantages
- Brings the best results for improving obesity
- Affects bowel hormones to cause less hunger and more fullness after eating
- It is the most effective procedure to treat type 2 diabetes
Disadvantages
- Has slightly higher complication rates than other procedures
- The highest malabsorption rate and greater possibility of vitamins and micro-nutrient deficiencies
- Reflux and heart burn can develop or get worse
- Risk of looser and more frequent bowel movements
- More complex surgery requiring more operative time