Obesity surgery types of bariatric surgeries

Now an important point: to understand the intricacies, types and differences of methods of such operations

In this article, we decided to talk about all the available types of operations of this kind in order to provide a complete picture of how the knowledge and skills of doctors in this matter have improved and developed.

You can read the first introductory article in this series here.

Longitudinal gastric resection (LRG) is a surgical procedure to reduce the volume of the stomach by removing its lateral part. This type of surgery is currently considered the most popular, effective and physiological in the fight against obesity (loss of an average of 60% of excess weight). Most doctors who perform this operation resort to it.

OPERATING PRINCIPLE

With PRG, most of the stomach is removed, but at the same time the physiology of both nutrition and digestion processes is preserved, that is, the principles of the stomach and intestines do not change, as with some other types of bariatric surgeries (more on that later). As a result of resection, the stomach, figuratively speaking, turns from a large sac into a narrow tube with a volume of no more than 100-120 ml, in which food, without lingering for a long time, passes into the intestine, which contributes to effective and stable weight loss.

FEATURES

Each type of bariatric surgery has its own characteristics and indications. When performing PRG, which is prescribed for large people, but not with pathological weight (up to 150 kg), the area of ​​the stomach that produces the hormone ghrelin, which is responsible for the feeling of hunger, is also removed. This means that after the operation, the constant need for food disappears, which means that the likelihood of relapse is practically zero.

It is also important that the work of the intestinal tract after such an operation returns to the physiological norm. A clear advantage of this operation is that, unlike banding and an intragastric balloon (more on this later), PRG does not imply the introduction of a foreign object into the body and can be performed on patients of any age, including adolescents and the elderly.

On the forums dedicated to this type of operation, there are a lot of good reviews about the operation itself and about the recovery process, which is very important. On average, doctors recommend taking a week to recover, and Bekkhan Bayalovich Khatsiev writes about this: “Recently, one patient told us that he was operated on on Thursday, was at home on Friday, and went to work on Monday. There are many similar precedents. But I must make a reservation again, it is better to count on 7-10 days. If everything goes as usual, that is, without complications (and this happens very rarely), free days will be a bonus to the operation – days of rest ”.

Biliopancreatic shunting (BPS) is today the most difficult, but also the most effective bariatric surgery, if we are talking about the treatment of morbid obesity and type 2 diabetes, as a result of which weight is lost on average by 80% due to the dual mechanism of its reduction.

OPERATING PRINCIPLE

The BPS is carried out in two stages. First, doctors perform the classic operation of a longitudinal gastric resection (LLG). Then they switch to the malabsorptive mechanism of weight loss, as a result of which the intensity of food digestion and the volume of its absorption from the intestine change. In other words, there is a change in the anatomy of the intestine, due to which the patient receives a persistent and stable change in weight, regardless of the caloric content of the diet.

FEATURES

The flip side of the coin with such an operation, although very rarely, is still observed depletion – this is 2-3% of those operated. Under these circumstances, it is possible to restore the continuity of the intestinal tract, that is, we can say that BPS is, to some extent, still functionally reversible. It is also worth noting that, as a rule, during the operation, the gallbladder is removed: due to the restructuring of the digestive tract and changes in the digestion process itself, active stone formation begins to occur in the gallbladder, so it is more correct to remove it.

When performing this method, a silicone balloon is placed in the stomach endoscopically, usually under short-term anesthesia. After installation, it is filled with saline solution from 400 to 800 ml, depending on the individual need of each case.

OPERATING PRINCIPLE

With this type of operation, the volume of the stomach is reduced due to the balloon in it, due to which there is a rapid saturation in small portions.

FEATURES

Balloon placement is considered a temporary weight loss measure to change the patient’s eating habits. Usually, such an operation is justified for people who are overweight no more than 35 kg. But, as practice shows, after removing the balloon, the weight sooner or later returns again. Also, this type of operation is actively used as a preliminary method for weight loss before the PRG and BPS for people with superobesity, in order to ensure a more favorable course of the operation and the postoperative period.

It is one of the most common weight loss surgeries in the United States. The essence of all gastric bypass methods (of which there are several) boils down to reducing the “reservoir” for food in the stomach and changing absorption in the digestive tract.

OPERATING PRINCIPLE

During the operation, a “small ventricle” with a volume of no more than 30-40 ml is formed from our main stomach, and a constriction is made in its outlet part – as a result, the volume of food consumed is significantly reduced, and food in the new stomach lingers longer, causing a prolonged feeling of satiety.

Plus, the gastrointestinal tract is reconstructed in such a way that most of the stomach and duodenum are turned off from the act of digestion, and food from the “new ventricle” enters the small intestine.

FEATURES

Gastric bypass patients, due to their very small “new stomach”, have to eat slowly and thoroughly chew their food until they are puree. Failure to comply with this condition may cause discomfort, nausea, vomiting, pain. It is also necessary to avoid easily digestible, high-calorie carbohydrate and fatty foods, as they, when quickly passing through the stomach into the intestines, can cause the development of “dumping syndrome” – temporary discomfort during or in the first 20 minutes after eating. We are talking about the appearance of a feeling of fullness in the stomach, a feeling of heat in the upper half of the body, general weakness, dizziness, sweating, tinnitus, tremors (tremors in the limbs), heart palpitations, shortness of breath, headache and sometimes even loss of consciousness. True, the “dumping syndrome” occurs in a small percentage of patients, is well corrected by the diet and disappears within a year.

This is a bariatric surgical procedure that is currently considered an outdated and unsafe weight loss method., the principle of which is the imposition of a silicone ring, or bandage, on the upper stomach. Thus, the stomach is divided into two parts, where the upper part of the stomach above the band is a reservoir with a volume of 15-20 ml and actually performs all the main functions of the stomach.

OPERATING PRINCIPLE

Within 2 months, the bandage should be properly fixed in the tissues, therefore, during this period, the person does not lose weight. After this time, the first adjustment of the band is performed – a liquid is introduced into the system, the volume of which is controlled by the surgeon together with the patient, focusing on his health or radiological data (during the adjustment, the patient tries to drink water). Due to the decrease in the capacity of the stomach after adjusting the band, the amount of food consumed is significantly reduced, as a result of which there is a decrease in weight.

FEATURES

The number of installed bandages in the world is falling rapidly. The ease of installation and relative safety of this operation have made it very popular for a long time. Just a few years ago, it was one of the most common bariatric procedures in the world, but with the accumulation of professional experience, the number of such operations began to decrease. According to several sources, on average one patient needs from 1 to 10 band adjustments, i.e. the patient must visit the clinic or doctor after surgery about 10-12 times a year to make adjustments, which is completely inconvenient in terms of organizing life, plus each adjustment costs money. It is also important to say that almost 50% of bandaged patients are subsequently operated on for one reason or another. The most common reason for reoperation is dissatisfaction with the results and comfort of food. The next reason is complications. This is how Bekkhan Bayalovich speaks of this method of bariatric surgery: “We made a fundamental decision not to install new bandages, and our relations with bandaged patients concern only solving problems and complications after bandaging, removing bandages and adjusting them.”

These are brief comparisons of the available bariatric surgery methods. For more detailed information about each method with a detailed description of the postoperative period, diet and complications, with access to forums and videos, read here, as well as on the doctor’s page on the Internet.

Of these methods, the most popular, safe and effective at the moment are bariatric surgeries of the first and second types. However, it should be noted that in some individual cases, the doctor may decide to resort to bariatric surgery and other types. In this case, he is obliged to explain in detail why he proposes such a method and what side points it entails. In any case, the doctor will help you at a preliminary consultation to determine exactly which operation you need.