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Types of surgery<br />
Bariatric procedures are divided into restrictive or malabsorptive:<br />
Restrictive procedures:<br />
The stomach is made smaller so that it holds<br />
less food, producing a feeling of fullness.<br />
Adjustable gastric band<br />
Adjustable gastric banding places a hollow, adjustable<br />
band made from silicone, around the stomach. This band<br />
effectively divides the stomach in two with a small upper<br />
pouch above the band and a larger pouch below. The<br />
small pouch restricts the amount of food that a patient<br />
can eat at any one time and will result in a feeling of<br />
fullness after consuming only a small quantity of food.<br />
The band has an adjustment ‘port’ placed under the skin<br />
of the abdominal wall where the surgeon can adjust the<br />
tightness of the stomach banding, if necessary.<br />
About 50-60% of excess weight is lost<br />
Benefits within five years of having the operation<br />
and this means that the risk of Type 2 diabetes is reduced,<br />
high blood pressure and cholesterol levels go down and<br />
mobility, the ability to exercise and sleeping patterns are<br />
all restored. The procedure is fully reversible which means<br />
the band can be removed at any time.<br />
Risks<br />
This procedure is performed during a routine<br />
day procedure appointment. In general, the<br />
risks associated with gastric band surgery are small but<br />
problems that can occur include band slippage, tube<br />
rupture or disconnection, abscesses and infection.<br />
Gastric balloon<br />
insertion<br />
(intragastric balloon)<br />
Gastric balloon insertion is a less permanent type of<br />
surgery which restricts the stomach capacity enabling<br />
you to lose weight. This surgery works best for<br />
patients with a weight problem who<br />
want an intense period of fast weight<br />
loss before returning to more<br />
sensible eating habits. A balloon is<br />
placed on the end of a thin, flexible<br />
tube called an endoscope, which<br />
is inserted into your stomach via<br />
your mouth. Sterile solution or air<br />
is pumped into the balloon so that<br />
it partially fills the stomach, creating a feeling of fullness.<br />
The balloon is usually removed after<br />
six months.<br />
A gastric balloon means that you lose<br />
Benefits weight quickly and easily, because<br />
the capacity for food in your stomach is restricted by<br />
the balloon. The procedure is relatively simple and is<br />
performed under a local anaesthetic, so you don’t have to<br />
stay overnight in hospital. Once you’ve lost the weight<br />
the balloon is removed and you can return to eating<br />
normal portions.<br />
Balloon deflation or bowel obstruction,<br />
however these are extremely rare.<br />
Risks<br />
Malabsorptive procedures”<br />
They limit calorie uptake from the intestine,<br />
which changes the body’s ability to absorb<br />
calories from food.<br />
Gastric bypass<br />
This is the most common form of bariatric surgery. A small<br />
pouch is created at the top of the stomach. Part of the<br />
intestine is then grafted to the top of the pouch so that<br />
food bypasses the stomach and some of the intestine.<br />
Less food is required to satisfy your appetite and fewer<br />
calories are absorbed.<br />
You feel fuller more quickly and for<br />
Benefits longer and because the amount of food<br />
is restricted as well as the numbers of calories absorbed,<br />
there is usually a dramatic initial weight loss. Once you’ve<br />
recovered from the operation you will be able to enjoy a<br />
‘normal’ diet.<br />
Risks<br />
You may feel or even be sick after eating,<br />
especially if you try to eat too much. Sugary<br />
foods can make you feel faint and sweaty – a syndrome<br />
known as ‘dumping’. You will usually need to take vitamin<br />
supplements due to the restricted diet, and your bowel will<br />
absorb less well than before surgery.<br />
Duodenal switch<br />
A duodenal switch starts with a procedure called a<br />
sleeve gastrectomy which reduces the size of the<br />
stomach by about 75%. The stomach is divided<br />
vertically from top to bottom leaving a bananashaped<br />
stomach. A short segment of the<br />
duodenum at the base of the stomach is<br />
left. Because of the reduced stomach<br />
size less food can be eaten and there is<br />
reduced food absorption as only 15%<br />
of the bowel will absorb food. Changes<br />
occur in the hormones released from<br />
the bowel and stomach too, which<br />
control the feeling of hunger.<br />
This procedure<br />
Benefits combines a restrictive<br />
and a malabsorptive aspect and is reported to<br />
give the highest percentage of long-term weight<br />
loss of all the weight-loss procedures. One advantage<br />
of this is that you will be less restricted in the foods you<br />
can eat in the longer term, and you will also have a greater<br />
degree of malabsorption after a duodenal switch, which<br />
means you will absorb fewer calories from your food and<br />
therefore lose more weight.<br />
Risks<br />
Eating high-fat foods can lead to more<br />
undigested fat passing through your system<br />
and, in 30% of people, this leads to foul-smelling wind<br />
and loose stools. Reducing your overall fat intake should<br />
solve this problem. To prevent deficiency, your diet has to<br />
include twice as much protein as normal. It will also be<br />
necessary to take vitamin and mineral supplements for<br />
the rest of your life.<br />
Photograph: iStock<br />
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