Types of Metabolic and Bariatric Surgeries

Bariatric surgery is performed to assist individuals with severe obesity in achieving significant weight loss.

Surgery is also performed on Individual with obesity associated conditions / diseases, hence it is also named as metabolic surgery. Procedures lead to long term sustained weight loss, resolution and / amelioration of type 2 diabetes, medication reduction, high blood pressure, heart diseases, sleep apnoea, improvement in lipids and in quality of life etc.

The most common types of bariatric surgeries include laparoscopic gastric bypass and laparoscopic sleeve gastrectomy. Less common procedures include, adjustable gastric banding, and biliopancreatic diversion with a duodenal switch. Metabolic and Bariatric surgery is often a suitable solution to manage obesity, obesity associated diseases, and improving overall health, but it should be considered after careful evaluation and consultation with healthcare professionals.

Let’s explore the different types of metabolic and bariatric surgeries available…

What is metabolic and bariatric surgery?

Metabolic and Bariatric surgery involves modifying the digestive system to limit the amount of food intake or reduce the body’s ability to absorb nutrients. The mechanism also includes effects on central nervous system regulation of appetite and metabolism and improvements in insulin secretion and insulin sensitivity. There are several types of bariatric surgeries, each with its unique approach and benefits.

1. Laparoscopic Roux-en-Y Gastric Bypass Surgery (RYGB)

Laparoscopic Gastric bypass surgery, bypasses ~ 95% of the stomach and upper part of small intestine. It involves creating a small gastric pouch at the top of the stomach, which is then directly connected to the small intestine. The remainder of stomach and upper part of small intestine remain in the body and are excluded from nutrient flow. Duodenum is reattached further down with middle part of small intestine to allow bile acids and digestive enzymes to reach nutrients. This reduces the stomach’s capacity which alters digestion, leading to decreased food intake and nutrient absorption.

2. Laparoscopic Sleeve Gastrectomy (LSG)

In Laparoscopic Sleeve Gastrectomy, nearly 80% of stomach along greater curvature is removed, create a narrow tubular stomach. The reduced stomach capacity restricts food intake, resulting in decreased calorie consumption. Additionally, the procedure affects the hunger-regulating hormones, leading to a reduced appetite. It is also less invasive than Laparoscopic Roux-en-Y Gastric bypass as it does not involve intestinal rearrangement.

3. Laparoscopic Adjustable Gastric Banding (Lap Band)

Lap-Band surgery, or adjustable gastric banding, refers to the placing of an inflatable band around the upper part of the stomach. This creates a small pouch above the band, which can be adjusted by adding or removing saline solution through a port placed under the skin. The band restricts the amount of food that can be consumed, inducing a feeling of fullness with smaller portions. Lap-Band surgery is reversible and requires regular follow-ups for band adjustments. While it is a less invasive procedure, the weight loss results may be less significant compared to other bariatric surgeries.

4. Laparoscopic Biliopancreatic Diversion with Duodenal Switch

Lastly, biliopancreatic diversion with duodenal switch (BPD-DS) is a complex procedure that involves two components. Firstly, a smaller, tubular stomach pouch is created, similar to a sleeve gastrectomy. Secondly, a large portion of the small intestine is bypassed, limiting the absorption of nutrients. BPD-DS results in significant weight loss due to both the restriction of food intake and reduced absorption of calories and nutrients. However, this surgery is typically reserved for individuals with extreme obesity due to its complexity and potential risks.

Conclusion

Metabolic and Bariatric surgery offers a solution for many individuals who are struggling with severe obesity and obesity related health issues. Laparoscopic Gastric Bypass and Laparoscopic Sleeve Gastrectomy, are the most common types of surgeries performed today. Lap-Band is rarely performed, and Laparoscopic biliopancreatic diversion with duodenal switch reserved for selective patients. Each procedure has its own benefits and considerations, and the choice of surgery depends on various factors such as the individual’s health status, weight loss goals, and surgeon’s recommendation. It is crucial to consult with a qualified healthcare professional to determine the most suitable option and understand the potential risks and benefits associated with each type of metabolic and bariatric surgery.

For more information please contact Dr M Khalil, Specialist Surgeon at Ahmed Kathrada Private Hospital
Tel: 011 854 5192 / 0870878628

The Lenmed Group is a world-class group of Private Hospitals that brings quality healthcare to communities across Southern Africa.