Bariatric surgery

What is Bariatric surgery?

Bariatric surgery (also known as metabolic surgery or weight loss surgery) is a surgical procedure used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size (stomach reduction surgery),] reduction of nutrient absorption, or a combination of these. Standard of care procedures include Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, from which weight loss is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.

In morbidly obese people, bariatric surgery is the most effective treatment for weight loss and reducing complications. A 2021 meta-analysis found that bariatric surgery was associated with reduction in all-cause mortality among obese adults with or without type 2 diabetes. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes. The risk of death in the period following surgery is less than 1 in 1,000. A 2016 review estimated bariatric surgery could reduce all-cause mortality by 30-50% in obese people. Bariatric surgery may also lower disease risk, including improvement in cardiovascular disease risk factors, fatty liver disease, and diabetes management.[12]

Stomach reduction surgery is frequently used for cases where traditional weight loss approaches, consisting of diet and physical activity, have proven insufficient, or when obesity already significantly affects well-being and general health. The weight-loss procedure involves reducing food intake. Some individuals might suppress bodily functions to reduce the absorption of carbohydrates, fats, calories, and proteins. The outcome is a significant reduction in BMI. The efficacy of stomach reduction surgery varies depending on the specific type of procedure. There are two primary divisions of surgery, specifically gastric sleeve surgery and gastric bypass surgery.

Weight loss
In adults, malabsorptive procedures lead to more weight loss than restrictive procedures, but they have a higher risk profile. Gastric banding is the least invasive, so it may offer fewer complications, while gastric bypass may offer the highest initial and most sustainable weight loss. A single protocol has not been found to be superior to the other. In one 2019 systematic review, estimated weight loss (EWL) for each surgical protocol is as follows: 56.7% for gastric bypass, 45.9% for gastric banding, 74.1% for biliopancreatic bypass +/- duodenal switch and 58.3% for sleeve gastrectomy. Most patients do remain obese (BMI 25-35) following surgery despite significant weight loss, and patients with BMI over 40 tended to lose more weight than those with BMI under 40.

With regard to metabolic syndrome, bariatric surgery patients were able to achieve remission 2.4 times as often as those who underwent nonsurgical treatment.[30][28] No significant difference was noted for changes cholesterol, or LDL, but HDL did increase in the surgical groups, and reduction in blood pressure was variable between studies.

Source : https://en.wikipedia.org/wiki/Bariatric_surgery