BARIATRIC SURGERY

&
OBESITY
 Guidelines for Bariatric Surgery
NICE (National Institute for Health and Care Excellence)

 BMI 40 kg/m²
 BMI 35 - 40 kg/m² + obesity related co-morbidity
 All non surgical methods have failed to achieve /
maintain clinically beneficial wt loss
 BMI 50 kg/m² (surgery 1st line)
 Offer bariatric surgery to people with a BMI of 35
kg/m² *
 Consider bariatric surgery for people with a BMI of
30 - 34.9 kg/m²
 History

 Term Bariatric is derived from baros (weight)

 iatreia (medical treatment)
 1st Bariatric surgery - 1954 by AJ Kremen
intestinal bypass
 Gastric bypass was developed in 1966
stomach stapling
Normal anatomy of GI tract
 Principles of bariatric surgery

 The basic principle of bariatric surgery is to restrict food

intake and decrease the absorption of food in the stomach
and intestines.

 Bariatric surgery is designed to alter or interrupt this

digestion process so that food is not broken down and
absorbed in the usual way. A reduction in the amount of
nutrients and calories absorbed enables patients to lose
weight and decrease their risk for obesity-related health
risks or disorders.
 Laparoscopic Gastric Banding

Laparoscopic gastric banding is a surgical procedure

to help with weight loss. The surgeon places a band
around the upper part of the stomach to create a
small pouch to hold food. The band limits the
amount of food one can eat by making you feel full
after eating small amounts of food
Laparoscopic adjustable gastric band (LAGB), is an
inflatable silicone device placed around the top
portion of the stomach
 Gastric Banding

 Restrictive procedure
 Ideal for those with BMI
35 - 45 kg/m²
 Weight loss ~ 20%
 Risk of complications ~
10%
 Risk of mortality 1:1000
 Hospital stay ~ 1 day
 1/10 may need a repeat
surgery
 LAP – BAND® SYSTEM

An adjustable silicone
elastic band is placed
around the upper
part of the stomach
creating a small
pouch and restricting
the passage of food
Gastric Banding

Unfilled Band

Filled Band
 Roux-en-Y Gastric Bypass

 Ideal for those with

BMI 40 - 55 kg/m²
 Weight loss ~ 30%
 Risk of complications
~ 5%
 Risk of mortality 1:300
 Hospital stay ~ 3 days
 ROUX-EN-Y GASTRIC BYPASS

 During this surgery, the upper stomach is

stapled creating a small pouch that is
completely divided from the remainder of the
stomach

 Roux-en-Y Gastric Bypass is the most

frequently performed weight loss procedure in
the United States
 RYGB – 5 procedures in 1

 Restriction
 Altered flow of nutrients
 Vagal manipulation
 Bile flow alteration
 Enteric gut & adipose hormone modulation
 Vertical Sleeve Gastrectomy

 Reduce stomach volume

by 75%
 Ideal for those with BMI
> 55 kg/m²
 Can be done as a 1st
stage before RYGB
 Weight loss ~ 20%
 Risk of complications ~
5%
 Risk of mortality 1:500
 Hospital stay ~ 3 days
VERTICAL BANDED GASTROPLASTY (VBG)

 VBG is a purely
restrictive procedure
in which the upper
stomach is stapled
and divided, forming
a small pouch that
reduces the size of the
stomach and the
amount of food the
stomach can hold
 Bariatric Surgery

Biliopancreatic
Adjustable Gastric
Sleeve Gastrectomy Roux-en-Y Gastric Bypass Diversion/Duodenal
Procedure Banding
Switch
(SG) (RNYGB)
(AGB)
(BPDDS)
• Restrictive • Malabsorptive
Mechanism
• Restrictive • Restrictive • Malabsorptive • Hormonal
of Action
• Hormonal • Restrictive
• Low
• Continuous GI • Better Weight Loss
Complications
Benefits Tract • Best Weight Loss
• Early Effect on
• Good Weight
• Reduces Hunger Diabetes
Loss
 EndoBarrier™

 Procedure time ~ 1 hour

 The sleeve is inserted via
the mouth
 Weight loss ~ 20%
 Patients who benefit
 - Type 2 diabetics
 - Aged, 18 – 60 years
 - BMI, 30 - 50 kg/m²
 - HbA1c, 7.5 - 10.5 %
 - Taking either oral
glycemics or <150 units
Insulin/day
 Bariatric Embolization (BE)

BE delivers embolic microspheres into

the gastric arteries to induce localized ischemia
and has modified appetite hormones in several
animal models, leading to reductions in weight.
Early clinical trials have produced promising
short-term results
 Bariatric Embolization (BE)

Trans-arterial left gastric artery embolization via

embolic microspheres leads to local ischemia of the
stomach's fundus and suppresses the anabolic
hormone function, that is, decrease in serum ghrelin
hormone level secretion and evenly reduce body
weight which then decreases appetite and reduces
weight. Several clinical trials were conducted in the
past ten years that showed promising short term
results