Bariatric surgery includes a type of procedure performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with a gastric band or by removing a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and redirecting the small intestine into small stomach pouches (gastric band surgery). .
The fundamental basis of bariatric surgery for the purpose of weight loss is the determination that severe obesity is a disease associated with multiple adverse health effects that can be reversed or ameliorated by successful weight loss in patients who do not. have been able to maintain weight loss by non-surgical means. It even helps in the reduction of cardiovascular disease (CVD), as well as other expected benefits of this intervention. The ultimate benefit of weight loss is related to reduced comorbidities, quality of life, and all-cause mortality.
Specific criteria established by the NIH consensus panel indicated that bariatric surgery is appropriate for all patients with a BMI (kg/m2) >40 and for patients with a BMI of 35 to 40 with associated comorbid conditions. These standards have been maintained over the years, although specific indications for bariatric/metabolic surgery have been recognized for people with less severe obesity, such as people with a BMI of 30 to 35 with type 2 diabetes. Bariatric surgery evolve rapidly to consider the presence or absence of comorbid conditions, as well as the severity of obesity, as reflected by BMI.
Specific bariatric surgical procedures are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, biliopancreatic diversion with duodenal switch, device implantation (includes adjustable gastric banding, intermittent vagal blockade, gastrointestinal endoscopic devices).
The bariatric surgical community enacted a number of changes to result in this improved safety record. Included is the identification of the importance of surgeon and facility expertise, the establishment of pathways, care protocols, and quality initiatives, and the incorporation of all of these aspects of care into a facility accreditation program. The transition to laparoscopic methodology occurred during the same period and also contributed to improving safety.
Weight loss after bariatric surgery has been studied and reported both in the short and long term after all surgical procedures performed, since weight loss is the main goal of bariatric surgery. Average weight loss is consistently reported. However, it is crucial to identify the high variability of weight loss after apparently standardized surgical procedures such as RYGB or laparoscopic adjustable gastric banding (LAGB).
The ultimate benefit of weight loss, whether medical or surgical, is related to reduced comorbidities, quality of life, and all-cause mortality. Despite the importance of evaluating these risks and taking steps to implement effective medical management with variable success, surgery has been shown to be more effective.