Increasing Utilization of Bariatric Surgery & Its Minimally Invasive Options

A large portion of the world today deals with a generally self-inflicted problem of obesity. Causes range from a lack of exercise, poor food habits, stress & emotional duress, lack of sleep, lack of access to healthy produce, genetics & underlying illnesses, or disease. Through conscious choices and informed decisions, many paths which lead to ending up overweight and unhealthy can be avoided but for individuals whose bodies unfortunately do not react to diets or exercise, ‘Bariatric’ or ‘weight-loss’ surgery is sometimes the only option to achieve somewhat of a normal life.

Understanding Bariatric Surgery

Bariatric surgery refers to various surgical procedures which provide an alternative for weight loss to people, for whom a healthy diet & regular exercise are ineffective. Also referred to as ‘weight loss surgery,’ these operations assist in losing weight by altering an individual’s digestive system. This is usually done by either restricting the amount of food the stomach can hold or by reducing the body’s ability to absorb nutrients and occasionally as a combination of the two methods.

Why & When is Bariatric Surgery Performed?

In most cases, being severely overweight or obese comes in tandem with the person suffering from or at high risk of life-threatening diseases such as :

  • Stroke
  • Heart Disease
  • High Blood Pressure
  • Sleep Apnea
  • Type 2 Diabetes
  • Fatty Liver

To either prevent or battle against such illnesses, losing weight is paramount. Individuals requiring Bariatric Surgery can be identified if their Body Mass Index = 35 or greater.
Body Mass Index is a means to understand if a person is over or under weight and is calculated by dividing their weight by the square of their height. To grasp the true scale of the problem, a normal and healthy body mass index ranges from (18.5 -24.9) .

Types of Bariatric Surgery:

  • Roux-en-Y Gastric Bypass (RYGB) or Gastric Bypass:

Roux-en-Y Gastric Bypass (RYGB) or Gastric Bypass:
The most common type of bariatric surgery, it is a 2-stage procedure which has been performed for over 50 years. Firstly, the stomach divided into two distinct sections, with a smaller pouch remaining on top. Subsequently the small intestine is also divided, and the bottom part is now connected to the smaller pouch, therefore ‘bypassing’ a large part of the stomach. The upper section of the small intestine is re-connected a few feet below back into the small intestine allowing gastric juices, acids & enzymes to mix with the food.

This procedure allows the newly formed stomach to hold lesser food, reducing hunger, increasing the sensation of fullness as well as the lowering the number of calories & nutrients ingested.

  • Sleeve Gastrectomy:

Less complex than a gastric bypass, this procedure involves surgical removal of about 80% of the stomach, with a banana shaped structure left behind. A smaller sized stomach eventually leads to reduced production of the ‘ghrelin’ or the hunger hormone hence restricting the amount of food required or ingested.

Due to its relatively simpler nature, it is preferred as the first type of weight loss surgery for patients and can also be performed on individuals with high-risk medical conditions. It’s important to note that the sleeve gastrectomy is a non-reversible procedure which needs to be considered before signing off on it.

  • Adjustable Gastric Band:
    The adjustable gastric band or (AGB) is a device made of silicone placed around the upper part of the stomach to limit the amount of food stored or passing through at a time. This is essentially done to induce a sense of fullness, hence reducing overeating. As the name suggests the size of the band can be re-adjusted as per requirement through fluid injections.
    Being the least effective method of weight loss surgery, its use has declined over the years.

  • Biliopancreatic Diversion with Duodenal Switch (BPD/DS):
    A tube shaped stomach pouch is created quite similar to the sleeve gastrectomy followed by a connection to the lower half of a now divided small intestine. Through this procedure almost 75% of the small intestine is bypassed resulting in a largely reduced no. of calories, nutrients. The BPD-DS method is believed to be the most effective way to improve blood sugar levels and deal with type-2 diabetes. Patients also need to take supplementary minerals and vitamins post-surgery.

Minimally Invasive Variants of Bariatric Surgery:

With massive advancements in the technology and equipment available within the healthcare sector, bariatric surgery too is transitioning towards minimally invasive & robotic assisted procedures.

Today, majority of weight loss surgeries are performed through a procedure called ‘Laparoscopic Bariatric Surgery’ wherein 4-5 extremely small incisions are made near the abdomen. The laparoscope is a small instrument with a high-definition camera attached at the end for internal visuals during the operation. The other cuts allow extremely maneuverable equipment to be introduced without large cuts being made. Advantages include much lesser pain & bleeding, reduced scarring, lesser span of hospitalization & faster recovery to normal life.

Other techniques like robotic weight loss surgery, single site weight loss surgery and innovative endoscopic techniques like NOTES & EBT do exist but are still on the fringes of widespread adoption.
NOTES or (Natural Orifice Transluminal Endoscopic Surgery) is a novel & ‘scarless’ endoscopic procedure wherein highly advanced surgical instruments are passed down to the stomach through the esophagus. Also referred to as Endoscopic Bariatric Surgery (EBT), this variation is sure to be harnessed in the near future.

The world of Minimally Invasive Surgical procedures is widening with each passing year as doctors search for innovative approaches to ease pain & suffering. The 2nd ANNUAL MARKETSANDMARKETS MINIMALLY INVASIVE SURGERY CONFERENCE scheduled for the 14th-15th of September 2022 aims to explore opportunities, challenges & future disruptions in this field.


Ayush Kanitkar

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