A Comprehensive Report on Bariatric Surgery: Procedures and Outcomes

This report provides a detailed overview of bariatric surgery, a procedure aimed at achieving weight loss through various methods such as gastric banding and bypass surgery. It highlights the surgery's effectiveness in reducing mortality rates and improving diabetes mellitus outcomes. The report delves into the benefits of bariatric surgery, particularly its role in managing diabetes by improving glycemic control and potentially reducing the need for antidiabetic medications. It also describes different types of bariatric surgeries, including Laparoscopic Adjustable Gastric Banding (LAGB), Biliopancreatic Diversion with Duodenal Switch (LBPD-DS), Laparoscopic Roux-en-Y Gastric Bypass (LRYGB), and Laparoscopic Sleeve Gastrectomy (LSG), outlining their procedures and outcomes. The report concludes that bariatric surgery is a significant method for weight reduction and for managing obesity-related conditions. The report also includes references to support the information provided.

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Introduction
Bariatric surgery is a procedure that aims at increasing weight loss. Weight loss can be
attained through bariatric surgery by decreasing the size of the stomach using a gastric band. It
can also be achieved by removing a segment of the stomach or by cutting and redirecting the
small intestine to a little stomach pouch also referred to as gastric bypass surgery. Studies
indicate that the operation reduces the mortality rate from an estimated 40% to 23% as well as
recovery from Diabetes Mellitus.
The effectiveness of Bariatric surgery in the treatment of Diabetes Mellitus.
Obesity is a severe persistent problem that has increased mortality rates from
cardiovascular diseases, pulmonary diseases, musculoskeletal diseases as well as diabetes
mellitus. The ever-rising prevalence of obesity has led to an increase in type 2 diabetes mellitus.
Various treatment methods have been practiced including preventive measures such as
modification of diets and lifestyles, pharmacotherapy and behavioral therapy. However, the use
of these therapies has not been effective in ensuring long-term weight loss.
It is clear that Bariatric surgery is the most effective treatment in guaranteeing permanent
weight loss. Research indicates that patients who have undergone the procedure have shown
approximately 83% reduction in the incidence of diabetes mellitus. Enhancement of the control
of blood sugar, diabetes remission and decreased use of antidiabetic medicines after the bariatric
procedure can be undertaken for an extended period and hence reducing morbidity rates (2, 4).

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Benefits from Bariatric Surgery
Diabetes mellitus is a long-term metabolic disease that is distinguished by increased
insulin resistance as well as the continued failure of pancreatic beta cells, resulting in
hyperglycemia. Since obesity is one of the significant risk factors that increase the occurrence
and continuance of type 2 diabetes, long-term weight management can help in the management
of Diabetes Mellitus. Bariatric surgery results in sustainable weight loss and the remission of
diabetes mellitus in the majority of the patients. Once the procedure is performed, the glycemic
control is put back by a mixture of necessary caloric intake reduction and increased insulin
secretion and sensitivity (1).
Research indicates that engaging in physical activities and proper diet reduces the
incidence of type 2 diabetes. Physical exercises also result in enhanced glucose homeostasis.
Bariatric surgery results in loss of more weight than other older methods of losing weight to an
estimated 25% of the overall body weight (3). Moreover, 87% of the individuals with diabetes
type 2 attain a healthier glucose control and require fewer antidiabetic medications. At least 78%
can achieve a normal glycemic control without using the antidiabetic medications. Both the
gastric bypass and restrictive procedures can result in the relaxing of the beta cells since their
production of insulin is reduced.

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Types of Bariatric surgeries
Laparoscopic adjustable gastric banding (LAGB), is performed as a laparoscopic surgery
where small cuts are made in the upper gut. The surgeon also places a movable band near the
upper part of the stomach. As a result, a little pouch emerges. One then feels full after taking less
food and hence helping in losing weight. The band can be moved by either adding or getting rid
of fluid present in a balloon near the band. This can be achieved by placing a port beneath the
skin of one's abdomen. A tube is also put from the port to the band around the stomach (6).
One then visits the doctor after the procedure where he or she places a needle to penetrate
the skin to where the port is. As a result, the fluid moves through the tube into the balloon near
the band and pushes the upper part of the stomach (6). A little quantity of fluid is normally added
during each hospital visit. The level of weight loss is also monitored. This procedure is
prescribed to individuals who have unsuccessfully tried to lose weight using other methods. The
procedure may result in the emergence of blood clots in the legs, infection, and bleeding. One
may also develop breathing problems as a result of anesthesia (1).

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Biliopancreatic diversion with duodenal switch (LBPD-DS) is a risk-free procedure that
is undertaken by mini-invasive surgery. This method aims at affecting the intake of food and
rapidly decreases the absorption of nutrients from the stomach. The absorption of nutrients is
reduced since a considerable piece of the intestines is bypassed and unused. The digestion of
food is so rapid such that a less amount of time is taken in the absorption of nutrients. After the
procedure, the Volume of the stomach ranges from 150 and 250 ml while the length of the
functioning portion of the intestinal tract ranges between 75 and 100 cm long (5).
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a bariatric surgery procedure that is
more effective in ensuring weight loss as compared to the adjustable gastric banding. This is the
most recommended bariatric procedure. It involves the reduction in the gastric volume as well as
the redirection of the consumed nutrients away from the proximal intestine. Laparoscopic sleeve
gastrectomy (LSG), is undertaken laparoscopically by making little around five or six cuttings in
the abdomen and conducting the surgery with the help of a video camera and a long device that
is put using the already created small incisions (7).
During the surgery, approximately 75% of the stomach is eliminated and hence creating
a sleeve. The operation takes an estimated 2 to 3hours. This procedure decreases the size of the
stomach and reduces the amount of food consumed at a time. It can also lower a person's
appetite. After this procedure, patients feel full after eating little amounts of food. Studies
indicate that this procedure results to efficient weight loss to an estimated three years. Patients
with higher BMI who undergo laparoscopic sleeve gastrectomy, as a first stage procedure can
lose 40 to 50% of their excess weight in about two years (7).

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In conclusion, Bariatric surgery is an effective procedure for reducing weight. It helps in
the management of restoring the glycemic control by reducing the caloric intake and increased
insulin secretion and insulin sensitivity. It also helps in improving other obesity-related
conditions such as heart disease and high blood pressure and hence making it the most preferred
method of weight loss.

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References
1. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obesity surgery.
2013 Apr 1;23(4):427-36.
2. Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric
surgery worldwide 2013. Obesity surgery. 2015 Oct 1;25(10):1822-32.
3. Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC,
Nordmann AJ. Bariatric surgery versus non-surgical treatment for obesity: a systematic
review and meta-analysis of randomised controlled trials. Bmj. 2013 Oct 22;347:f5934.
4. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and
risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012.
JAMA surgery. 2014 Mar 1;149(3):275-87.
5. Topart P, Becouarn G, Ritz P. Laparoscopic biliopancreatic diversion with duodenal
switch (LBPD/DS) is a safe operation. Surgery for Obesity and Related Diseases. 2013
Jul 1;9(4):588.
6. Kim SM. Laparoscopic Adjustable Gastric Banding (LAGB). InBariatric and Metabolic
Surgery 2014 (pp. 55-68). Springer, Berlin, Heidelberg.
7. Kasama K. Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). InBariatric and
Metabolic Surgery 2014 (pp. 37-43). Springer, Berlin, Heidelberg.

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8. Types of Bariatric Surgery. National Bariatric Link.
https://www.nationalbariatriclink.org/types-of-bariatric-surgery.html (accessed
September 14, 2018).

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