Bariatric Surgery Overview

Bariatric Surgery Overview

Bariatric surgery

Americans are becoming obese at an alarming rate and their associated health costs are rising along with it. In 2008, there was as much as $147 billion in obesity related medical costs.47 Morbid obesity increases risks for serious conditions like Type 2 diabetes, cardiovascular problems and sleep apnea.

Bariatric surgery can help many obese patients restrict calorie intake, lose weight and improve or resolve their serious and expensive related diseases (co-morbidities). And 75% of weight loss surgeries performed are taking advantage of minimally invasive techniques that can reduce cost and improve the overall medical experience for the patient.460

Candidacy for bariatric surgery

How does somebody become a candidate for bariatric surgery? The National Institutes of Health has set the following guidelines:

  • Age 18 years or older
  • Patient's body mass index (BMI) is equal to or greater than 40kg/m2.

OR

  • Patient’s body mass index (BMI) is equal to or greater than 35kg/m2 and they have one or more obesity-related diseases, such as sleep apnea, Type 2 diabetes, cardiopulmonary problems, joint disease, to list a few.

Bariatric surgery candidates also need to demonstrate that they have attempted diet and exercise for long-term weight loss to no avail. They must be committed to making lifestyle changes after surgery, which include routine medical visits, testing and changes to nutritional habits. Also, because of the dramatic lifestyle changes that the patient will have to undergo before and after surgery as well as the physical change that surgery may bring, patients should be evaluated by a psychiatrist or psychologist before being referred for surgery. It's important that the patient understand all the aspects of the procedure in order to make an informed decision.

Because of the unique technical demands of the surgery, patients should be referred only to surgeons who perform a high volume of these procedures annually. The surgeon should have substantial experience with both minimally invasive weight loss surgery and open bariatric procedures, in case conversion is required.

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

The American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) combined their respective national bariatric surgery accreditation programs into a single unified program to achieve one national accreditation standard for bariatric surgery centers, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

MBSAQIP works to advance safe, high-quality care for bariatric surgical patients through the accreditation of bariatric surgical centers. A bariatric surgical center achieves accreditation following a rigorous review process during which it proves that it can maintain certain physical resources, human resources, and standards of practice. All accredited centers report their outcomes to the MBSAQIP database.

Types of bariatric surgery

Gastric Bypass – In the United States, the Roux-en-Y Gastric Bypass is one of the most frequently performed procedures for morbid obesity.460 It restricts food intake, utilizing restrictive and malabsorptive surgery techniques, which prevents the body from absorbing calories and nutrients. Aside from creating a smaller stomach pouch, the overall digestive process of the body is changed so that food will bypass the large part of the stomach and most of the small intestine. Studies show that an average of 61.6% of excess weight is lost after the surgery, with noted improvement in obstructive sleep apnea, Type 2 diabetes, high blood pressure, and depression.22

Sleeve Gastrectomy – This restrictive surgical weight loss procedure limits the amount of food patients can eat and makes them feel full quicker. During the procedure, a thin, vertical, banana-sized sleeve of stomach is created and the rest of the stomach is removed. Patients with this procedure may experience significant health improvements and one study showed excess weight loss at an average of 55% of their original weight.40

About minimally invasive bariatric surgery

All three of these bariatric procedures can be performed laparoscopically using minimally invasive techniques.

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