Overview of bariatric surgery


Revisional surgery is an important component of addressing weight regain and complications following primary bariatric surgery. Owing to provincial need and the complexity of this patient population, a specialized multidisciplinary revision clinic was developed.
Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques 
First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed.
During the past two years, a number of new minimally invasive methods for revising bariatric operations laparoscopic ally have come onto the scene. Although the risks associated with the new techniques are quite low, preliminary weight loss results are similar to those of the operations performed 20 years ago. A critique of these new approaches is found below.

Sclerotherapy

Sclerotherapy is injection of a glue-like substance via an endoscope in and around the stretched anastomosis to make it smaller. Moreover, because the glue alters the tissue where it’s injected, subsequent surgical revision is likely to be more hazardous.

Endoscopic/Endoluminal Suture Plication

This refers to the narrowing of the circumference/size of the stretched anastomosis using either sutures or metal fasteners which are placed through an endoscope.

Banding the Bypass

This is the placement of a laparoscopic adjustable band above the stretched anastomosis/stoma. Subsequently, this procedure functions like a primary LAP-BAND operation.

Selecting the Right Operation

Choosing the appropriate revisional procedure is probably more important than selecting the first bariatric operation. This is because it’s crucial to know or ascertain why the first operation failed.

Advantages of bariatric surgery

1.      Produces significant long-term weight loss (60 to 80 percent excess weight loss)
2.      Restricts the amount of food that can be consumed
3.      May lead to conditions that increase energy expenditure

Disadvantages of bariatric surgery

1.      Is technically a more complex operation than the AGB or LSG and potentially could result in greater complication rates
2.      Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate
3.      Generally has a longer hospital stay than the AGB

Treatment Reference

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