Bariatric Surgery: A Primer

Severe obesity, the inability to lose weight by means of diet and exercise, and health problems related to obesity all qualify as reasons to consider bariatric surgery as a viable option. This surgery works by restricting appetite and, in some surgeries, altering the digestive system.

Bariatric surgery is a gastrointestinal surgery and has three forms: combined restrictive/malabsorptive, restrictive, and malabsorptive. The main focus here will be on the restrictive surgery.

In order to be a candidate for bariatric surgery, a patient must have a body mass index (BMI) of greater than 40. Patients with BMI's between 35 and 40 are considered candidates if they have life-threatening heart conditions or severe diabetes.

Restrictive bariatric surgery seeks to limit food intake and does not alter the normal process of digestion. A small pouch is constructed on the stomach with a small restricted outlet. This pouch only holds approximately one ounce of food and can later stretch to hold two to three ounces. The small outlet on the pouch delays the movement of food from the pouch to the stomach and aids in achieving that "full" feeling. After surgery, patients are unable to consume large amounts of food at one time. Any quantities over ½ to 1 cup of food will cause severe discomfort and nausea.

One type of restrictive bariatric surgery is the placement of an adjustable gastric band. In this surgery, a band is placed around the upper portion of the stomach, creating the pouch and a narrow opening into the larger part of the stomach. After placement, the band is filled with a sodium solution. A port is then placed below the surface of the skin that allows for an adjustment in the amount of the sodium solution, thereby adjusting the size of the opening into the stomach.

The other type of restrictive bariatric surgery is vertical banded gastroplasty. In this surgery, staples are added to the process. This technique, although popular in the past, is not as widely used today.