In order to attain a more healthy body weight for obese individuals who have been unable to achieve significant weight loss through diet modifications and exercise programs alone, bariatic surgery is a consideration. Bariatic surgery, also known as weight loss surgery, encompasses all surgical treatments to treat morbid obesity by modification of the gastrointestinal tract to reduce nutrient intake and/or absorption. However, this does not include procedures for surgical removal of body fat, such as liposuction and abdominoplasty. This treatment option is highly recommended for patients with a body mass index of 40 kg/m2 or greater who presently suffer from obesity–related co-morbid conditions, such as hypertension and diabetes mellitus.
There are a number of surgical options available to treat obesity, each with their advantages and pitfalls. The procedures may be classified into three main categories: predominately malabsorptive, predominately restrictive, and mixed procedures.
Predominately malabsorptive procedures reduce stomach size, but mainly create malabsorption. Biliopancreatic diversion (BPD) or the Duodenal switch (DS) involve procedures where part of the stomach is resected, creating a smaller stomach. The distal part of the small intestine is then connected to the pouch, bypassing the duodenum and jejunum. Fewer surgeons perform BPD/DS compared to other weight loss operations due to the complications in nutritional deficiencies and long–term monitoring of patients.
Predominately restrictive procedures mainly involve the reduction of the stomach size. In vertical banded gastroplasty, also called the Mason procedure, a part of the stomach is permanently stapled, creating a smaller pouch, which serves as the new stomach. The same effect can be created using a procedure known as Lap Band surgery. During this operation, surgeons place a band around the top part of the stomach, restricting the amount of food the stomach can hold, so patients feel full faster, it can also be adjusted as time goes on, depending on how the patient is losing weight. Gastric band placement, unlike malabsorptive weight loss surgery, does not cut of remove any part of the digestive system. Unlike the individuals who undergo, BPD or DS, it is unlikely that gastric band patients will experience any nutritional deficiencies or malabsorption of mutirents.
Mixed procedures involves the application of both techniques in unison. Gastric bypass surgery is the most popular performed operation for weight loss in the United States. This procedure makes the stomach smaller and allows food to bypass part of the small intestine. The patient will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed, leading to weight loss. The most common gastric bypass surgery is a Roux-en-Y gastric bypass. In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).
Following bariatic surgery, or any substantial amount of weight loss, the skin and tissues often lack elasticity and cannot conform to the reduced body size. As a result, the severely stretched skin is unsupported, causing sagging. With the help of a plastic surgeon, surgical body contouring after a weight loss procedure improves the shape and tone of the underlying tissue that supports fat and skin, removing excess sagging fat and skin. There are several areas of the body in need of improvement include the face, neck, arms, abdomen, back, and thighs.