Surgical Treatments for Obesity

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Dear friends,

This is my first blog of this month. In relation to our theme for this month i.e. 'OBESITY', I am going to present my blog on the topic "Surgical Treatments for Obesity."

As my team mates have already posted blogs explaining the history, introduction & mechanism, I am going to give a view regarding the Surgical Treatments for Obesity.

Need For Surgical Treatments :

Even though there are many conventional methods in the treatment of Obesity, Surgical treatments can be considered as most effective & essential procedures for Morbid Obesity (BMI between 40-44.9 or 49.9) [1] and when all other treatments like life style changes & medications fail to work. These are also called as Bariatric Surgeries. These asurgeries are preferred to the patients of age group 16 - 72years.

The Surgical Treatments for obesity are of two types [2][3][4] -

RESTRICTIVE PROCEDURES - The main objective of the gastric restrictive procedures is to reduce the storage capacity of the stomach.[3] These procedures have less procedural complications than malabsorptive procedures.[5]

VERTICAL BANDED GASTROPLASTY: It is also known as VBG or Stomach Stapling.[2] In this procedure, a small window is cut in the stomach and stapling is done around the window with the help of a Surgical Stapling Device. Stapling is also done vertically to form a small pouch below the oesophagus. A silastic ring is inserted into the window and is wrapped around the narrow way formed to prevent its stretching. The formation of small pouch reduces the capacity of the stomach as a result of which a feeling of fullness is attained fastly.[3]

Image Source:[9]

ADJUSTABLE GASTRIC BANDING: Also known as AGB or Lap-Band Procedure or Laparoscopic Adjustable Gastric band Technique.[2][4] In this technique, an inflatable band is wrapped around the stomach horizontally in its proximal region. As the band is inflated it will squeeze the stomach into two regions. Food taken remains in the upper pouch & slowly moves to the lower part through the narrow opening. [2][3][4]

Image Source:[10]

BYPASS PROCEDURES - These are also known as Malabsorptive Procedures. The main objective of these procedures is to decrease the absorption of calories by shortening the functional length of small intestine.[4]

BILOPANCREATIC DIVERSION: In this procedure, distal part of the stomach is cut & a small pouch is left. The other end is connected to the small intestine directly. Such an arrangement will bypass the duodenal & jejuna absorption.[2][4]

ROUX-EN Y GASTRIC BYPASS: This technique is also known as Duodenal Switch. This is a combination of both restrictive and malabsorptive procedure. The size of stomach is decreased by stapling the stomach and making it into two portions. Movement of food from top portion to the bottom portion is not allowed. A portion of small intestine is attached to the upper part of the stomach by which absorption of nutrients in the bottom portion of stomach and proximal part of small intestine is prevented. [2][4][6]

Image Source - [11]

USES & COMPLICATIONS - [3] -

CONTRAINDICATIONS FOR BARIATRICK SURGERY [7][8] - Personality disorders; Active substance abuse;

DIET [6] - Patients who undergo malabsorptive techniques should take mineral & vitamin supplements. Intake of sweets by the patients may develop sweating, dizziness & tachycardia.

WATCH THE FOLLOWING VIDEO FOR A CLEAR VIEW ON BARIATRIC SURGERIES:
http://www.youtube.com/watch?v=I8D8zpLqpw8

REFERENCES:

  1. http://en.wikipedia.org/wiki/Obesity
  2. http://www.youtube.com/watch?v=I8D8zpLqpw8
  3. http://www.weight.com/obesitysurgery.html
  4. http://www.eje-online.org/cgi/content/full/158/2/135
  5. Santry HP, Gillen DL & Lauderdale DS. Trends in bariatric surgical procedures. Journal of the American Medical Association 2005; 294: 1909-1917.
  6. http://www.endotext.org/obesity/obesity20/obesityframe20.htm
  7. http://findarticles.com/p/articles/mi_m0FSL/is_4_76/ai_93069834/pg_2/
  8. http://emedicine.medscape.com/article/197081-overview
  9. http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19498.jpg
  10. http://www.asklapband.com/wp-content/uploads/2010/12/lap_adjustable_gastric_band1.jpg
  11. http://www.bariatric-surgery-thailand.com/images/roux-en-y-gastri-bypass-thailand.gif

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Comments

Sravani kompella's picture

A very nice representation mam.
Sudha Thamarapalli's picture

Hello Sravani, Thanks a lot. Hope you imbibed some information from this.

Regards,

Sudha.T

K Rajakrishna's picture

Respected mam. You have explained it very well with diagrams. Easy to understand. I have a query. By narrowing the passage of the stomach. We are trying to attain satisfaction of filled stomach. But wont that cause reduction in absorption of other nutrients. How far is it encouraged.
Sudha Thamarapalli's picture

Hello Raja, Thanks a lot for your appreciation. Your comment 'easy to understand' is making me happy because my ultimate aim was to provide you quality information in an understanding manner. And regarding your query, You are right. If you go through the last paragraph, there i specified about the diet. Persons who had undergone bariatric surgeries have to take nutritional supplements.

Regards,

Sudha.T

Gangadhar Hari's picture

You have illustrated elegantly with colorful diagrams madam. In this regard i have a small query. If a person is on drug regimen for treatment of some disease/disorder state and if he/she has previously undergone one of these bariatric surgical procedure, then, what is the influence of these procedures on the absorption of those drugs??
Sudha Thamarapalli's picture

HEllo Sir, Thanks a lot for ur positive response. Regarding your query, Definitely drug absorption & less bioanailability is a most prevalent problem in persons who underwent these bariatric surgeries. In case of restrictive surgeries, The stomach portion is reduced into a size of small pouch. Hence the amount of Hcl released is very less. Therefore, the absorption of drug that depend on acidic pH will be reduced. And in case of Roux-en-Y bypass procedures, portions of jejunum & ileum are removed. Therefore extended release formulations that remain in the intestine for prolonged periods show less bioavailability. Ref: http://www.medscape.com/viewarticle/545489_4

Regards,

Sudha.T

Shikha Chauhan's picture

Dear Madam, Please clarify :- a) The factors which physician take into consideration before undergoing Bariatric Surgeries.? b) General Strategy followed by Doctors for the treatment of Obesity.? c) which one is the better approach- Restriction or Bypass??

Thanks and Regards, Shikha Chauhan http://www.pharmainfo.net/shikhachauhan/biography Lecturer (Pharmaceutics) Amity Institute of Pharmacy Amity University Noida Email: schauhan@amity.edu

Sudha Thamarapalli's picture

Hello mam,

Here are the answers for your queries: a & b,

Strategy of a physician/ factors a ohysician should consider before going for baraitric surgery:[1]

Answer to Qc)

Among all the methods available, Roux-en-y is the most effective and safer one.

  1. http://www.mayoclinicproceedings.com/content/81/10_Suppl/S25.full

Regards,

Sudha.T

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