Bariatric Surgery: Types, Side Effects, Before & After Results

According to Singh et al., 2023, the prevalence of obesity in India has increased from 12.6% to 24% in women and 9.3% to 22.9% in men. This growing obesity trend emphasises the crucial need for effective intervention strategies. Bariatric surgery is ideal for people who fail to shed weight from diet and exercise.

Weight loss surgery includes different surgical methods aimed at helping patients lose weight by altering their digestive tract. Continue reading to know more about these types, procedures, and recovery. 

Bariatric surgery meaning is explained as a group of medical procedures that help individuals with severe obesity lose weight. It modifies the digestive system to restrict food intake, reduce the absorption of nutrients, or both. 

This type of surgery may also be a good option for patients with health problems related to obesity, like type 2 diabetes. Significant weight loss can result in improved blood sugar control and, in some cases, remission of the disease. 

Bariatric surgery is an effective weight management option. Moreover, it also improves several obesity-related conditions, including: 

1. Type 2 Diabetes: Excess fat can lead to insulin resistance. Bariatric surgery can improve blood sugar control. 

2. Hypertension (High Blood Pressure): Many patients experience better regulation of blood pressure levels after the procedure, reducing the risk of heart disease.

3. Heart Disease: By managing diabetes and hypertension, surgery can lower the risk of heart disease and stroke.

4. Fatty Liver Disease: Weight loss can reduce liver fat, inflammation, and fibrosis. This decreases the risk of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).

5. Obstructive Sleep Apnoea: It is a condition in which breathing stops and restarts during sleep. Weight loss after bariatric surgery can improve this disorder.

Bariatric surgery offers a significant opportunity for weight loss. However, qualifying for this procedure involves meeting specific medical guidelines. These include: 

1. Body Mass Index (BMI) of 40 or above without comorbidities.

2. BMI of 35 to 39.9 (obesity) with comorbidities like type 2 diabetes, high blood pressure, or severe sleep apnoea.

3. Long-term commitment to extensive dietary, exercise, and lifestyle changes.

Benefits of Bariatric Surgery

Surgery is the only treatment that has shown long-term efficacy for class III obesity. However, the advantages extend beyond substantial weight loss. The benefits of bariatric surgery include: 

1. Improved cardiovascular health.

2. Remission of type 2 diabetes.

3. Relief from depression (that results from physical limitations and societal stigma associated with obesity).

4. Joint pain relief (carrying excessive weight can place significant stress on weight-bearing joints, leading to chronic pain and joint damage).

5. Improved fertility during childbearing years (it also reduces the risk of miscarriage).

6. Sleep apnoea resolution.

Preparing for bariatric surgery requires a clear understanding of the necessary steps before and on the day of the operation to guarantee its effectiveness. Patients must adhere to their doctor’s guidance.

Before Bariatric Surgery

This preparatory phase ensures that the surgery is suitable for the patient. Before the procedure, individuals must follow a nutritionist-guided diet to reduce abdomen fat and decrease surgery risks. Some other instructions and preparations include the following: 

On the Day of Bariatric Surgery

Understanding the flow of events on the day of bariatric surgery can significantly reduce anxiety and help patients undergo the procedure with confidence. Here’s what one can expect: 

There are various types of bariatric surgery, each of which helps in weight loss by altering the structure of the digestive system. The techniques for these types differ. The most common procedures include: 

1. Gastric Bypass (Roux-en-Y): A small pouch is created at the top of the stomach using surgical staples. It is then connected directly to the lower part of the small intestine. After surgery, food bypasses the rest of the stomach and the upper portion of the small intestine. The procedure takes 2 hours to complete. 

2. Sleeve Gastrectomy: The surgeon makes five minor cuts in the abdomen to remove 80% of the stomach. The sleeved-shaped stomach reduces the amount of food eaten at once. Bariatric sleeve surgery takes 1-3 hours. 

3. Adjustable Gastric Banding (Lap-Band): A silicone band is placed around the upper stomach. A port connected to the band allows for adjustment. The port inflates the band, which tightens like a belt to create two smaller sections. This restricts food intake. The complete procedure takes 3-4 hours. 

4. Biliopancreatic Diversion With Duodenal Switch (BPD/DS): It combines both gastric sleeve and gastric bypass. In this procedure, 75% of the small intestine is bypassed. This significantly reduces the absorption of nutrients and calories and limits food intake.

Note: The selection of treatment approach is based on the patient’s condition and the doctor’s opinion. 

Patients can also opt for less invasive alternatives to bariatric surgery. These techniques are performed using an endoscope inserted through the mouth and into the stomach. The following are two common procedures for weight management:

1. Intragastric Ballooning: It involves placing a silicone balloon inside the stomach to occupy space and promote a feeling of fullness. The balloon is left in place for six months before being removed. It can help lose up to 15% of the patient’s body weight. 

2. Endoscopic Sleeve Gastroplasty: During this procedure, a series of sutures are placed in the stomach to reduce its size by 70%. It helps patients lose up to 20% of their body weight.

After weight loss surgery, recovery and post-operative care are critical to achieving long-term success. The following is what patients can expect during the recovery phase:

In Hospital Recovery 

Depending on the type of surgery, patients may be hospitalised for 1 to 3 days. During this time, they are monitored for any complications. 

1. After surgery, the patient is shifted to the recovery room. The nurse monitors their breathing, heart rate, and blood pressure. 

2. Once their condition stabilises, they are moved to a general ward. 

3. The doctor prescribes antibiotics to prevent infections and pain relief medications for discomfort. 

At-home Recovery 

Patients can return to their normal activities 4 to 6 weeks after discharge. During this time, it is important to follow these instructions: 

1. Diet: Adhering to portion control is vital to avoid regaining weight and to support nutritional health.

1. For the first two weeks, patients will follow a liquid diet (like thin soup). 

2. During weeks 3 and 4, they will transition to pureed foods like yoghurt. 

3. They can eat soft foods like mashed potatoes during weeks 5 to 8. 

4. A gradual return to a balanced diet can be achieved after week 8. 

2. Hydration: Staying hydrated is crucial to avoid nausea and vomiting. However, it is important to sip small amounts of fluids throughout the day to avoid filling the stomach too quickly. It is recommended that patients drink 1.5 to 2 litres of water every day. 

3. Wound Care: It includes keeping the area clean and dry. Patients should look for signs of infection, such as redness, swelling, or discharge.

4. Physical Activity: Walking is highly recommended to improve circulation and promote healing. However, patients should avoid strenuous activities and heavy lifting for six weeks after surgery. 

Follow-Up Appointment

The first follow-up appointment will be scheduled with the healthcare team two to three weeks after the surgery. After the initial visit, regular check-ups will be scheduled at three, six, nine, and twelve months post-operation. The patient will continue to see their doctor for annual check-ups after the first year. 

These visits with the surgical team are vital to monitoring recovery and addressing any concerns or complications that may arise. The doctor may recommend laboratory tests, blood work, and other assessments. 

The procedure can offer various benefits for individuals with obesity. However, like any major operation, certain risks and complications can occur. The bariatric surgery side effects can range from short-term issues to long-term challenges. 

Short-term Risks

1. Infection 

2. Blood clots 

3. Bleeding 

4. Adverse reactions to anaesthesia 

5. Breathing problems 

Long-term Risks

1. Malnutrition

2. Gallstones

3. Hernias

4. Bowel obstruction 

5. Dumping syndrome (food passes too quickly from the stomach to the small intestine) 

When to consult a doctor?

After bariatric surgery, it is important to know when certain symptoms or changes in the patient’s condition warrant a call to the doctor. Here are situations when reaching out to the healthcare provider is advised:

1. Fever above 101°F

2. Increased swelling, redness, or discharge from the surgical incision sites 

3. Shortness of breath or chest pain 

4. Nausea or vomiting for more than 12 hours 

5. Unable to urinate for eight hours 

6. Persistent pain that does not improve with medication 

Delaying bariatric surgery can have several risks and implications for individuals struggling with severe obesity. This is especially true when a doctor recommends the procedure for medical reasons. These risks include:

1. The pain and social stigma associated with obesity can impact mental health. It leads to depression, anxiety, and a reduced quality of life.

2. Postponing the procedure can increase the severity of conditions such as arthritis and joint pain. It can impact a patient’s ability to exercise and maintain mobility. 

3. The risk associated with other obesity-related diseases is likely to increase with a delay in weight loss surgery. These may include cardiovascular disease, dyslipidemia (abnormal cholesterol levels), and diabetes. 

Cost of Bariatric Surgery 

The bariatric surgery cost in India can differ depending on several factors. It generally ranges between ₹ 2,20,000 to ₹ 6,00,000. The average price of the procedure is ₹ 3,50,000. 

Note: These figures are approximate. Patients are advised to consult HexaHealth experts for the most current expenses. 

Factors that influence the cost of weight loss surgery include: 

1. Type of Surgery: Different bariatric procedures have varying costs. For example, gastric bypass is costlier than adjustable gastric banding due to its complexity and the technology used. 

2. Surgeon’s Fees: Medical specialists with extensive experience or high success rates in performing weight loss procedures may charge more for their services.

3. Type of Hospital: The expenses are higher in private facilities than in government centres. Moreover, super-speciality hospitals charge more than small clinics due to the amenities offered. 

4. Location: Costs are higher in metropolitan cities and urban areas based on regional economic factors. 

5. Health Coverage: Insurance that covers bariatric surgery can reduce the financial burden on the patient.

Bariatric surgery offers a life-changing solution for individuals with severe obesity. It provides significant weight loss and improvement in obesity-related health conditions. The procedure requires a commitment to lifelong changes in diet and lifestyle to maintain the benefits.

Knowing bariatric surgery before and after results can help you understand its potential. HexaHealth is dedicated to supporting patients through this process, offering expert guidance, comprehensive care, and personalised support. From initial consultation through surgery and beyond, we ensure you achieve and sustain your health goals.

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