Bariatric surgery

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Introduction

Surgery as a treatment for obesity

For many obese patients, diets and lifestlye changes do not work in long term. Bariatric surgery has proved to be the only effective method in the long term treatment of obesity.

How surgery works

Bariatric surgery works by altering the anatomy of the gastrointestinal tract: limiting the volume of food the stomach can hold, interfering with the absorption of calories, and by interfering with orexigenic and anorexigenic signalling between the gut, adipose tissues and the brain.

Bariatric Surgical Procedures

Restrictive Surgery

Restrictive surgery reduces the size of the stomach causing decreased hunger and an increased satiety following ingestion of smaller amounts of food. Surgical procedures include gastric banding, where an adjustable band is clipped just below the cardia of the stomach creating a small gastric pouch above(kerrigan, le roux). Other forms of restrictive surgery includes gastroplasty and sleeve gasrectomy.

Malabsorptive Surgery

Jejuno-ileal bypass, duodenojejunal bypass and biolopancreatic bypass (with or without duodenal switch)

Combination Surgery

Combination surgery combines the benefits of both restrictive and restrictive surgery. The most common bariatric procedure in the US is the Roux-en-Y Gastric Bypass (RYGP).

Duodenal switch

Surgical Effects Regarding Gut Hormones

Hindgut Hormones

Peptide YY

Glucagon-like peptide-1

Midgut Hormones

Neurotensin

Foregut Hormones

Ghrelin, Cholecystokinin, Gastrin