Bariatric surgery: what it is, who can do it and main types

Bariatric surgery is a type of surgery in which the digestive system is altered in order to decrease the amount of food tolerated by the stomach or to modify the natural digestion process, in order to drastically reduce the amount of calories absorbed, facilitating the loss of weight.

Because it is a type of surgery that, in most cases, is very invasive, bariatric surgery is usually only indicated as a form of treatment when the person has already tried other forms of treatment but without the expected results, or when overweight puts life at risk.

Thus, before having such a surgery, everyone must undergo a rigorous medical evaluation with a multidisciplinary team comprised of a surgeon, a nutritionist, a psychologist, a cardiologist and other medical specialties.

Who can do the surgery

Bariatric surgery is usually indicated for people with obesity above grade II who have not shown results after several months of treatment with an adequate diet and regular exercise.

This surgery is usually only indicated for people aged between 16 and 65 years and is only indicated by the Ministry of Health of Brazil in cases of:

• BMI equal to or greater than 50 kg / m²; BMI equal to or greater than 40 kg / m², without weight loss even with proven medical and nutritional monitoring for at least 2 years; BMI equal to or greater than 35 kg / m² and presence of other diseases of high cardiovascular risk, such as high blood pressure, uncontrolled diabetes and high cholesterol.

At the same time, the Ministry of Health also indicates some cases in which bariatric surgery is discouraged and which include: having an uncontrolled psychiatric disorder, including the use of drugs and alcoholic beverages; having severe and decompensated heart or lung disease; having portal hypertension with esophageal varices; have inflammatory diseases of the upper digestive tract or suffer from Cushing's syndrome due to cancer.

Watch the following video and check the conditions under which the surgery can be performed:

Main advantages

In addition to significant weight loss, bariatric surgery also brings benefits related to diseases associated with obesity, with improvement and cure of diseases such as:

• Arterial hypertension; Heart failure; Respiratory failure; Asthma; Diabetes; High cholesterol.

This type of surgery is also often associated with other social and psychological advantages, such as decreased risk of depression and increased self-esteem, social interaction and physical mobility.

Types of bariatric surgery

The type of surgery should be chosen together with the doctor, according to the person's clinical conditions and preferences. These surgeries can be done with the normal cut in the abdomen or by videolaparoscopy, where only small cuts are made during the operation:

1. Gastric band

This is the least invasive type of bariatric surgery and consists of placing a band, in the shape of a ring, around the stomach, so that it decreases in size, contributing to a lower intake of food and calories.

Usually, this type of surgery presents less health risks and has a faster recovery time, but its results may be less satisfactory than other techniques. Learn more about gastric band placement.

2. Gastric bypass

Bypass is an invasive surgery in which the doctor removes a large part of the stomach and then connects the beginning of the intestine to the remaining portion of the stomach, reducing the space available for food and reducing the amount of calories absorbed.

This type of surgery has great results, allowing you to lose up to 70% of the initial weight, however it also has more risks and a slower recovery. Understand better how gastric bypass is done.

3. Vertical gastrectomy

Unlike gastric bypass , in this type of surgery, which can also be known as " sleeve surgery", the surgeon maintains the natural connection of the stomach to the intestine, removing only part of the stomach to make it smaller than normal, reducing the amount of calories ingested.

This surgery has fewer risks than the bypass , but it also has less satisfactory results, allowing to lose about 40% of the initial weight, being similar to the gastric band. See how this type of surgery is done.

4. Biliopancreatic shunt

In this surgery, part of the stomach and most of the small intestine are removed, which are the main region where nutrient absorption occurs. In this way, a large part of the food is not digested or absorbed, reducing the amount of calories in the diet.

However, and although a large part of the small intestine is removed, bile continues to be released in the first piece of the small intestine that is then connected to the most final portion of the small intestine, so that there is no interruption in the flow of bile, even that the food is no longer passing in this most initial part of the small intestine.

Possible risks of surgery

The risks of bariatric surgery are mainly linked to the number and severity of diseases associated with obesity, the main complications being:

• Pulmonary embolism, which is the clogging of a blood vessel in the lung, causing severe pain and difficulty breathing; Internal bleeding at the operation site; Fistulas, which are small pockets that form at the internal points of the operated region; Vomiting, diarrhea and feces with blood.

These complications usually arise during the hospital stay, and are quickly resolved by the medical team. However, depending on the severity of the symptoms, it may be necessary to perform a new operation to correct the problem.

In addition, it is common that after bariatric surgery, patients have nutritional complications such as anemia, folic acid, calcium and vitamin B12 deficiency, and malnutrition may also occur in the most severe cases.

To have a faster recovery and less complications, see what food should be after bariatric surgery.