Obesity is a chronic
disease that has become a major nutritional health problem in the
industrialized as well as in the developing countries. Worldwide, the number of
overweight children and adolescents is increasing. The prevalence of severe
obesity seems to be increasing at an even higher rate than moderate degrees of
obesity. Bariatric surgery or weight loss surgery is widely accepted as the
treatment of severe obesity. It involves surgical manipulation of the
gastro-intestinal tract to induce long term weight loss. The surgical
procedures are classified as restrictive (reduce intake), malabsorptive (reduce
absorption of food) and combined restrictive/malabsorptive operations. Most
modern bariatric surgery is performed laparoscopically unless it is revisional
or cannot be performed due to technical reasons. The different types of Weight
loss Surgery in Mexico are
Vertical banded gastroplasty (VBG)
It involves construction of a small gastric pouch at the lesser curvature of stomach. The outlet of pouch is restricted with a prosthetic band or mesh. It is a restrictive procedure and weight loss occurs due to calorie restriction.
Laparoscopic adjustable gastric banding (LAGB)
The band is placed around the proximal aspect of the stomach immediately below the gastro-esophageal junction through laparoscopic approach. The gastric band is made of silicone with an inflatable ring on the inner surface which is infused with saline. Band inflation adjustments are done percutaneously by injecting saline through an infusion port in the abdominal wall.
Roux-en-Y gastric bypass (RYGB)
This operation is currently considered the most efficacious operation combining a restrictive and malabsorptive component. It is the most widely performed surgery, representing about 70% to 75% of all bariatric procedures. It is performed using five or six abdominal ports. The gastric (stomach) pouch having a capacity of 15 to 20 ml is constructed below gastro-esophageal junction. Then the proximal (nearer) jejunum is divided. The distal (farther) divided end is attached to the gastric pouch and the proximal end is anastomosed (joined surgically) further down the small intestine. This results in the bypass of food from the gastric pouch to the distal intestine, thereby resulting in reduced absorption of calories.
It has recently become a common and popular operation because of good results and short learning curve of the bariatric surgeon. It is a restrictive operation. In this surgery the greater curvature of the stomach is removed and the stomach is converted into a tube along the lesser curvature. The part of stomach removed is the source of appetite stimulating hormone ‘ghrelin’ which results in reduction of appetite after surgery.
Biliopancreatic diversion (BPD) and duodenal switch
This is a malabsorptive operation in which the small intestine is divided 250 cm short of ileo-caecal junction and a subtotal gastrectomy is done. The distal alimentary limb is connected to the gastric pouch. The proximal limb is connected to the ileum 50 cm proximal to the ileo-caecal junction. The duodenal switch is a modification of the BPD where a sleeve gastrectomy is performed rather than a subtotal gastrectomy. The duodenum is divided immediately beyond the stomach. The alimentary limb is connected to the duodenum and the bilio-pancreatic limb is connected to the ileum 75 cm short of ileo-caecal junction. These procedures may have a role in treating extremely obese patients (BMI > 60 kg/m2).
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