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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