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Bariatric surgery, or weight loss surgery, refers to a variety of surgical procedures for treatment of morbid obesity. Obesity is determined by Body Mass Index or BMI, which is calculated as the ratio of body weight over square of body height. The higher the BMI the higher the extent of obesity. A normal BMI is between 20 and 25. An individual is considered morbidly obese if he or she has a body mass index of 40 or more, or of 35 or more if he or she also has obesity-related health problems such as diabetes, sleep apnea or hypertension. Weight loss is achieved by reducing the size of the stomach. Smaller stomach makes the patient feel full faster and therefore makes it easier to reduce the amount of food intake.
Roux en-Y Gastric bypass, advantages and disadvantages.
This is the most commonly performed bariatric surgical procedure and is considered the gold standard for weight loss treatment. This procedure involves two steps:
- Step 1: the stomach is divided into two parts : one small pouch at the top of the stomach where it is connected to the esophagus , and the rest of the stomach which will be bypassed. The two parts are separated and stapled.
- Step 2: Rerouting of the intestine: the intestine is cut at about 45cm or 18in down from the end of the stomach. The first part of the intestine - the duodenum - will be bypassed. The top end of the second part - the jejunum - is pulled up and connected to the gastric pouch created in step 1. The lower end of the duodenum is reconnected to the jejunum at a lower point. The new configuration has a shape of an Y, hence the name of the procedure.
How weight loss is achieved?
Firstly, the volume of the stomach is now greatly reduced to a small pouch, usually less than 10% of the original volume, which is filled up fast after a small amount of food intake. This sends a signal to the brain that the stomach is full and generates a feeling of fullness or satiety. This helps to reduce the amount of food intake. Secondly, as the first part of the intestine - the duodenum - is bypassed, the amount of nutrition absorbed by the body is greatly reduced. In normal digestion, this is where most of the nutrition is absorbed. Malabsorption contributes to weight loss effect.