Understanding Bariatric Surgery: Procedures, Outcomes, and Care
This podcast delves into the fundamentals of bariatric surgery, exploring four major procedures—gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass, and duodenal switch. Learn about patient considerations, surgical impacts, and the importance of postoperative care for long-term success. Transcript [00:00] Hello and welcome back once again to Surgery 101, the podcast series brought to you with the help of the Department of Surgery at the University of Alberta. This is Jonathan White broadcasting to you [00:20] live from the Royal Alexandra Hospital in Edmonton, Alberta. This week’s episode is number 3 in a series on bariatric surgery and obesity, brought to us by medical student Julie La, who is visiting on a surgical educational active from McMaster University. In this episode, Julie will be getting to the main topic, the bariatric surgery [00:40] itself she’ll be giving a brief overview of the four main procedures, the gastric band, the gastric bypass, the sleeve gastrectomy and the juillenal switch. So let’s get ready to get all the way up into bariatric surgery itself here on surgery 101. [01:00] Hi everyone, my name is Julie Law and I’m a third and final year medical agent. [01:20] Student at McMaster University in Hamilton, Ontario. This podcast was written and produced with guidance and support from Jenny Marshall, program assistant in digital education, and Dr. Jonathan White, general surgeon at the University of Alberta, creator of Surgery 101. The expert content reviewers were Dr. Alia Kanji, bariatric surgeon at the University of Alberta, and Dr. Renika Moti, [01:40] assistant clinical professor in the Department of Family Medicine at the University of Alberta, and medical lead for the Edmonton Adult Bariatric Clinic. The topic of today’s podcast is surgical options for the management of obesity. By the end of this episode, you should be able to describe various types of bariatric surgery, including the adjustable gastric band, [02:00] sleeve gastrectomy, row and wide gastric bypass, and the duodenal switch. Let’s start by reviewing the NIH [02:20] guidelines for bariatric surgery. 1. Age 18 to 64 2. BMI greater than 40 or BMI greater than 35 with comorbidities such as type 2 diabetes, cardiovascular heart disease, severe obstructive sleep apnea, or GERD. 3. Some contraindications include current [02:40] substance dependency, recent major cancer, untreated psychiatric illness, diseases that would make you ineligible for any surgery, if you are pregnant, have cirrhosis, or chronic pancreatitis. Most bariatric surgery is performed by general surgeons with subspecialty training in minimally invasive surgery and bariatrics. [03:00] Bariatric surgery has been evolving since the 1950s. Many groups around the world recognized obesity as a medical issue and began to try various ways to reduce the size of the stomach, the concept of restrictive surgery, rearrange the intestines to facilitate malabsorption, and then eventually a combination of both. As we learn more about [03:20] how and why bariatric surgery works, we are learning that there are a number of gut hormones that are involved in augmenting weight loss in these procedures. These procedures, while initially done open, are now almost exclusively performed laparoscopically. In Canada, bariatric surgery is covered by our Public Health Plan, which is decided upon provincially. [03:40] With that, there is variation in procedures that are covered. In Ontario, where I’m from, the Ministry of Health funds three types of bariatric surgery, all of which are done laparoscopically. The Roux-en-Y gastric bypass, the vertical sleeve gastrectomy, and the duodenal switch. In Alberta, the duodenal switch is not yet performed, but the adjustable gastric bandage. [04:00] is. Now to review the steps in anatomy of bariatric surgery. These can be tricky to follow. Honestly, reading them in textbooks repeatedly was even difficult to follow. I hope that I’ve simplified things and the slides that we provided will be a helpful tool. This might be a section that needs a few listens. [04:20] The first procedure I’ll discuss is the adjustable gastric band. The gastric band was initially approved by the FDA in 2000. Since then, hundreds of thousands of these bands were placed around the world. The principle behind this procedure is the placement of a foreign body, the adjustable gastric band around the proximal [04:40] stomach. This is then connected via tubing to a port that sits on the fascia below the skin. The port can then be accessed to inflate the band with saline or deflate the band removing saline. The adjustment is to allow for more or less restriction. The band was initially a very attractive weight loss procedure as it is minimally invasive, adjustable, and [05:00] completely reversible. Unfortunately with it were many complications that led to a large number of these bands being removed. Next the components of the Roux-en-Y gastric bypass. This procedure includes the pouch, [05:20] which is a small segment of the stomach that is stapled off. It acts as the new gastric reservoir with a much smaller volume. This will help decrease overall intake and increase the sense of satiety or fullness. Next is the bypass part, where a distal portion of the small intestine, the jejunum, is divided and then attached to the gastric pressure. [05:40] pouch. This is called a gastrostomach to jejunum jejunostomy. This is the new pathway that food will travel and it’s called the Roo Lim. Recall the physiology of obesity. One simple way to look at it is energy in versus energy out. Using a distal portion of the small intestine will [06:00] result in bypassing a large absorptial surface, decreasing the amount of energy in. Okay, now about 100 to 150 cm downstream from this new connection, the proximal aspect of the jejunum from your division is connected to a downstream part of your small intestine. Remember, this connection goes [06:20] from the bottom part of your stomach, the distal stomach, from where the pouch was stapled off, all the way down to the proximal jejunum. But as you might notice, there’s an important area stuck between the stomach and the jejunum, the duodenum.