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Bariatric Surgery
 
Weight-Loss Laparoscopic Surgery
 
  • Are you a candidate for weight-loss surgery?
    If you are severely obese (over weight), i.e. body mass index (BMI) of 37.5 kg/m2 or more, you are eligible for weight loss surgery to reduce your weight. If your BMI is more than 32.5 kg/m2 with obesity related co-morbidity, such as diabetes mellitus, high blood pressure, high cholesterol level, back pain, and sleep apnea, you can also consider surgery to lose weight.

  • What is weight-loss surgery?
    Weight-loss surgery can be divided into two main categories. The first is restrictive surgery where your stomach’s size is reduced and therefore, less food is allowed to go through, and directly also decreases your appetite. Laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy are representatives of this type of surgery. These procedures tend to provide gentler weight loss with minimal risks of malnutrition.

    The second type is mal-absorptive (reduced absorption of food) procedure, which involves some forms of intestinal bypass to reduce the absorption of food and nutrient. In combination with stomach stapling, the weight loss is good with small risk of malnutrition. The two main procedures in this category are gastric bypass and bilio-pancreatic diversion.

  • Laparoscopic Adjustable Gastric Banding (LAGB)
    LAGB is using an inflatable band placing it around the top of the stomach to control how much food can go through and provide a sense of fullness. It is the safest operation available to achieve weight loss because it does not involve any cutting or stapling of your gastrointestinal tract. It is also fully reversible. The risk of malnutrition is negligible compared to other more invasive operations. This procedure is proven to achieve 50 to 60% of excess weight loss at 2 years.

  • Laparoscopic Sleeve Gastrectomy
    Laparoscopic sleeve gastrectomy makes your stomach smaller and look like a tube. It will reduce your appetite and the amount of food that can go through your stomach. The divided stomach will be removed from your body. However, the gastrointestinal tract remains intact, which will allow endoscopic examination of the remaining stomach should the need arise later. The risk of malnutrition is significantly reduced compared to a gastric bypass procedure.

  • Laparoscopic Gastric Bypass
    This involves making the top of the stomach as small as a golf ball, and bringing a loop of small bowel to connect to this stomach. Two connections need to be created, and food will go directly into the intestine without going through the divided stomach even though the “old stomach” lies in your body. It provides great weight loss in shorter period of times, but it does carry higher operative risks and post-operative mal-nutrition problem. You also need to take vitamin and iron supplements for life.

  • Intragastric Balloon – solution for those who do not want surgery or do not meet the surgery criteria?
    This procedure involves putting a silicone balloon in your stomach. It is round and the surface is smooth. It is inflated with 500 to 700ml of normal saline. It sits in your stomach to reduce what you can eat. It is placed through a gastroscope, which the physician uses to look for any stomach ulcer or tumour. This procedure lasts about 30 mins and requires mild sedation. This is not a surgical procedure, as no cutting or stapling of the stomach is involved. The balloon is temporary, and it has to be removed 6 months after placement. The average weight loss ranges from 15 to 25 kg in the literature. The known complications are gastric ulcer, nausea and vomiting, rupture of stomach (in patients with previous stomach surgery), bowel obstructions, etc.
 
 
 
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