Overview
Bariatric surgery is also referred to as weight loss surgery and metabolic surgery. It is the recommended treatment for people with morbid obesity (men who are at least 100 lbs overweight or women who are at least 80 lbs overweight) in which the BMI is 40 or more.
It can also be recommended if you have a BMI of 35 with obesity-related health risks such as diabetes or arthritis.
The aim of bariatric surgery is to lower the weight significantly in order that health risks of obesity such as type 2 diabetes, high blood pressure, and sleep apnea are minimized.
Weight loss surgery significantly reduces the chances of dying prematurely from obesity-related health risks. Obesity is one of the leading causes of premature deaths in young people.
According to Harvard School, every 5 units increase in BMI above 25 kg/m2 raised your risk of premature death by about 31%.
There are various weight loss surgeries but gastric bypass surgery is the most frequently performed because it poses lesser complications.
It can provide you with sustained loss weight only if you are consistent in your healthy eating habits and exercise on a regular basis.
Eligibility for bariatric surgeries
You become eligible for weight loss surgery if you fulfill the following criteria.
- You are morbidly obese. That is you have a BMI of 40 or more. Or the excess weight is 100 lbs more than what your weight should be in men and 80 lbs in women.
- You have a BMI between 30 to 40 along with anyone obesity health risks such as diabetes, high cholesterol, high blood pressure, sleep apnea, etc.
- Have religiously tried to lose weight by dietary means and exercises, but failed.
- Have understood and are ready to accept the risks associated with bariatric surgery.
- You are judged too risky for the more invasive gastric bypass surgery due to some underlying health problems.
Types of weight loss surgeries
After having decided to go in for weight loss surgery, your doctor has to decide which type of weight loss surgery is best for you. His decision will be based on the following factors:
- The preference of your bariatric surgeon,
- Your choice of aim – how much weight you want to lose,
- The current status of your health vis-a-vis the complications of obesity, and
- Which surgery is covered by your insurance
There are three types of weight loss surgeries:
- Restrictive weight loss surgery
- Malabsorptive weight loss surgery
- Combination of restrictive and malabsorptive weight loss surgery
1. Restrictive weight loss surgery
This type of bariatric surgery involves restricting the size of the stomach, which can be available for the food that you eat, and slowing down the passage of food.
As a result, you eat less because the capacity of the stomach is considerably reduced from the normal of three pints to two to three ounces. The lap band surgery and the vertical banded gastroplasty are restrictive weight loss surgeries.
- Adjustable gastric banding procedure (LAP-BAND and REALIZE BAND) surgery is carried out using a laparoscope with a video attachment. The lap band surgeon uses an inflatable band to squeeze the stomach into two pouches, the smaller upper pouch and a larger lower pouch connected by a very narrow passage. This restricts the amount of food you can eat at one time and also slows down the passage of food through the stomach.
- Vertical banded gastroplasty. This surgery involves the use of a band as well as staples to divide the stomach into two pouches. Since other surgeries give better results, this surgery has become obsolete.
- Vertical sleeve gastrectomy (VSG) has been recently devised. This surgery is performed using a laparoscope and involves the removable of about 75% of the stomach in a vertical plane. As a result, what remains of the stomach is a small sleeve or tube which connects to the intestine. Sometimes this surgery may be sufficient to give the desired results, but at times a follow-up surgery may be required, which can either be a gastric bypass or biliopancreatic diversion.
2. Malabsorptive weight loss surgery
This type of bariatric surgery does not limit food intake but involves surgical removal of part of the digestive tract so that the body’s ability to absorb calories and nutrients is reduced.
The use of these surgeries is now very restricted because of the nutritional deficiencies they cause. The Biliopancreatic Diversion and Extended (Distal) Roux-en-Y Gastric Bypass procedures are malabsorptive weight loss surgeries.
3. Combination of Restrictive and Malabsorptive Surgery
In this type of bariatric surgery, part of the stomach is resected along with bypassing part of the intestines. This is the most successful and is now widely followed. The Roux-en-Y gastric bypass is a combination of restrictive and malabsorptive bariatric surgery.
About weight loss surgeries
Before going for the surgery, you will want to clear a few doubts about the surgeon, hospital stay, and some discharge from the hospital.
Choosing a Bariatric surgeon
It is necessary to do thorough research on the surgeon and the weight loss surgery center before you finalize. The qualifications and the experience of the surgeon have to be considered first giving his fees last priority.
A surgeon may charge more because he is good and people are ready to pay him more because his success rates are high. Keep this in mind when making a choice.
Here are some tips to choose a bariatric surgeon:
- Does the bariatric surgeon offer different surgical options?
- Will he use a minimally invasive approach?
- Will the surgery be performed at a Bariatric Center of Excellence that is accredited by the SRC and provide the gold standard in bariatric care?
- What experience and testimonials do the surgeon and his team have?
- What kind of pre and post-operative support is available?
- Is the surgeon attentive to your concerns and do you feel comfortable talking to him?
Duration of surgery
The surgery duration depends on the surgeon and the condition of the patient. But normal parameters are given below.
- Adjustable band surgery performed through the laparoscope normally takes about an hour.
- Open Gastric bypass surgery may take 3 to 4 hours. Gastric bypass done through the laparoscope may take double the time.
Hospital stay for bariatric surgery
- Bariatric surgery performed through a laparoscope requires a hospital stay of about one to two days. You may be discharged on the same day if you have shown good post-operative recovery.
- Open bariatric surgery may require a hospital stay of about 5 to 8 days.
Conditions for discharge from the hospital
- You have no fever
- You can take fluids and nutrients orally
- Pain is controlled with medicines
- Complications of obesity, if any, are controlled.
Risks
As with any major surgery, bariatric surgery comes with potential short-term and long-term health complications.
Short-term risks associated with bariatric surgery can include:
- Excessive bleeding
- Infection
- Side effects due to anesthesia
- Blood clots
- Leaks in your gastrointestinal system
- Rarely, death may occur on the operation table
Long-term risks and complications can include:
- Bowel obstruction
- Dumping syndrome
- Gallstones
- Hernia
- Hypoglycemia
- Malnutrition
- Ulcers
- GERD
- Rarely death
Cost of bariatric surgery
Bariatric surgery for weight loss is performed to reduce weight and it can be pretty expensive. Depending on the choice or type of bariatric surgery, surgery costs differ. Even for the same weight loss surgery, operation costs differ.
Costs of bariatric surgery include various expenses and the cost differ due to varying factors. Various options for undergoing the surgery are available in the U.S. and outside the U.S. Read them below.
Factors on which bariatric costs depend
- On the type of bariatric surgery. A gastric bypass surgery will cost more than an adjustable lap band surgery.
- On the hospital chosen. A bigger hospital with additional facilities will cost more.
- On the operating surgeon. The cost of surgery by itself varies from surgeon to surgeon because of varying qualifications and experience.
- Type of anesthesia
- Patients’ condition
- Medicines and drugs used
- Complications of obesity present in the patient. Complications, if present, will require additional expenses to be treated.
- Follow up care
- Cosmetic surgery after weight loss surgery, if the patient chooses to have one.
- The cost of surgery also depends on the geographic location – an urban area will cost more than a semi-urban one.
Bariatric surgery cost break up
Bariatric surgery rates vary between U.S. $15,000 to $40,000 and involve the following:
- Hospital charges, which include room charges and operation theatre charges.
- Pathology and radiology charges for pathology investigations and imaging tests.
- Surgeon’s fees for the surgery
- Anesthetist’s fees for the anesthesia given during surgery
Some facilities will quote a composite cost, while in some cases a surgeon will quote his operation fees and the rest of the charges will have to be paid separately.
- LAP-BAND Surgery Cost. LAP-BAND Surgery Cost varies from $17,000 to $ 30,000.
- Gastric Bypass Surgery Cost. The cost of a Gastric Bypass procedure ranges from $18,000 to $35,000.
These are figures for the United States. These figures mentioned above cover all the costs except that of cosmetic surgery for loose skin and flab, post-operative counseling for diet, exercise, behavior modification therapy, and post-operative nutritional supplements.
Options for Bariatric surgery outside the US
In recent years, many countries have come up as medical tourism destinations. they offer high-quality facilities are offered at lower prices. For instance, the cost of weight loss surgery in the United States is around $20,000 whereas the price of bariatric surgery in Mexico begins from $4,395.
Other countries that offer good facilities at more reasonable prices include:
- Latin American countries like Mexico, Costa Rica, and Brazil.
- Asian countries like India and Thailand.
- European countries like Belgium, Italy, Sweden, and Switzerland.
- Canada and Australia.
These countries offer good options outside the US where the cost of bariatric surgery is anywhere between 40% to 70% less than in the United States.
The disadvantage may be that your insurance in the US does not cover these foreign options. In that case, foreign options for bariatric surgery may be for those who are not covered by insurance for this surgery.
Added costs for foreign options are traveling and staying expenses of yourself and one companion till follow-up considerations after surgery are completed.
Closing Advice.
Weight loss surgery or bariatric surgery is not a cure for obesity. It helps you in taking that first step in getting rid of excess weight. You have to be committed to eating a low-calorie healthy diet, exercising regularly, and preserving healthy lifestyle habits on a consistent basis.
