Bariatric Surgery: Helping Adults Lose Weight and Lead Healthier Lives
The bariatric surgery team at Health City Cayman Islands is committed to helping patients overcome chronic obesity and the many serious health risks it poses. Your initial consultation is an introductory meeting in which our experienced bariatric surgeons will answer all of your medical and personal questions. We provide an individualized, patient-focused bariatric surgery program that large general hospitals cannot offer, utilising the latest minimally invasive techniques. We have helped many patients lose weight, improve their nutrition, and lead healthier, happier lives.
Bariatric surgical procedures cause weight loss by:
- Restricting the amount of food the stomach can hold
- Causing mal-absorption of nutrients
- Utilising a combination of both food restriction and mal-absorption
- Triggering a change in a key gastrointestinal hormone
Bariatric Surgery Requirements
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify adults as overweight or obese. BMI is as a person's weight in kilograms divided by the square of his height in meters (kg/m2). Although obesity is classified as a BMI greater than or equal to 30, there are specific qualifications one must meet to be considered a candidate for bariatric surgery, including:
- BMI ≥ 40, or more than 100 pounds overweight for men and 80 pounds for women.
- BMI ≥35 and at least two obesity-related co-morbidities such as type 2 diabetes, hypertension, sleep apnea or other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
- Inability to achieve and maintain a healthy weight through prior weight loss efforts.
- Failure of all other physician-supervised weight loss treatment options.
Types of Procedures
The most common bariatric surgery procedures are Roux-en-Y gastric bypass and sleeve gastrectomy. At Health City Cayman Islands, our surgeons can perform these laparoscopically, which means making one or several very small incisions in the abdomen, rather than a major surgical incision. Utilizing minimally invasive surgical techniques leads to faster recovery and less risk of complications for our patients.
Roux-en-Y gastric bypass (also known as gastric bypass)
This is considered the “gold standard” of weight loss surgery. It is the most commonly performed bariatric procedure worldwide and has been in existence for the last 50 years, albeit with less sophisticated methodologies than currently used. In gastric bypass surgery, a large section of the stomach is stapled off, creating a very small pouch which connects to the small intestine. The pouch can only hold a few ounces of food at a time, so patients cannot eat as much as they did prior to surgery and feel satiated quickly. The food bypasses part of the intestine so some of the nutrients and calories in food are not absorbed. The rerouting of the food also decreases production of a gastrointestinal hormone called ghrelin, thereby helping to promote satiety, suppress hunger, and reverse one of the primary mechanisms in which obesity induces type 2 diabetes.
Sleeve gastrectomy
This procedure, which is usually performed laparoscopically, involves removing about 75% of the stomach, resulting in a tube or sleeve-like stomach which holds far less food. Originally, sleeve gastrectomy was performed as the first stage of a two-stage procedure for morbidly obese or high-risk patients, followed by gastric bypass 12 to 18 months later. Now, it is frequently performed as the sole procedure in patients with a BMI of 40 or higher. Removing a portion of the stomach decreases the level of the peptide hormone ghrelin (also known as the hunger hormone) in the gastrointestinal tract. Many patients not only feel far less hungry, but since the hormone is tied to blood sugar metabolism, patients with type II diabetes often experience an immediate decrease in the need for medications. Unlike the adjustable gastric band and the gastric bypass, the sleeve gastrectomy is permanent and cannot be reversed.
Endoscopic Intragastric Balloon Procedure
A less invasive and temporary option for individuals seeking medical intervention to assist with health-related weight loss is the endoscopic intragastric balloon.
The intragastric balloon is a silicone device that occupies a partial space in the stomach, and assists the ingestion of a smaller quantity of food, changing the eating habits. The intragastric balloon is a non-surgical treatment for obesity that must be performed by a fully-trained physician and involve a multidisciplinary team.
The intragastric balloon assists weight loss as part of a treatment that includes the change of habits, in order to have a long-lasting weight loss.
This option is best suited for patients with a Body Mass Index (BMI) of 30 to 40, who do not fit the criteria for traditional bariatric surgery. It is most often used an induction for weight loss in patients whose obesity is not severe enough for surgical indication and who have not lost weight when undergoing traditional treatments.
The intragastric balloon may also be used as a pre-surgical treatment for the reduction of body weight and surgical risk in obese patients with Body Mass Index (BMI) above 40kg/m².
The procedure is endoscopic and takes just 15 to 20 minutes, during which the intragastric balloon is placed into the stomach under endoscopic guidance.
The balloon device is ready made to be inflated with 600 ml to 700 ml of solution, and will occupy 40 percent of the total stomach volume.
Weight loss of 15 percent of total body weight is expected over a six-month period. When combined with diet and exercise, weight loss of up to 30 percent of total body weight can be achieved.
Consultation with a registered dietician is mandatory prior to undergoing the procedure, to ensure compliance with dietary requirements and to facilitate optimal health and nutrition for the patient.
The procedure usually requires a one-day admission, with intake in the morning following fasting. The vast majority of patients – 90 percent – can be discharged in the evening of the same day, following observation. About 10 percent of patients may require overnight observation.
Since the procedure is conducted under either conscious sedation or brief general anesthesia, medical observation following the procedure is mandatory.
Side effects of nausea, vomiting and a feeling of fullness of the stomach are seen in less than five percent of patients.
A Viable and Effective Treatment Option
As with all major surgeries, bariatric procedures involve the risk of serious complications, but in carefully selected, morbidly-obese patients, they are considered a very effective treatment option. The many health risks associated with morbid obesity often far outweigh the small chance of a negative surgical outcome. Recent studies have demonstrated that up to 80% of excess body weight can be lost, and 95% of co-morbidities (diseases related to obesity) can be controlled or reversed. Long-term success requires lifelong compliance of dietary habits, nutritional guidelines, and exercise – working with a multidisciplinary bariatric team.
Minimally-Invasive Weight Loss Surgery Benefits
- Small incisions (most less than 1/2 inch)
- Shorter hospital stay of 2 to 3 days
- Return to work in 2 to 3 weeks
- Decreased risk of infection
- Less postsurgical pain
- Decreased risk of hernias
