Bariatric Surgical Procedures
Bariatric surgical procedures are carried out on two basic principles. The first is restrictive interventions in which food intake is restricted/the stomach reservoir is reduced (restrictive); The second is malabsorptive interventions that cause absorption defects other than restriction of food intake.
Apart from these procedures, some initiatives contain two basic principles together; these are called “combined” initiatives.
Applications in which gastric volume is restricted
- Gastric balloon
Gastric balloon is an application performed endoscopically without the need for general anesthesia. In this method, a balloon with certain features for medical application is placed into the stomach endoscopically and then inflated. In this way, a volume restriction is provided in the stomach and thus excessive food intake is prevented.
- Adjustable Gastric Band
Adjustable gastric band is one of the bariatric methods that is not preferred much nowadays, while it was preferred more in the 1990s.
- Sleeve Gastrectomy
Sleeve gastrectomy surgery which is applied minimally invasive involves cutting the stomach vertically with the help of a technological tool that works with the stapling technique and creating a narrow gastric sleeve. In this procedure, the fundus and great curve of the stomach are removed.
There is evidence that there is variability in neural and endocrine signaling pathways that affect feeding behaviors, appetite, satiety and energy intake after this application.
- Vertical Band Gastroplasty
This procedure of bariatric surgery is not a very preferred type. The front and back parts of the stomach are fastened together with staples, and a ring is attached to the end of this connection to prevent the stomach from expanding.
- Biliopancreatic Diversion
With the biliopancreatic method, it is aimed to disrupt the absorption of fat and carbohydrates. Two-thirds of the stomach is removed and the remaining stomach is connected to the middle of the intestine.
- Duedonal Switch
Another alternative method to the BPD method is the duodenal switch method. Vertical gastrectomy is performed instead of distal gastrectomy with DS. Most of the stomach is removed, the small intestine is divided and one end is joined to the stomach. The food coming into the stomach goes directly into the intestine. Absorption is aimed with the digestive enzymes secreted from the stomach and pancreas.
Combined (restrictive and malabsorptive) bariatric procedures
Roux-En-Ygastric Bypass (RYGB)
In this procedure, a small gastric pouch is created to keep the stomach and the rest of the duodenum away from food. The length of the bypassed small intestine can be varied to increase or decrease the amount of malabsorptive component. Despite the proven success of Roux-N-Y Gastric Bypass, there are many complication risks.