What is Bariatric / Metabolic Surgery?

Definition

Bariatric surgery is defined as “surgical procedures performed on the stomach or intestines to induce weight loss”.

Historical perspective

Surgeons first began to recognize the potential for surgical weight loss while performing operations that required the removal of large segments of a patient’s stomach and intestine.

After the surgery, doctors noticed that in many cases patients were unable to maintain their pre-surgical weight.

With further study, surgeons were able to recommend similar modifications that could be safely used to produce weight loss in morbidly obese patients.

Experiments were done in the last half of the 20th century to see if diseases like high lipids and cholesterol could be treated with surgical procedures such as intestinal bypass.

In 1995, Dr. Walter Pories and his research team published an article titled “Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus”. Since that landmark paper, much evidence has been accumulated showing that bariatric surgery can cure/improve several metabolic diseases, especially adult onset or Type 2 diabetes mellitus.

In 2009 the American Society for Bariatric Surgery (ASBS) changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS) to promote information on the beneficial effects of surgeries for weight loss in treating metabolic diseases, especially Type 2 Diabetes Mellitus (T2DM).

Today, the term Metabolic Surgery is used to describe surgical procedures to treat metabolic diseases, especially, type 2 diabetes.

The best-known metabolic surgery is the Gastric Bypass with over 50 years of experience with this procedure. Other established procedures are the Vertical Sleeve Gastrectomy and the Biliopancreatic Diversion with or without Duodenal Switch.

These hese procedures have been continually refined in order to improve results and minimize the risks.

Today’s bariatric surgeons have access to a substantial body of clinical data to help them determine which surgeries should be used and why.

Click here for  a comparative summary of the various procedures.

How does bariatric/metabolic surgery help loose weight and keep it off?

In order for a person with morbid obesity to achieve significant long-term weight loss, the body’s weight regulation system must be reset so that the body will stop storing excess fat.

Bariatric/metabolic surgery modifies your set point. By altering the complex relationship your body has with food and its metabolism, bariatric surgery helps reset your body’s ability to effectively manage weight.

By altering the anatomy of the stomach and/or intestine, these surgeries affect hormonal signals, resulting in decreased appetite, increased feelings of fullness, increased metabolism, and healthier food preferences. These positive changes allow your body to lose weight without the internal fight to return to the higher set point.

Without the hormonal changes and alteration of the “set point” that bariatric surgery provides, many patients with severe obesity are not successful in managing their weight and related health conditions by diet alone.

What is the difference between “Open” and “Laparoscopic” bariatric surgery

Bariatric surgery that was first started in the 1950’s was performed by open or conventional approach of a cut right down the middle of the belly as shown in the figure below (left).

This often resulted in a debilitating infection in the cut, which took months to heal (middle).

One third of patients developed an incisional hernia, a medical term for a large defect in their abdominal wall that allowed the intestines to leave the abdomen and emerge just under the skin (right).

This hernia is very difficult to repair, even by the most experienced general surgeons

midline incision wound infection hernia

To avoid this devastating complication, surgeons begun using the minimally invasive or laparoscopic approach since the late 1990’s. When a laparoscopic operation is performed, a small video camera is inserted into the abdomen. The surgeon views the procedure on a separate video monitor. The camera and surgical instruments are inserted through small incisions made in the abdominal wall (left picture below).

This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. The patient is left with 5 small (less than 1 cm) cuts that heal quickly and minimize pain (right picture below)

Our founding bariatric surgeon Dr. Nicolas Christou, performed the first elective laparoscopic gastric bypass in Canada at the McGill University Health Center in Montreal on February 8th 2002. Our first patient is shown here on the morning after her surgery (left), at 3 years after her surgery (center) and after 10 years (right).