Bariatric Surgery: Types, Benefits, Risks & Recovery

What Is Bariatric Surgery?

Bariatric surgery, often referred to as weight loss surgery, is a medical procedure designed to support people living with severe obesity when traditional methods like diet and exercise have not been enough. These surgeries work by making gentle changes to the digestive system, either by reducing the stomach's capacity to hold food, limiting the absorption of nutrients, or using a combination of both approaches.

Bariatric surgery is not a quick fix — it’s a long-term medical tool that supports lasting weight management, improves overall health, and reduces obesity-related risks. For many, it becomes a positive step toward greater mobility, renewed energy, and a better quality of life.

Who Should Consider Bariatric Surgery?

According to the Obesity and Metabolic Surgery Society of India (OSSI), those who meet one or more of these criteria are considered more suitable candidates for bariatric surgery:

• Individuals with a BMI over 32.5 kg/m² who also have obesity-related health conditions
• Individuals with a BMI above 37.5 kg/m², even if no co-existing conditions are present
• Individuals with a BMI greater than 30 kg/m² who suffer from serious obesity-related disorders, such as uncontrolled diabetes, heart disease, cardiomyopathy, and severe obstructive sleep apnoea
• Candidates who are motivated to lose weight and are willing to adhere to long-term follow-up care
• Individuals who have tried and not succeeded with conventional weight loss methods in the past
• Most candidates are between 18 and 65 years old, although exceptions may be made in special medical circumstances.

Types of Bariatric Surgery

The main types of bariatric surgery performed today include:

1. Gastric Bypass Surgery (Roux-en-Y)

In Roux-en-Y gastric bypass, the surgeon creates a small stomach pouch and connects it directly to the small intestine, bypassing most of the stomach and the upper part of the small intestine. This leads to reduced food intake and decreased calorie and nutrient absorption.

This type of bariatric surgery typically results in significant, long-term weight loss and is especially effective for improving type 2 diabetes. However, it is a more complex procedure and carries a higher risk of nutritional deficiencies if dietary guidelines are not followed.

2. Sleeve Gastrectomy

Sleeve gastrectomy involves removing approximately 80% of the stomach, leaving a narrow, banana-shaped "sleeve" behind. This restricts the amount of food that can be eaten and lowers levels of the hunger hormone ghrelin.

Sleeve gastrectomy is the most commonly performed weight loss surgery worldwide. It provides substantial weight loss with fewer nutritional side effects compared to gastric bypass. However, the procedure is not reversible.

3. Adjustable Gastric Band

In the adjustable gastric band procedure, also called "lap band", a silicone band is placed around the upper part of the stomach, creating a small pouch that limits food intake. The band's tightness can be adjusted by adding or removing saline solution.

While this procedure is less invasive and reversible, it generally results in less weight loss compared to other bariatric surgeries. However, this procedure has fallen out of favour due to higher rates of long-term complications and reoperations.

4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

BPD/DS is a two-part procedure that begins with a sleeve gastrectomy, followed by rerouting the small intestine to bypass a large portion of it. This leads to both restricted food intake and significantly reduced calorie and nutrient absorption. BPD/DS can result in the greatest weight loss but also has the highest risk of nutritional deficiencies, requiring strict lifelong monitoring.

How Bariatric Surgery Works: Mechanism of Action

Bariatric surgery promotes weight loss through several mechanisms:

1. Restriction: Reduces stomach size, limiting food intake.
2. Malabsorption: Bypasses part of the small intestine, decreasing calorie and nutrient absorption (in procedures like gastric bypass and BPD/DS).
3. Hormonal Changes: Alters gut hormones that regulate appetite, satiety, and blood sugar control (particularly after sleeve gastrectomy and gastric bypass).
4. Improved Insulin Sensitivity: Rapid improvement in blood sugar regulation, often before significant weight loss occurs.

Benefits of Bariatric Surgery

The benefits of bariatric surgery go far beyond weight loss — it can transform overall health and quality of life. They include:

• Significant long-term weight loss
• Remission or improvement of type 2 diabetes
• Reduced risk of heart disease and stroke
• Improved blood pressure and cholesterol levels
• Alleviation of sleep apnoea symptoms
• Enhanced mobility and quality of life
• Decreased overall risk of premature death

Potential Risks and Complications

As with any major surgery, there are certain risks of bariatric surgery. Some risks can appear shortly after the procedure, while others may develop gradually over time. Being aware of them helps patients make informed choices and prepare for the best possible outcome.

Short-Term Risks

• Bleeding: Excessive bleeding during or after surgery may require medical intervention.
• Infection: At the incision sites or internally, infections may occur if not monitored closely.
• Blood clots: Deep vein thrombosis or pulmonary embolism can pose serious risks post-surgery.
• Leakage from surgical connections: Fluids may leak from the stapled or sutured areas.
• Adverse reactions to anaesthesia: These can vary from mild to severe complications.

Long-Term Risks

• Nutritional deficiencies (vitamins and minerals): Lifelong supplements may be necessary.
• Bowel obstruction: Blockages in the intestine can cause discomfort and require surgery.
• Gallstones: Rapid weight loss often increases the risk of gallstone formation.
• Ulcers: Particularly in patients who smoke or take certain medications.
• Dumping syndrome (rapid stomach emptying): Causes nausea, diarrhoea, or dizziness after meals.
• Hernias: May occur at incision sites or internally.
• Weight regain (in some cases): Possible if lifestyle changes are not maintained.

Preparing for Bariatric Surgery

Preparing for weight loss surgery involves several key steps:

1. Comprehensive medical evaluation by a bariatric team.
2. Nutritional counselling to learn about dietary changes before and after surgery.
3. Psychological assessment to ensure readiness and support.
4. Development of a physical activity plan to begin a safe exercise routine.
5. Smoking cessation, if applicable, before surgery.
6. Medication review to adjust or discontinue certain medications as needed.
7. Preoperative weight loss is sometimes recommended to reduce surgical risk.

What to Expect During the Procedure

Bariatric surgery is usually performed laparoscopically, using small incisions and a camera to guide the procedure. Surgery typically lasts 1-3 hours, depending on the type. Most patients stay in the hospital for 1 to 3 days. Recovery time varies by procedure, but minimally invasive techniques have shortened hospital stays and reduced postoperative pain.

Post-Surgery Recovery and Care

After weight loss surgery, patients can expect the following as part of their recovery process:

• Close monitoring for complications
• Gradual progression from liquids to solid foods
• Pain management
• Early mobilisation to prevent blood clots
• Lifelong vitamin and mineral supplementation
• Regular follow-up visits with the healthcare team

Diet and Nutrition After Bariatric Surgery

Dietary changes are crucial for successful weight loss and preventing complications after bariatric surgery. The typical progression includes:

1. Clear liquid diet for the first few days post-surgery
2. Gradual advancement to pureed foods, then soft foods
3. Small, frequent meals (usually 5-6 per day)
4. High-protein, low-sugar, low-fat diet
5. Avoidance of carbonated, caffeinated, and sugary beverages
6. Lifelong vitamin and mineral supplementation (e.g., multivitamins, B12, iron, calcium, vitamin D)

Lifestyle Changes for Long-Term Success

Achieving lasting weight loss and health benefits after bariatric surgery requires a lifelong commitment to healthy lifestyle habits, such as:

• Adherence to prescribed dietary guidelines
• Regular physical activity
• Routine medical and nutritional follow-up
• Avoidance of tobacco and excessive alcohol use
• Ongoing psychological support as needed
• Setting realistic goals and tracking progress

Cost of Bariatric Surgery in India

In India, the cost of bariatric surgery varies based on factors like the specific procedure, surgeon, hospital, and city. Typical costs range from ₹180,000 to ₹500,000 for standard procedures. This may include pre-surgical evaluation, surgery, hospital stay, and initial follow-up. Additional expenses may arise for nutritional supplements, extra consultations, or complications.

Note: Costs are approximate and may vary by hospital, surgeon, and location.

When to Contact Your Doctor Post-Surgery

After bariatric surgery, it's essential to contact your healthcare team if you experience:

• Persistent vomiting or inability to keep liquids down
• Signs of infection (fever, redness, swelling, or pus at incision sites)
• Severe abdominal or chest pain
• Shortness of breath
• Symptoms of dehydration (dizziness, little or no urine output)
• Unusual swelling, heat, or pain in the legs (possible blood clot)
• A sudden, severe weakness or confusion

Alternatives to Bariatric Surgery

For individuals who do not qualify for or choose not to undergo weight loss surgery, alternative options include:

• Medically supervised weight loss programmes
• Prescription weight loss medications
• Endoscopic bariatric procedures (e.g., intragastric balloon)
• Intensive lifestyle interventions (diet, exercise, behaviour modification)

Conclusion

By understanding the types of bariatric surgery, their benefits and risks, and the lifestyle changes involved, you can make informed decisions and achieve lasting success. With lifelong commitment to healthy habits and regular follow-up care, bariatric surgery can lead to lasting improvements in health, mobility, and quality of life.

If you are considering bariatric surgery in India, Metropolis Healthcare offers comprehensive diagnostic services to support your journey. Our certified and experienced phlebotomists provide convenient at-home sample collection, and our state-of-the-art labs across 220 labs in 28 states and 7 union territories deliver accurate, timely results to guide your pre- and post-surgical care. With a commitment to accuracy, quality, and personalised care, including a CAP-proficiency score exceeding 98%, Metropolis Healthcare is here to support you in prioritising your family's health and well-being.

FAQs

1. How much weight can you lose with bariatric surgery?

Weight loss after bariatric surgery varies by procedure and individual factors. On average, patients lose 50-80% of their excess body weight within 1 to 2 years post-surgery. Long-term success depends on adherence to lifestyle changes.

2. Is bariatric surgery safe?

While bariatric surgery carries risks like any major surgery, it is generally considered safe when performed by experienced surgeons on appropriately selected patients. Advances in surgical techniques and postoperative care have significantly reduced complication rates.

3. What is the recovery time after bariatric surgery?

Recovery time varies by bariatric surgery type and individual factors. Most patients return home within 1-3 days and resume normal activities within 2-4 weeks. However, it may take several months to fully adapt to dietary changes and reach maximum weight loss. Lifelong follow-up care is essential for maintaining results and preventing complications.

4. Can you regain weight after bariatric surgery?

Weight regain is possible after any weight loss surgery if patients do not adhere to the necessary dietary and lifestyle changes. On average, patients maintain 50-60% of their initial weight loss long term. Factors that can contribute to weight regain include grazing, high-calorie beverage intake, lack of exercise, and hormonal changes.

5. Is bariatric surgery covered by insurance?

Insurance coverage for bariatric surgery varies by insurer and specific policy. In India, some insurance plans cover weight loss surgery if certain medical criteria are met, such as a BMI over 32.5 with obesity-related comorbidities or a BMI over 37.5 without comorbidities. It's essential to check with your specific insurer regarding coverage and requirements.

6. What foods should be avoided after bariatric surgery?

After bariatric surgery, patients must avoid foods high in sugar, fat, and calories to prevent complications and promote weight loss. These include sugary snacks and desserts, carbonated and high-calorie beverages, fried and greasy foods, high-fat meats and dairy products, refined carbohydrates (white bread, pasta, and rice), and fibrous vegetables (in the early stages).

References

• https://www.practo.com/health-wiki/weight-loss-surgery-india/304/article
• https://www.drrajatgoel.com/how-much-does-bariatric-surgery-cost-in-india/
• https://my.clevelandclinic.org/health/treatments/bariatric-surgery
• https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
• https://www.theossi.com/surgery-guidelines