Bariatric surgery is a surgical treatment for obesity. It is restrictive and malabsorptive, which means it limits the amount of food ingested and decreases the amount of nutrient absorption from the gastrointestinal tract. There are several forms of the surgery; patients can undergo different procedures like laparoscopic adjustable gastric band, roux-en-Y gastric bypass, biliopancreatic diversion/duodenal switch, or vertical banded gastroplasty. In these surgeries, the size of the stomach is physically restricted, making digestion slower, or parts of the digestive tract are physically removed, which interferes with absorption of calories (Rickers & McSherry).
A laparoscopic adjustable gastric band is an inflatable silicone device that is put on the superior portion of the stomach to slow consumption of food and reduce the amount of food consumed (Rickers & McSherry). During this procedure, a laparoscope, which is a small, tubular instrument with a camera attached, is inserted through small incisions in the abdomen. The tiny camera on the tip of the laparoscope allows the surgeon to see and operate inside the abdomen without making large incisions (“What You Can Expect”). In a Roux-en-Y gastric bypass, a small part of the stomach is used to create a new stomach pouch. The new pouch is sewn and connected to the middle portion of the jejunum; thus bypassing the rest of the stomach and the duodenum and leaving a part of the small intestine unused. The biliopancreatic diversion or duodenal switch is a weight loss surgery procedure that is composed of both restrictive and malabsorptive aspects. A part of the stomach is separated and removed. The pyloric valve remains with a part of the small intestine that is connected to the duodenum. Food goes through the reduced stomach and to the lower intestine where it is joined to the duodenum and then to the colon; by passing an entire segment of the lower intestine (Rickers & McSherry). A vertical banded gastroplasty is when the stomach is divided into two parts, which restricts how much food can be held in the stomach. The smaller upper pouch empties food into the lower pouch (“What You Can Expect”).
There are many potential short and long-term health risks associated with the surgical procedures, such as excessive bleeding, infections, reactions to anesthesia, blood clots, breathing problems, and leaks in the gastrointestinal system. Longer term risks and complications of weight loss surgery can include bowel obstruction, dumping syndrome causing diarrhea, nausea or vomiting, gallstones, hernias, low blood sugar, malnutrition, ulcers, vomiting, and perforations in the stomach (“Risks”). There is also a risk of developing common nutritional deficiencies after receiving bariatric surgery. When receiving a laparoscopic adjustable gastric band, there are low risks in nutritional deficiencies in copper, folate, selenium, thiamine, vitamin A, vitamin B, vitamin E, vitamin K, and zinc; medium risks in calcium and iron; and high risk in vitamin D. When receiving a roux-en-Y gastric bypass, there are low risks in nutritional deficiencies in copper, folate, selenium, thiamine, vitamin A, vitamin E, and vitamin K; medium risks in calcium and zinc; and high risks in iron, vitamin B, and vitamin D. When receiving biliopancreatic diversion with or without duodenal switch, there are low risks in nutritional deficiencies in copper, folate, selenium, thiamine, and vitamin E; medium risks in vitamin A, vitamin B, vitamin K, and zinc; and high risks in calcium, iron, and vitamin D. The cause of nutritional deficiencies can occur because of the type of surgical procedure, affects to the intestines, the decreased gastrointestinal transit time, or poor eating behavior (Rickers & McSherry).
Because of nutritional deficiencies, it is important to obtain normal amount of minerals and vitamins. Patients take micronutrient supplements to make up for the vitamins and minerals they would normally receive before the surgery in their larger portions of food. A deficiency in vitamin D and calcium leads to muscle cramps, proximal weakness, and bone pain. Vitamin B is important in the functioning of the nervous system and brain and the production of red blood cells. Iron is important in hemoglobin, which is used in transferring oxygen throughout the body. Thiamine deficiency results in Wernicke’s encephalopathy, which is a neurological disorder that has symptoms of mental confusion, abnormal eye movements, and unsteady gait. Folate supplements are suggested because it is absorbed in the small intestines. Patients who receive any bariatric procedure are recommended to take multivitamin and calcium with vitamin D. Those who receive Roux-en-Y gastric bypass are told to take multivitamins and minerals, such as vitamin B, iron and vitamin C, and calcium with vitamin D. After receiving a biliopancreatic diversion with or without duodenal switch, patients are instructed to take multivitamins and minerals, such as calcium with vitamin D, vitamin B, iron, vitamin C, and fat soluble vitamins (Rickers & McSherry).
After undergoing bariatric surgery, patients generally blend foods and chew each bite slowly and completely. If the food is not smooth, it may not fit between the new and smaller opening between the new stomach pouch and the intestines. Many patients puree their food because once they have started to eat solid foods, their stomach pouch can initially only hold about one tablespoon initially. The stomach pouch will get slightly larger over time (Rogers), but at first, liquid foods are eaten to protect the small stomach pouch, and liquids are all the stomach can tolerate. Eating puréed foods helps the transition into solid foods and helps the stomach hold food down. Puréed food helps prevent food from blocking the stomach pouch outlet. Because the new stoma opening is about the size of a dime, puréed foods are easier to pass through. Without going through a stage of puréed foods, patients can have symptoms of vomiting and nausea because of possible band slippage, stomach slippage, or stretching of the small stomach pouch above the band (Nebraska Medical).
Patients who have initially had bariatric surgery cannot drink liquids with meals; they drink liquids in between meals. Drinking water keeps the patient hydrated; it can also fill them up. Water can lubricate food and make it easier for patient to eat more than they should, but they cannot drink from a straw because air would enter the stomach and fill it without having food inside (Rogers). Drinking liquids after meals tend to flush food through the pouch. When a patient drinks a liquid during eating, the food becomes liquid and then the effectiveness of the surgery decreases. Drinking liquid helps flush out the waste products that come from weight loss and the decrease in fat content (Nebraska Medical). Fluid intake is also important because of the possibility of dehydration. The body requires fluid to burn the stored fat calories for energy. After surgery, drinking 64 ounces of fluid will help prevent constipation and kidney stones as well as dehydration (“Life After Bariatric Surgery”).
Certain foods must be avoided following bariatric surgery. Foods that are dry, like popcorn and nuts, and fibrous foods, like celery and corn, may cause discomfort or pain because of the small stomach opening, and it can also block the stoma (Rogers). After the surgery, the stomach is so small that only three meals per day are allowed. Because patients can only eat small quantities, foods that do not have nutritional value are not recommended. Lean protein has the highest priority, followed by fruits and vegetables (Nebraska Medical). Because patients are allowed to eat a minimal amount, protein is important in preserving muscle tissues. Patients should avoid sugar, sugar-containing beverages and foods, fruit juices, and concentrated sweets because of the high number in calories but low nutritional value. They must also avoid raw vegetables, rice, breads, and meats that are not easily chewed because they can be hard to tolerate in the stomach (“Life After Bariatric Surgery”). High calorie foods are easier to tolerate because they require less chewing than healthier foods like fruits and vegetables, but they must be avoided because they lead to unhealthy eating habits, long-term nutritional problems, and possible weight regain (Rickers & McSherry).
After receiving a bariatric surgery, there is a possibility that patients can develop a condition called Barret’s esophagus. In this condition, the tissue that lines the esophagus is replaced by tissues that are similar to the lining of the intestines. Barrett’s esophagus is associated with gastroesophageal reflux disease and esophageal cancer. Gastroesophageal reflux disease is a more serious form of gastroesophageal reflux. It occurs when the lower esophageal sphincter opens spontaneously often and does not close correctly. The contents in the stomach rise into the esophagus. It is called acid reflux because acidic digestive juices rise with the food or fluid. When gastroesophageal reflux disease occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus, it may cause a burning sensation in the chest or throat called heartburn or acid indigestion (“Barrett’s Esophagus”).
Bariatric surgery helps weight loss, but after the surgery, the patients’ lifestyle must change to accommodate a healthier life for success. Patients are recommended to exercise daily, access social support groups, commit to long-term follow up, acquire coping strategies like relaxation techniques or writing down and talking about emotions as comfort instead of turning to food, adopt healthier eating habits, and live a more active lifestyle. Vomiting is common after bariatric surgery, but it is not normal. It can occur because the patient is eating too fast or too much. It can also occur because certain foods are difficult to digest if they are not eaten properly. The most important thing to do after this surgery is to sustain an appropriate diet and follow positive lifestyle changes to maintain weight loss (Rickers & McSherry). Patients can also experience mood changes, hair loss or hair thinning, feeling cold or tired, dry skin, and body aches, but if a healthy lifestyle is put in place, the surgery will result in weight loss (“What You Can Expect”).