What Is a Bariatric Surgeon?
Bariatric surgeons are physicians who perform bariatric surgery, to promote weight loss in patients with morbid obesity. Bariatric surgery involves rerouting or manipulating the gastrointestinal system to restrict food intake, food absorption or both. After surgery, patients must commit to a lifetime of health habits, including healthy eating and physical activity, to ensure the surgery's success. Here is a review of the training required to become a bariatric surgeon and the four types of bariatric surgery performed.
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Training
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Training to become a bariatric surgeon involves four years of medical or osteopath school, five to seven years of a general surgery residency and one to two years of a minimally invasive fellowship. During the residency, the physician receives training in multiple surgical subspecialties, including bariatric surgery. In minimally invasive fellowships, the amount of training focused on bariatric surgery varies from program to program. The surgeon should carefully review the program's details to ensure he will receive sufficient training on bariatric procedures.
Screening
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Bariatric surgeons carefully screen patients to ensure they are appropriate for surgery. Generally, candidates must be adults, have a body mass index (BMI) equal to or greater than 35; have an obesity-related medical condition; have had only short-term results with diet and exercise; and not have a disease causing obesity. Candidates must have a rigorous psychological examination to demonstrate they are ready to make substantial lifestyle changes.
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Adjustable Gastric Banding
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In the adjustable gastric banding procedure, a band is placed around the upper part of the stomach to limit the stomach's food intake and increase the sense of fullness. After the surgery, the surgeon can tighten or loosen the band by inflating it with saline or deflating it, in an outpatient setting. This is the only bariatric procedure that is adjustable and reversible.
Roux-en-Y Gastric Bypass
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The roux-en-y gastric bypass is similar to adjustable gastric banding but with an additional component. Like adjustable gastric banding, the roux-en-y gastric bypass limits food intake by creating a small pouch from the stomach. Food absorption is also decreased by connecting the pouch to the bottom of the small intestine, bypassing most of the stomach and small intestine. Only the areas in contact with food can absorb nutrients.
Biliopancreatic Diversion with a Duodenal Switch
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In biliopancreatic diversion with a duodenal switch, a large portion of the stomach is removed, creating a "gastric sleeve." The sleeve is connected to the lower part of the small intestine, bypassing much of the small intestine. Bile and some digestive juices that decrease absorption are re-reouted to the lower part of the small intestine. The procedure causes significant weight loss because only the lower part of the small intestine can hold food and absorb nutrients, and the distance between the stomach and large intestine is shortened causing malabsorption.
Vertical Sleeve Gastrectomy
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Vertical sleeve gastrectomy involves only the first portion of biliopancreatic diversion with a duodenal switch, such as creation of the gastric sleeve. This is performed in patients who are at high risk for complications from more extensive procedures, due to excessive morbid obesity or other medical conditions.
Open and Minimally Invasive Procedures
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Bariatric procedures can be performed as "open" procedures (with a traditional abdominal incision) or as minimally invasive procedures. Minimally invasive procedures, also called laparoscopic procedures, involve multiple small incisions in the abdomen. Cameras and surgical instruments are inserted into the incisions. The cameras transmit images to a monitor, where the surgeon visualizes the procedure. Laparoscopic methods may not be appropriate for patients who are excessively obese, who have had prior abdominal surgeries or have other medical conditions complicating their situation.
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- Photo Credit Walter Pories, MD FACS
