are-all-bariatric-operations-same
by Dr. Yogesh Gautam
Sep 22, 2018

When we search the net for types of bariatric procedures all sorts of confusing terms are encountered. Is bariatric and weight loss surgery the same, or are metabolic surgery and surgery for diabetes similar, you will find many similar sounding names that add up to confusion.

I will try to make it a bit simpler. Broadly speaking all bariatric and metabolic operations can be clubbed into two major types, a restrictive type operation, or a mal-absorptive type. However, there is no such thing as a purely restrictive, or a purely mal absorptive operation. For example sleeve gastrostomy has also some mal- absorptive component too.

The most common type of bariatric operations, is Sleeve Gastrectomy; LSG and Gastric sleeve, are its other name. In common parlance it is also known as stomach stapling whereas, stapling is a technique of cutting and sealing tissue, it is employed in all bariatric and many GI surgeries.

Then there are types of bypass operations called Gastric bypass, one such operation is RYGB which is a standard and the longest running operation for morbid obesity lasting more than 40 years. In fact its anti diabetic effects were discovered accidently, when it was done for other diseases, later on it was modified to suit weight loss requirements.

Mini Gastric bypass, one anastomosis gastric bypass (OABG), Billroth- 2 are the names of a variant of RYGB. There are minor technical differences with different outcomes and complications. A word of caution however, it is a powerful operation, there is nothing mini about it.

In other types of bypass operations a bypass is added to Sleeve Gastrectomy to potentiate its anti Diabetic effect, here the bypass joint is made at the level duodenum the first part of intestine. Depending upon how much intestine is bypassed, They are named, for example DJB in which first 2 meters of intestines are bypassed, and SADIS in which majority of small intestine is bypassed leaving only last 3 meters to absorb nutrients.

Then there are metabolic surgeries for diabetes, that have a profound effect on glucose metabolism i.e. sugar control, but with minimal weight loss; Ileal- interposition is one such operation which is performed majorly in brazil, and select centers, in India and abroad. DJB also comes under this category; its effect on Diabetes is similar to the Ileal- interposition.

So, it is enough to remember there are two major types of bariatric operations one with a bypass and the other without. Rest is all technical.

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