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Bariatric surgery for obesity

What is Weight loss surgery (Bariatric surgery)? 

Weight loss surgery, sometimes referred to as" bariatric surgery", is a surgical treatment for overweight patients. These are operations to reduce the size of the stomach.  Some types of surgery also alter the way food is taken through the intestines so that you take in fewer calories and nutrients.

Who gets bariatric surgery? 

The surgeon uses a measurement called "body mass index" or  BMI, in order to determine who needs this operation. Your body mass index will show whether your weight is normal for your height.

Bariatric surgery is only suitable for those patients who are unable to lose weight using other methods, and for those who:

has a BMI of more than 40; or

has a BMI index between 35 and 40, and also has diseases such as diabetes, heart disease, and hypertension.


Is there a difference between the types of bariatric surgeries? 


Yes. There are different types of operations for obesity. Most frequently used:

Gastric banding – in this type of operation, the surgeon puts an adjustable bandage on the upper part of the stomach, which reduces the upper part of the stomach and this contributes to rapid saturation, since the receptors that signal that the stomach is full are located in the upper part of the stomach. The doctor adjusts the cuff of the bandage to achieve a comfortable condition of the patient and, subsequently, the desired weight.

Gastric bypass (gastric bypass) - in this type of operation, the surgeon disconnects part of the stomach, leaving only a small area for food – the "small stomach". It then connects the "small stomach" to the middle part of the small intestine. This leads to a" shunt " of food or a short path of food passage.

Longitudinal (sleeve) resection of the stomach (gastroplasty), or DRAIN-1 is a type of operation that involves removing a large part of the stomach, and from the remaining part a tube is formed, otherwise called a "sleeve".

The installation of a gastric balloon is a temporary measure aimed at initial weight loss in patients with overweight and severe concomitant disorders, in order to prepare them for a full-fledged operation.


Currently, gastric banding is losing its popularity, and the most effective operations are considered to be longitudinal resection of the stomach and gastric bypass surgery. 

How are bariatric surgeries performed? 

Various types of operations for obesity are performed in an "open" or "laparoscopic" way. With the open method, the surgeon makes a large incision on the abdomen and directly works on the abdominal organs. In laparoscopic surgery, the surgeon penetrates the abdominal cavity to the organs with several punctures, and then inserts manipulator tools through them. The manipulators are equipped with micro-tools, lighting and a micro-camera, which allow performing operations with visual control, while not making large incisions, which minimizes surgical trauma to the tissues and reduces the time of rehabilitation.


What do different types of operations look like in comparison? 

Gastric bypass surgery leads to the greatest weight loss and works faster, but it is the most serious operation with high risks, especially if the recommendations are not followed in the postoperative period. After gastric bypass surgery, there is a very high probability that type 2 diabetes will be completely stopped. Gastroschunting can cause a problem such as malabsorption, which can lead to malabsorption and nutrient deficiencies and mean that your body will lack important nutrients. After gastric bypass surgery, your doctor will monitor your body's nutrient levels.


Longitudinal (sleeve) resection of the stomach is a safer and less traumatic method than gastric bypass surgery, because it is not associated with redirecting the transit of food through the gastrointestinal tract and with intestinal resection, as a result of which there are fewer problems with absorption and nutrient deficiency. This operation may even be safer than gastric banding, since there is no foreign body in the body. The effectiveness of the operation is on average higher than with gastric banding.


Which operation should I choose? 

To decide which type of surgery is right for you, discuss all the options with your doctor. If you have several options, ask the following questions:

  • how much weight can I lose by using different types of operations?
  • how long will it take to lose weight?
  • what are the risks of each type of operation?
  • what changes in lifestyle, and what diet should be followed after each type of such operation?

Whatever you decide, make sure that the surgeon who will operate on you has sufficient experience in performing bariatric operations. Most hospitals that have experience in bariatric surgery offer lectures for patients on the surgical treatment of obesity, where you can learn more about the operations and treatment options that are specific to you.


What are the benefits of bariatric surgery compared to non-surgical treatments for obesity and type 2 diabetes?


In addition to weight loss, In addition to helping you lose weight, surgery can help improve or even get rid of some health problems, including:

  • Type 2 diabetes mellitus
  • Hypertension
  • Increased cholesterol levels
  • Nocturnal apnea is a condition characterized by respiratory arrest (cessation of pulmonary ventilation) during sleep for more than 10 seconds;
  • Gastroesophageal reflux disease, which constantly invokes a feeling of heartburn.

What are the risks of the operation? 


The risks of surgical treatment depend on:

  • Choosing the type of weight loss surgery
  • Method of operation: laparoscopic or open;
  • Your age and the presence of concomitant diseases;
  • How experienced is the surgeon?

In general, the risks may include:

  • Bleeding;
  • Infection or suppuration of postoperative wounds;
  • Failure of anastomoses or sutures on the stomach or intestines;
  • Obstruction or perforation of the gastrointestinal tract;
  • Heart or lung problems;
  • Formation of concretions in the gallbladder;
  • Power problems;
  • Diarrhea;
  • The need to perform a second operation.


Do I need to change the way I eat? 


Yes. You need to work with a nutritionist (a nutrition expert) to find out how your diet should change.

You need to eat healthy food before surgery. For example, you should choose foods that are high in protein and low in fat and calories. You should also avoid liquid foods that are high in calories, such as ice cream. If you eat the wrong foods, you may reduce your chances of losing weight. 

If you have a gastric bypass, you will need to avoid certain foods that can lead to a relapse of obesity. In addition, you will need to constantly take special multivitamins with minerals. This is due to the fact that gastric bypass surgery is accompanied by a violation of the absorption of nutrients in the gastrointestinal tract and leads to their deficiency throughout the body. You will need to take vitamins all your life.  Your body will always need them to stay healthy.


Diagnosis and treatment of morbid obesity and diseases associated with metabolic syndrome should take place in a specialized department with the participation of a bariatric surgeon, endocrinologist, gastroenterologist and nutritionist.

GBUZ Moscow Clinical Scientific Center named after Loginov MHD