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Bariatric Surgery: Complete Guide to Procedures, Candidacy, Risks, and Life After

What Is Bariatric Surgery?

Surgical modification of stomach/intestines to restrict intake and/or reduce absorption. Major procedure with risks, but highly effective for severe obesity.

Candidacy (NIH/ASMBS Guidelines)

  • BMI ≥40, or
  • BMI ≥35 with obesity-related comorbidity (T2DM, hypertension, OSA, NAFLD, etc.),
  • Failed structured non-surgical attempts.
  • Psychological readiness, no contraindications.

Common Procedures

  • Roux-en-Y Gastric Bypass (RYGB): gold standard; pouch + bypass → restriction + malabsorption + hormonal changes.
  • Sleeve Gastrectomy (SG): 80% stomach removed → restriction + ↓ ghrelin; most common now.
  • Adjustable Gastric Band (AGB): reversible but higher reoperation rate; less used.
  • BPD/DS: maximal malabsorption; for BMI >50 or super-obese; higher nutritional risk.

Risks

  • Early: leak, bleed, infection, VTE, death (~0.1–0.3% in high-volume centers).
  • Long-term: deficiencies (iron, B12, D, thiamine, calcium), dumping, strictures, ulcers, regain.

Post-Op Life

  • Lifelong: protein-first eating, hydration, vitamins, labs, activity.
  • Follow-up: 2w, 1m, 3m, 6m, 1y, then annually.
  • Support groups improve outcomes.

Decision

Not a quick fix—a chronic disease treatment requiring permanent lifestyle change. Multidisciplinary evaluation essential.

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