How Metabolic Surgery Is Different From Bariatric Surgery

With rising metabolic problems, it’s becoming more challenging to manage them with only food habits and lifestyle changes. The new solution is a surgery that gives immediate results at a cost. That’s a metabolic surgery which includes a variety of surgical methods performed for controlling metabolic issues. However, it’s different from bariatric surgery in specific ways. Here’s discussed all you need to know. To learn more about the two distinct surgeries, you can consult the reputed obesity surgeon, Dr. Vikas Singhal, at Medanta Medicity, Gurgaon, Haryana, India. 

What is metabolic surgery?

Metabolic surgery refers to a set of gastrointestinal surgeries performed to treat diabetes and metabolic disorders (including obesity).

Among diabetic patients, metabolic surgery benefits more those with type 2 diabetes where obesity is more severe. However, in type 1 diabetic patients also, obesity is increasingly becoming an issue.

What is bariatric surgery?

Bariatric surgery collectively refers to several surgeries that make changes to the digestive system for helping you lose weight (since the Greek term ‘baros’ means “weight”) and treat severe obesity.

However, the benefits of this surgery extend beyond treating obesity in correcting the other associated problems like heart disease, sleep apnoea, etc.

Differences between metabolic surgery and bariatric surgery

• On the one hand, bariatric surgery mainly aims at people having a body mass index (BMI) of 40 or above (morbid obesity) or of 35-39.9 (obesity) or sometimes of 30-34 if they have acute weight-related health disorders.

On the other hand, metabolic surgery may be performed on diabetic and obese patients having a BMI of about 28-30. 

• However, surgical disciplines can never be defined by specific procedures- far less likely by BMI ranges. Preferably the name and definition of surgical subspecialties are based on the disorders intended to be treated and the concerned organ system. Metabolic surgery is meant for addressing metabolic diseases like obesity and diabetes, which have earlier failed to respond to medication and lifestyle changes. 
• Although bariatric surgery can also be called weight-loss surgery, the mechanisms and benefits of gastrointestinal surgeries stretch far beyond weight loss. For instance, bariatric surgery treats not only morbid obesity but also high blood pressure, heart disorder and stroke, type 2 diabetes, non-alcoholic steatohepatitis (NASH), or non-alcoholic fatty liver disease (NAFLD) and sleep apnoea.
• Compared to the bariatric surgery unit, a particular study showed that the metabolic surgery group was older, had a better balanced male-female ratio, established cardiovascular disorder at baseline and showed more incidences of hypertension, type 2 diabetes, higher cardiovascular risks, and dyslipidemia. 
• A metabolic surgery program and a bariatric surgery service differ for their stated objectives but provide the same procedures and also use almost similar eligibility criteria in people having morbid obesity. For instance, for both the surgeries, you must try lifestyle changes and medicines for managing excess weight and have failed before opting for surgery as your last resort.  

Primary metabolic and bariatric procedures

Laparoscopic gastric bypass

• The stomach is squeezed to a walnut’s size and attached to the middle of the small intestine by bypassing a part of your small intestine (jejunum and duodenum) and restricting the absorption of calories.
• Risks include stroke or heart attack pre or post-surgery, infection, breathing issues, blood loss, blood clots in your legs, and allergic reactions to medicines. 

Laparoscopic adjustable gastric band

• An adjustable silicone band is filled with saline and wrapped around the upper stomach, making a small pouch that limits food intake.
• Risks include injury to the intestines, stomach or other organs while surgery, scarring inside your belly, poor nutrition, infection in your port, stomach ulcers, heartburn, gastritis, and the gastric band slipping slightly out of position or eroding through your stomach.

 Sleeve gastrectomy

• The stomach is vertically divided and stapled, eliminating more than 85% part and making a banana-shaped pouch or tube limiting the food intake and absorption by your body.
• Risks include injury to your intestines, stomach or other organs while operation, stomach ulcers, heartburn, gastritis, leakage from the lining where sections of your stomach have got stapled together, vomiting, poor nutrition, and scarring inside your belly which might result in a future blockage in your bowel.