Commonly Performed Bariatric Procedures in

Singapore

Lin Jinlin

Associate Consultant

General, Upper GI and Bariatric Surgery

Changi General Hospital

Scope

1. Introduction

2. Principles of bariatric surgery

3. Roux-en-Y gastric bypass

4. Sleeve gastrectomy

5. Other procedures

6. Conclusion

Introduction• Obesity has become a global epidemic, and is on the rise in

Singapore.

• This is contributed by an increasingly sedentary lifestyle and easy access to calorie-dense processed foods.

Introduction• Many studies have shown that bariatric surgery provides safe,

effective and durable weight loss compared to dietary modification and exercise

Principles of Bariatric Surgery1. Restriction

– Limits caloric intake by reducing the stomach’s reservoir capacity

– Induces a sense of satiety with reduced amount of food ingested

2. Malabsorption

– Decreases effectiveness of nutrient and caloric absorption by surgically decreasing the length of functional small bowel

3. Combination

4. Other effects

– Neuro-hormonal effects that act both on the gastrointestinal (GI) and extra-GI systems

– Not entirely well understood

Principles of Bariatric Surgery

• All surgeries are performed laparoscopically under general anaesthesia

Types of Bariatric Procedures

Restrictive Malabsorptive Combination

Sleeve gastrectomy Biliopancreatic diversion (with duodenal switch)

Roux-en-Y gastric bypass

Adjustable gastric banding

Jejunal-ileal bypass Single loop gastric bypass

Vertical banded gastroplasty

Sleeve gastrectomy and Roux-en-Y gastric bypass are the 2 most commonly performed bariatric procedures in Singapore

Roux-en-Y Gastric Bypass

• One of the first few bariatric procedures to be proven to be safe and effective

• “Gold standard” procedure against which newer procedures are compared against

• One of the most common procedures performed worldwide, though numbers are on a downward trend

Roux-en-Y Gastric Bypass

Restriction

Malabsorption

Gastro-jejunal anastomosis

Gastric pouch

Small bowel

Small bowel anastomosisBiliopancreatic limb

Common Channel

Roux limb

Completed Gastro-jejunal anastomosis

Gastric pouch

Small bowel

Gastric pouch formation

Gastric pouch

Excluded stomach

Roux-en-Y Gastric Bypass

• More effective and sustained weight loss, with higher rate of diabetic resolution compared to sleeve gastrectomy

• Suitable for patient with hiatus hernia / symptomatic reflux disease (which may worsen after sleeve gastrectomy)

• Longer surgery time, higher complication rates

Sleeve Gastrectomy

• Initially offered as a “first-stage procedure” for patients who are super obese (BMI >60) to induce weight loss before undergoing Roux-en-Y gastric bypass

• Weight loss from procedure was so effective that many patients who underwent sleeve gastrectomy did not require second procedure

• Increasing popularity to become the most commonly performed bariatric procedure worldwide in the last 5 years

Completed sleeve gastrectomy

Gastric sleeve

Greater curve resection

Gastric sleeve

Resected stomach

Stapling device

Greater curve mobilisation

Stomach

Omentum

Sleeve Gastrectomy

• Mainly a restrictive procedure

• Also has effects on gastric emptying and hormones secreted by gastric fundus affecting satiety

• Increasing popularity due to simplicity of procedure, short operating time, effectiveness in weight loss and lower complication rates

Other procedures

• Other procedures that are less commonly performed in Singapore include:1. Single loop gastric bypass (“mini” gastric bypass)2. Biliopancreatic diversion with duodenal switch3. Adjustable gastric band

Single Loop (“Mini”) Gastric Bypass

Adjustable Gastric Band

Biliopancreatic Diversion With Duodenal Switch

Resected stomach

Duodenal-jejunal anastamosis

Long length bypassed small bowel / alimentary limb

Short common channel 75 – 100cm

Conclusion

• Many procedures have been proposed in an effort to induce effective, durable and safe weight loss for obese patients.

• Procedure selected for patients has to be individualized based on patient profile, disease factor and surgeon expertise.

• The obese patient has to be managed by an experienced and dedicated multidisciplinary team, in order to achieve the best outcome.

Thank You!