**Question:** A 32 year old Subha, weighing 103 kg has opted for bariatric surgery for weight loss. All of the following are bariatric surgical procedures, EXCEPT:

A. Roux-en-Y Gastric Bypass
B. Vertical Sleeve Gastrectomy
C. Gastric Banding
D. Adjustable Gastric Banding

**Core Concept**

Bariatric surgery is a type of weight loss surgery performed on individuals with severe obesity, defined as a Body Mass Index (BMI) of more than 40 kg/m² or a BMI of over 35 kg/m² with comorbidities like type 2 diabetes, hypertension, dyslipidaemia, etc. Different types of bariatric procedures aim to restrict the stomach size, malabsorption of nutrients, or both.

**Why the Correct Answer is Right**

Roux-en-Y Gastric Bypass (RYGB) is a bariatric surgery that involves creating a small stomach pouch, bypassing a portion of the small intestine, and connecting the stomach pouch to the remaining small intestine. This procedure restricts food intake and absorption of nutrients, leading to significant weight loss.

Vertical Sleeve Gastrectomy (VSG) is another bariatric surgery that involves removing approximately 85% of the stomach, creating a smaller stomach pouch. This procedure restricts food intake but does not affect nutrient absorption, so weight loss is primarily due to reduced caloric intake.

Gastric Banding (GB) is a restrictive procedure where an adjustable silicone band is placed around the upper stomach, limiting the amount of food intake. However, this procedure does not affect nutrient absorption, so weight loss is primarily due to reduced caloric intake.

Adjustable Gastric Banding (AGB) is similar to gastric banding, but it involves an adjustable silicone band that can be tightened or loosened to control food intake. This procedure also does not affect nutrient absorption, leading to weight loss due to reduced caloric intake.

**Why Each Wrong Option is Incorrect**

Diverticulectomy is a surgical procedure to remove herniated pouches from the large intestine (diverticulitis) and does not relate to weight loss or obesity.

Adhesiolysis is a surgical procedure to separate adhesions (scar tissue) in the abdominal cavity, which also does not relate to weight loss or obesity.

**Clinical Pearls**

1. Bariatric surgeries (RYGB, VSG, AGB) are effective treatments for severe obesity and can lead to significant weight loss due to reduced caloric intake.
2. These procedures focus on restricting food intake and not affecting nutrient absorption, which is why they primarily lead to reduced caloric intake.
3. It is essential for candidates planning to undergo bariatric surgery to have a thorough preoperative evaluation and counseling to ensure they are fully informed and suitable candidates for the procedure.