Bariatric surgery is the most effective therapy available for the multidisciplinary treatment of morbid obesity and can result in an improvement or complete resolution of co-morbidities (the presence of one or more diseases in addition to the primary disease).
The objective of bariatric surgery is to improve health, life quality, and reduce risk factors especially in people with severe and significant obesity-related medical and psychological complications.
The success of bariatric surgery depends largely on the patient’s compliance with medical recommendations. There are various bariatric procedures, all of which enable a significant weight loss. The magnitude and duration of the goals achieved are directly related to the patient’s understanding of the need for a profound and permanent change in his/her lifestyle, and his/her commitment to the medical recommendations. These include changes in habits: behavior, eating, regular exercise, taking vitamin and nutritional supplements and attending medical monitoring appointments periodically.
Who can be operated?
Surgery is indicated for patients with morbid obesity and a body mass index (BMI) greater than 40, and have an associated illness derived from their obesity (co-morbidity).
Before opting for bariatric surgery a personal assessment should be done to determine the following:
Absence of an endocrine disease responsible for the obesity.
Comprehensive medical evaluation to minimize risks during and after surgery.
Assess the patient’s psychosocial adaptation, understanding of the surgical procedure as well as of its risks and monitoring; have appropriate and realistic expectations concerning surgery scope.
Positive perspective of the treatment.
What are the benefits of bariatric surgery?
70% to 100% loss of excess weight during the first 18 months after the operation.
Improvement of associated obesity conditions, including type II diabetes, hypertension, sleep apnea, osteoarthritis problems, and others.
Significantly facilitates mobility by eliminating discomfort and body aches.
Improved ability to perform any physical activity.
Provides a new physical appearance that increases self-esteem.
What are the risks?
Bariatric surgery is major surgery. Complications from these procedures are similar to any other abdominal surgery including bleeding, leaking sutures, obstruction and infection. However the risks of obesity per se and its accompanying diseases are much higher than those any surgery may have.
The gastric bypass operation is performed by laparoscopic surgery to reduce the stomach and cause food to go directly from this reduced stomach towards the end of the intestine (“bypassing” most of the intestine, hence its name).
The surgery involves two stages:
First, the stomach is reduced from about 1000 CC in an obese person to about 50 CC, dividing it into two parts at its highest point: the smallest part of the stomach receives the food that comes from the mouth and the “residual” part that continues secreting the biliopancreatic juices.
The second part of the intervention is bridging the intestine so that the secretion of biliopancreatic juices and food join at 75-200 cm from the stomach and, therefore, a great portion of the ingested food DOES NOT get absorbed. For this purpose, the intestine is also divided and part of it joins the small stomach and another part is rerouted at a distance of 75-200 cm. The malabsorption produced by this technique is the reason for weight loss success but in view of the risks that it poses it should only be used in selected patients.
For optimal results, it is necessary that the patient follows some recommendations regarding his diet. The diet after gastric bypass is liquids during the first two weeks; then, you advance to a soft diet, and then, to a normal diet, making these changes gradually. By diverting the normal route of food absorption, it is necessary to take multivitamins and calcium permanently and indefinitely because the absorption of these gets altered by surgery.
In this surgery, a reduction of the capacity of the stomach is performed into a shape of tube or sleeve of small capacity. This makes the patient feel full with little amount of food and lose weight significantly.
Surgery is performed through laparoscopy and it is necessary to staple and cut part of the stomach to decrease it in size, turning it into a tube; however, it is not necessary to cut and stitch the small intestine. This surgery is an excellent alternative and quality of life with gastric sleeve surgery is excellent. It is also the most recommended surgery for patients with less severe obesity (BMI between 30 to 40 kg/m²), for teenagers, and the elderly, since food absorption is not disrupted and normal growth is not affected.