Bariatric surgery: the solution to finally lose weight?

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

Apart from strict diets and intense sports programs, the bariatric surgery represents today a better reference in the obesity treatment especially in the presence of comorbidity. Discover in this article the different techniques it offers as well as the risks and complications it involves.

Definition

La bariatric surgery is a therapeutic alternative based on the stomach or intestinal surgery. The goal is to reduce the amount of food ingested and the caloric intake of a person to promote weight loss. She is specially dedicated to people with advanced obesity.

Bariatric surgery generally involves three operating techniques:

  • la sleeve gastrectomy,
  • le gastric bypass,
  • la adjustable band gastroplasty (gastric band).

La sleeve involves removing the stomach pouch by vertical incision. This practice reduces the gastric volume to nearly 75% and only a pipe-like stomach remains. This new structure slows the passage of food before it spills into the duodenum, dissipating hunger faster. At the same time, the production of ghrelin, the appetite hormone, decreases, thus limiting cravings for snacking. The average weight loss after the sleeve can reach 45 to 65% of excess weight.

Le gastric bypass is based on the design of a small gastric pouch at the top of the stomach and which will be directly connected to the jejunum. As in the case of the sleeve, the gastric bypass leads to a decrease in the food consumed. However, this technique preserves the structure of the stomach. It can cause considerable weight loss, 70 to 75% of excess weight.

THEGastric Band refers to an adjustable silicone ring that will be placed around the upper part of the stomach. Thanks to this device, a gastric pouch will form. During meals, food will remain longer in this cavity since the narrowed area slows down its passage. In addition, as soon as the pocket fills, the feeling of satiety appears, and this, with a small amount of food. According to specialists, gastric banding can lead to a loss of 40 to 60% of excess weight.

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Indications and contraindications for bariatric surgery

La bariatric surgery is an effective method to lose weight quickly and better manage your healthy weight over the long term. However, it must be recognized that it is not suitable for everyone. This is an operation that involves heavy surgery and the use of various invasive drugs.

Under formal medical advice, this type of treatment is only reserved for people with severe obesity:

  • BMI greater than 40 kg/m2;
  • BMI greater than 35 kg/m2 and who have significant comorbidities (diabetes, cardiovascular problems, joint disorders, etc.).

Le recourse to bariatric surgery is also recommended only if the patient concerned shows real resistance to dietary and sports methods to lose weight.

Furthermore, with regard to contraindications to bariatric surgery, they mainly address the following topics:

  • people with significant mental disorders;
  • people with eating disorders;
  • people who cannot tolerate general anesthesia;
  • people who cannot comply with lifelong medical monitoring;
  • alcoholics and drug addicts.

How does the procedure take place ?

Compared to other medical surgeries, bariatric surgery follows a fairly strict and long-term protocol.

The preoperative phase

Obviously, to know if the patient is fit to receive this kind of intervention, it is mandatory that he consults a doctor. During the first interview, the latter gives all the details concerning the operation: the principles, the procedure, the benefits, the risks, the post-operative follow-up conditions, etc. This information is normally recorded in a booklet that will be given to the patient so that he can analyze it properly.

The doctor also allocates a period of reflection of approximately 6 months during which the patient will meet various specialists, namely: a psychologist, dietitian, nutritionist, endocrinologist, gastroenterologist, cardiologist, lung specialist and anesthetist.

During this first step, the objective is to determine:

  • general state of health;
  • the level of obesity severity;
  • psychological state;
  • eating habits ;
  • lifestyle habits.

Various examinations will be carried out in order to establish a complete assessment for the patient file: ultrasound, fibroscopy, endocrine assessment, etc.

In addition, the patient will also follow a therapeutic education program. The latter covers knowledge of obesity and its various complications, the probable causes of this disorder and new healthy lifestyle habits (food balance, physical activity, smoking cessation). To promote discussion between patients, some sessions will be collective.

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Every week, medical specialists carry out a multidisciplinary consultation meeting (RCP) to assess progress and set up a new support program if necessary.

At the end of 6 months, thebariatric unit renders the verdict on the feasibility or otherwise of the surgical intervention. If the opinion is favorable and the patient is motivated, additional consultations with the surgeon and the anesthetist will take place to establish the therapeutic strategy to adopt.

The operating phase

La bariatric surgery is usually done by laparoscopy. The surgeon makes a small incision in the abdominal wall and introduces a probe equipped with a camera. Of course, the patient is put under general anesthesia.

Regarding the duration of the operation, it differs depending on the type of bariatric surgery chosen:

  • longitudinal gastrectomy (sleeve) lasts 2 hours;
  • gastric bypass lasts 1h30 to 3h;
  • adjustable band gastroplasty (gastric band) lasts 1 hour.

The post-operative phase

Once bariatric surgery is complete, the patient remains in the recovery room for approximately 2 hours. He then goes to the hospital room and stays there for a few days depending on the bariatric surgery adopted and the patient's condition:

  • sleeve: between 3 to 8 days;
  • gastric bypass: between 4 to 8 days;
  • gastric band: between 2 to 3 days.

From the moment the patient returns home, a long-term follow-up program is undertaken. It is used to prevent the occurrence of dietary deficiencies or, conversely, weight regain. Also equipped with psychological support, this follow-up prevents the risk of depression often linked to too rapid weight loss. It is true that the latter sometimes causes aesthetic problems that are difficult to manage: sagging arms and thighs, sagging breasts and appearance of abdominal apron (sagging skin on the lower abdomen region).

Complications and risks

Despite its great effectiveness, it must be admitted that the bariatric surgery is a heavy operation. As such, it contains certain more or less serious risks and complications. According to numerous studies, the risk rate of complications linked to an operation of this kind is estimated between 10 to 17%. However, the mortality rate is low, less than 1%.

During the operation, the main risks that may arise are haemorrhages, intolerance to anesthesia, accidental lesions on neighboring organs, etc.

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After surgery, the complications most to fear are bleeding, infection of the stitches and phlebitis.

For long-term complications of bariatric surgery, the best known are bowel obstruction, anastomosis stenosis, abdominal pain, stomach ulcer, esophageal reflux, vomiting and nausea after meals.

How is the recovery going?

In addition to the hospital stay, the patient who has undergone bariatric surgery also obtains a period of sick leave ranging from 15 days to 1 month.

For obese people with major health risks, bariatric surgery turns out to be an excellent solution. It offers weight reduction that helps achieve a healthy weight more easily. At the same time, the risks of complications as well as the symptoms of other pathologies associated with being overweight subside. The patient will thus have a much better quality of life.

Nevertheless, to be able to maintain these results over the years, it is more than necessary to respect good food hygiene and healthy lifestyle habits. Medical follow-ups are also to be preferred.

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