Bariatric surgery, or obesity surgery or weight loss surgery is a major surgical procedure that aims at creating a smaller digestive system and helps achieving significant weight loss. It requires lifelong commitment, change in attitude, adoption of a healthier diet and healthier life style. It applies to the morbidly obese, namely to people whose Body Mass Index (BMI) is over 40, or over 35 when other health problems coexist. The benefits include remarkable improvement in general health, prevention or treatment of diabetes, dyslipidemia, hypertension -factors that lead to cardiovascular diseases and premature death.
Contraindications include serious health problems that may lead to postoperative complications, severe psychological disorders, dependence from drugs and alcohol, an age under 18 or over 65, and failure to cooperate with the doctor and follow postoperative instructions.
The surgical techniques are divided in two categories:
» Restrictive surgeries, the aim of which is to limit food intake. These comprise the band, the sleeve, the plication and the balloon, and
» Mixed surgeries, which combine both the restrictive and malabsorptive techniques. This category includes the long-limb gastric bypass and the biliopancreatic diversion.
All the techniques are performed laparoscopically or robotically, to minimize the risk of postoperative complications. Open surgery is not an option, because then the surgeon has limited vision which could very likely lead to causing damage to organs, wound festering, evisceration, and hernias.
Which technique is good for me?
Before choosing the right technique, it is important to understand the changes that one’s body goes through with the onset of obesity. In addition to the external appearance, structural changes occur in the internal organs: the size of the stomach and the fundus increase, as does the number of ghrelin-producing cells, and the small intestine’s length and absorbency.
These basic changes affect the brain’s hunger centre, so people feel hungrier and become bulimic. To break this vicious cycle, we must try first to reduce the size of the stomach. To achieve this, we use restrictive techniques, such as the gastric band and the gastric sleeve.
The choice of the technique is decided after consulting the bariatric surgeon and depends on a number of factors related to the patient’s lifestyle and character. For instance, if the patient’s residence is far from the place where the operation is performed, or if the patient cannot follow the instructions of his doctor, then the gastric sleeve is selected, which is also the preferred option for diabetic patients. If the patient is willing to make an effort and only needs a push to loose his/her excess weight, or if he/she is afraid of surgery, then the best choice is the gastric band. If a band has been placed and the result of the operation is not as expected, whether due to bulimia, esophageal dilatation, or because the band has slipped, it is best to change into a gastric sleeve. If the initial surgery was the gastric sleeve and within a few years the patient relapses, then we should ascertain whether the sleeve is loose or has gotten stretched, in which case we apply the so-called plication, a simple, fast and safe procedure. If, however, the size is normal and the patient relapses, then we must perform a biliopancreatic diversion, a technique that has a high rate of success. In any case, our first choices are always the least invasive techniques, the ones that do not change the patient’s physiology and which limit the recovery time and the time to return to everyday activity. If these fail, then are applied mixed techniques, which are exceptionally effective.