Bariatric surgery – indications, types, and course

According to the WHO (World Health Organisation), over 1/3 of the world’s population is overweight.

The number of obese people is growing dramatically year by year. The role of bariatrics in modern medicine is, therefore, increasingly important. Surgical treatment of excess body mass aims at reducing the capacity of the stomach and consequently limiting the amount of food that a patient can eat. When should these procedures be performed? Are there any contraindications to this type of surgery?

Surgical treatment of obesity – when can it be carried out?

Obesity is a serious health condition. It causes strain on the joints, making mobility more difficult. Excess body mass puts the heart and blood vessels at great risk. It contributes to the development of diseases such as hypertension, atherosclerosis, heart attacks, strokes, and type 2 diabetes.

A swollen, distended stomach and excessive adipose tissue can be tackled with natural methods. Changing eating habits and exercising frequently might help some obese people to reduce their body mass. Unfortunately, for many patients, these measures do not bring satisfactory results. In their situation, surgical intervention using one of the available bariatric methods is often necessary.

The most important indication for surgical treatment of obesity is the ineffectiveness of other methods of combating excess body mass. These procedures can only be performed if the patient has previously made attempts to lose weight through lifestyle and dietary changes, but they did not bring the desired results.

Criteria to qualify for bariatric surgeries are based on the patient’s diagnosis, after establishing a high BMI (over 40 kg/m2 or 35 kg/m2 if at least one of the diseases associated with obesity is present, or over 32 kg/m2 if at least two associated factors are present). The procedures area meant for patients with extreme obesity, in whom such treatment may be an issue of life and health.

Not every obese person can qualify for bariatric surgery. The doctor decides if this form of treatment would be the best choice for his patient. He considers many criteria. Some of them are the obese person’s BMI and their comorbidities. Much depends on the patient’s attitude. Anyone who undergoes bariatric treatment should be advised that reduction of gastric capacity requires them to make many dietary sacrifices. Even after surgery, losing weight still involves making an active effort to maintain optimal body weight. If a patient doesn’t want to commit to a healthier lifestyle, they cannot be qualified for bariatric treatment.

The most important methods of surgical treatment of obesity

The most common methods of obesity treatment in modern bariatric surgery are:

• Laparoscopic gastric reduction (sleeve gastrectomy, gastric sleeve),
• Gastric bypass,
• Gastric banding,
• Gastric balloon.

Each of the methods mentioned above carries certain risks and benefits in the context of obesity treatment. Thus, before qualifying a person for surgery, a bariatric surgeon carefully analyses the patient’s situation and selects a procedure that would be most effective in their case.

Sleeve gastrectomy, a so-called gastric sleeve, is a laparoscopic method involving the removal of a fragment of the stomach in order to reduce both its capacity and the secretion of ghrelin, which is a hormone responsible for stimulating appetite. Surgeries of this type show very good results and a chance to reduce adipose tissue by up to 70% within the first year. During the procedure, between 70 and 80% of the stomach’s volume is taken away.

Gastric bypass consists of connecting the upper part of the stomach to the small intestine, bypassing most of the stomach and the duodenum. In KCM Clinic, the surgery is performed laparoscopically, which makes it quite safe and shortens the time of convalescence. This procedure reduces not only the volume of the stomach but also the intestinal surface involved in the absorption of nutrients. Thanks to this method, it is possible to reduce up to 70% of the adipose tissue within the first year after the surgery.

Mini gastric bypass is a method that gains popularity. It is a simplified type of gastric bypass. During this procedure, a surgeon makes one gastric-intestinal anastomosis and lengthens the gastric pouch while reducing its overall capacity and surface area. The rest of the stomach remains permanently separated and unusable.

Gastric banding is a reversible method of reducing gastric capacity. This procedure is no longer recommended. It is performed by placing a silicone band on the stomach to divide it into two parts. Due to the reduced volume, the feeling of satiety appears in the patient much earlier, and smaller amounts of food intake result in gradual weight loss.

The gastric balloon does not require cutting up the stomach. This method consists of placing a special balloon filled with saline in the patient’s stomach. It induces a feeling of satiety by filling a significant part of the stomach. This procedure is recommended mainly to patients in whom other forms of treatment are not accessible due to a very high degree of obesity. They need to lose some weight before they can undergo bariatric surgery. Placing a gastric balloon in their stomach helps them during that process. There are two types of balloons: a 6 and a 12-month balloon. After those respective periods of time, the device is safely removed from the patient’s stomach.

Comparison of available bariatric surgeries – indications and procedure

Thanks to the availability of various methods of reducing the capacity of the stomach, surgical treatment of obesity can bring visible and permanent results for the patient. It is the most effective method of reducing excess body mass.

The bariatric surgeon together with the patient decides, which procedure is the most adequate to the patient’s health condition. The right surgery, together with an appropriate diet and a change in eating habits, can significantly reduce the risks associated with obesity.

The course of bariatric surgery looks similar regardless of the chosen method. During the pre-operative consultation, the surgeon collects information about the patient’s previous attempts to treat obesity, such as the diets and training plans that they have used. It is important for the doctor to evaluate whether the obese person can commit themselves to a healthier lifestyle.

Recommendations after bariatric surgery

The operation is carried out under general anaesthesia and the recovery time is short. During this period, the patient heals his wounds and gets used to the new capacity of the stomach. For most people, adapting to new dietary recommendations might be quite challenging.

The diet that is to be followed after surgery must be low in calories and consist of small and healthy meals. After a laparoscopic procedure, the patient recovers much easier than in the case of open surgery. This allows for faster implementation of an exercise and rehabilitation plan that helps to lose excessive weight.

A key factor for the overall effectiveness of the surgical treatment of obesity is the patient’s commitment and willingness to change their eating habits. Although bariatric procedures significantly reduce the patient’s ability to overeat, proper diet and regular physical activity is still needed for them to regain health and fitness.