Bariatric Surgery
Bariatric surgery aims to rapidly reduce weight in obese patients. The criteria to perform a bariatric operation are particularly strict. In principle, the Body Mass Index (BMI) must exceed 40 Kg/m². B.M.I is calculated from the quotient: weight/height². Obesity operations are also indicated in patients with B.M.I. 35-40 when they have co morbidities such as type 2 diabetes, arterial hypertension and sleep apnea. In exceptional cases where obesity causes severe health problems, the operation can also be performed on people with BMI 30-35. The patient must be monitored by a nutritionist at least one year before the operation and only if the diet fails should he be taken to the operating room. Finally, patients must be monitored by a psychologist for a period of one year before surgery.
When patients meet the above criteria then they have an indication for surgery. It must be emphasized that morbid obesity is a condition that can cause many health problems and therefore must be treated.
Through obesity surgery, we significantly reduce the risk of life-threatening conditions such as:
Heart diseases and strokes
Arterial hypertension
Sleep apnea
Type 2 diabetes
Fatty infiltration of the liver
Treatment
Nowadays, operations for obesity are performed laparoscopically, and so they are almost painless and bloodless.
The advantages of Laparoscopic Surgery are impressive:
Small surgical incisions
Quick recovery and quick return to work
Minimize postoperative pain
Less blood loss and fewer postoperative complications
Better cosmetic result
Lower rate of postoperative hernias
In previous years, the placement of a gastric band had found particular appeal. However, this method is no longer used in the international bariatric treatment centers as it shows particularly high rates of complications in the long term and the weight loss is not as expected.
Thus, the internationally recognized and most effective methods of dealing with obesity are the following:
– Laparoscopic Gastric Sleeve
With this method laparoscopically we remove the biggest part of the stomach and a small “sleeve” shaped remnant remains. ( we remove about 80% of the stomach ) Thus, the capacity of the stomach is rapidly reduced and the feeling of satiety occurs quickly with the intake of a small amount of food. At the same time, we remove that part of the stomach that produces the hormone Ghrelin which creates the feeling of hunger.
Advantages
Lose 60-70% of excess weight
Short hospitalization (2-3 days)
Preservation of body anatomy
Disadvantages
Irreversible operation
Minor malabsorption of vitamins
-Laparoscopic Gastric Bypass
With this method we do not remove part of the stomach. Instead, we bypass most of the stomach and a large part of the small intestine.
So, we divide the stomach and use only a small upper part of it which we anastomose with the small intestine. Therefore, the capacity of the functional stomach is reduced and at the same time the part of the stomach that produces the hormone Ghrelin, which is responsible for the feeling of hunger, is bypassed. Finally, because we also bypass a part of the small intestine, not all the components of the food are absorbed.
Advantages
Loss of 70-80% of excess weight
Better management of diabetes mellitus
Disadvantages
Change in body anatomy
Technically more difficult operation than the gastric sleeve
Permanent malabsorption of vitamins and trace elements resulting in lifelong supplementation.
Longer duration of hospitalization
-Holopancreatic diversion
In this operation, we remove a large part of the stomach and anastomose the remaining part with the final part of the small intestine, bypassing approximately ¾ of the small intestine. In addition, the part of the small intestine that has the pancreatic enzymes is anastomosed to the final part of the rest of the small intestine where the food is mixed with the enzymes.
Advantages
Lose 80-90% of excess weight
More effective than all techniques in treating diabetes
Disadvantages
Technically the most difficult operation with the most postoperative complications
Longer duration of hospitalization compared to the other techniques
Very large malabsorption of ingredients and vitamins
In recent years, some new techniques have been applied to treat obesity which are less invasive. However, it must be emphasized that these operations are less effective than the internationally renowned ones.
These interventions are:
Endoscopic placement of a gastric balloon With this method we insert a balloon into the stomach with a gastroscope. This gives the patient a feeling of satiety, reducing the feeling of hunger and causing weight loss. The downside is that the solution is temporary as the balloon has to be removed after two months
Pouring a special injectable material (botulinum toxin) endoscopically into the stomach. With this technique we paralyze a specific part of the stomach that produces hormones related to hunger and the patient eats smaller amounts. The duration of the paralysis is about 4 months, after which the operation can be performed again if necessary
Gastric fold. In this operation, we do not remove part of the stomach, but sew the stomach with a special technique so that it ‘folds’ and reduces its capacity. In this way the patient eats smaller amounts of food.
Doctor Kyritsis Alexandros has trained in the field of Bariatric and Laparoscopic Surgery at the UK’s leading bariatric surgery hospital, King’s College Hospital London
Frequent questions
I suffer from morbid obesity. Should I have surgery?
Morbid obesity is a condition that will gradually cause serious complications and reduce life expectancy. If weight loss with diet fails, then surgery is recommended
Which method should I choose?
This depends on many factors. The B.M.I, the co morbidities , the financial situation of the patient plays an important role in the final choice
I don’t have a very high BMI but I want to lose a few pounds. Can I have surgery?
No, bariatric surgery has strict criteria and we shouldn’t end up with surgery just to lose a few pounds
Is the surgery high risk?
Bariatric surgery involves some risk as most of operations are major surgeries involving obese patients. Clearly, however, the non-surgical solution carries more risks for these patients in the future.
What should I expect after bariatric surgery?
After the operation, we strictly follow a specific diet which includes only liquids and protein solutions in the first period and then mushy foods. After a period of one month we allow a normal diet.
Can I relapse after surgery and gain weight again in the future?
Depending on the method we choose there are chances of recurrence in the future. A bariatric surgery will give us the tool to lose a very large number of pounds in a short period of time. However, attention and a specific diet are needed so that we do not gain weight in the future
What effects will a bariatric surgery have on my body?
Due to a large weight loss in a short period of time our body and skin can get soft and loose. Thus, exercise is required to avoid this phenomenon. Foe better cosmetic result plastic surgery may be needed.