Bariatric Surgery


Obesity-related health risks are many and, nowadays, bariatric surgery risks are decidedly low. Weight-loss surgery been shown to be very effective at producing significant and sustained weight-loss. Furthermore, the ineffectiveness of current non-surgical approaches to produce sustained weight loss in most cases, makes bariatric surgery the ideal option for many patients to acquire renewed self-esteem and, at the same time, it offers an excellent start for adopting a new, healthier lifestyle.

According to the latest figures from the World Health Organization, obesity has now reached epidemic proportions globally. It has been reported that at least 2.6 million people die every year due to obesity or being overweight.

Bariatric surgery is currently considered the only alternative for a patient with morbid obesity to achieve significant and sustained weight loss. Furthermore, a recent Swedish study involving a broad group of obese patients showed that patients who have undergone bariatric surgery are less likely to die of heart disease and, also, suffer less cardiovascular problems in general than obese patients who have tried to follow normal weight-loss treatment.

This type of surgery can be carried out by way of an open approach, i.e. open surgery (an incision in the middle of the abdomen) or through a laparoscopic approach. The techniques that are currently used are based on 3 basic concepts:-

 Gastric restriction:  the restrictive technique – vertical banded gastroplasty, gastric sleeve or vertical gastrectomy – which generates weight loss by reducing the gastric capacity, drastically limiting the amount of food that can be ingested at any given time.
 Malabsorption: malabsorption techniques tend not to be used owing to a high risk of complications.
 Restriction and malabsorption: these mixed techniques such as a gastric bypass, apart from reducing the gastric capacity, alter the normal gastric continuity and interrupt the absorption of nutrients.

Indications

Weight loss surgery is mainly recommended for those patients with morbid obesity who have frequently failed to achieve sustained weight loss through first-line treatment involving diet, exercise, psychotherapy and anti-obesity medication.

Contraindications

This type of surgery is not appropriate for patients under 13 years old or older than 65, nor in anyone with high anaesthetic risk, mental illness or a history of drug abuse.

The most common techniques are:-

Gastric bypass

The size of the stomach is reduced by creating a small pouch at the top of your stomach. This pouch is then connected directly to a section of your small intestine, bypassing the rest of the stomach and bowel. This means that it will take less food to make you feel full and you will also absorb fewer calories from the food you eat.

Gastric sleeve

During surgery, a section of the stomach is surgically removed, reducing the size of the stomach by three-quarters resulting in a patient’s appetite being much decreased.

 Adjustable gastric band

Gastric banding involves a laparoscopic (keyhole) procedure in which a plastic band with an inflatable inner collar is placed around the upper stomach to restrict food intake. This creates a small pouch and a narrow passage to the lower stomach. This small passage delays the emptying of food from the pouch and causes a feeling of fullness.  Although this type of surgery has less early complications, it can have a lot more later complications and is increasingly becoming the least used technique for weight loss.

Matters to be considered:-

Anyone thinking of undergoing weight-loss surgery must not only consider the benefits but also the possible risks, plus exactly what type of surgery would be more suitable in their case, before going ahead.

Bariatric surgery, as in the case of most surgery, is not without risk and should be only a part of a procedure to achieve weight loss, along with a determination to adopt better and healthier habits and, hence, a new lifestyle.

Doctors in Spain

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