When a patient reaches the degree of Severe or Morbid Obesity, the therapeutic objectives of weight loss are difficult to achieve and it is necessary to resort to surgical treatment.
When a patient reaches the degree of Severe or Morbid Obesity (BMI [Body Mass Index] equal to or greater than 40 or greater than 35 with associated Comorbidities) the therapeutic objectives of weight loss and correction of the associated diseases are difficult to achieve with the usual measures of medical treatment (change of eating habit, increase in physical activity, and use of drugs for obesity). That’s why a weight loss surgery is considered to be one of the best options out there
What is Bariatric Surgery?
Bariatric Surgery is the set of surgical procedures needed to treat obesity. In patients with morbid or serum obesity, Bariatric Surgery, the surgical treatment, is the only therapeutic alternative that achieves reproducible weight loss rates and remission of comorbidities and maintained in the long term.
Obesity surgery significantly reduces mortality rates and prevents the development of new obesity-related health problems in severely obese patients. A recent study showed that obesity surgery reduces the relative risk of death by 89%.
Interventions in Bariatric Surgery
There are three different types of interventions:
- Restrictive surgery
- Malabsorptive surgery
- Mixed surgery
Restrictive Surgery
Restrictive surgery, which consists of reducing the size of the stomach by means of a gastric band or a vertical gastrectomy (tubular gastroplasty), accounts for 20% of the interventions currently performed. This type of intervention is indicated in male patients under 45 years of age who are willing to change their lifestyle: play sports, don’t bite between meals, etc.
Malabsorptive Surgery
Malabsorptive surgery makes food reach the distal intestine faster, causing the patient to have an accelerated transit and, consequently, a malabsorption of the food. These, which account for between 5 and 10% of bariatric surgery interventions, are indicated in patients with a BMI over 50 and those over 50 years of age or in those who have failed the other techniques. The most commonly used techniques are: duodenal crossing and biliopancreatic diversion.
Mixed Surgery
Mixed surgery, the main indication, accounts for another 70% of the operations performed, and consists of the combination of the two previous ones by means of a gastric bypass.
Although obesity surgery is often considered to be risky, for many patients the risk of continuing to suffer from severe obesity is much greater than the risk involved in the operation. Bariatric surgery has a success rate of over 90% and, contrary to popular belief, is comparable in safety to hip or gallbladder repair.
In what cases is or can bariatric surgery be indicated?
Nowadays, there is an internationally accepted consensus that obesity surgery (bariatric surgery) is indicated in those patients who present an Obesity in which their Body Mass Index (BMI) is equal or higher than 40 or equal or higher than 35 with some associated disease (type 2 diabetes mellitus, hypertension, hypercholesterolemia, sleep apnea, etc.)
The Body Mass Index is calculated by dividing weight in kilograms by height in meters squared.
Notwithstanding this consensus, at present we are also assessing the operation of patients with a BMI between 30 and 35 but with certain associated diseases such as those that make up the metabolic syndrome: type 2 diabetes mellitus, hypertension, increased cholesterol, etc.
What type of intervention do you most commonly use in obesity surgery?
At present, the most commonly used surgical procedures are gastric by-pass, vertical gastrectomy, gastric banding and duodenal switch.
Of all of them, it should be noted that they are all performed in a minimally invasive way through a laparoscopic approach, making minimal incisions in the abdomen that make patients recover before surgery, have less pain after the operation and go home (1 or 2 days of postoperative).
What aspects can condition this decision to intervene and what variables must be taken into account in bariatric surgery?
Each surgical intervention is indicated on an individual basis, so depending on the conditions of each patient (family and personal history, dietary habits, level of physical activity, etc.) some more restrictive procedures will be indicated (vertical gastrectomy or gastric banding), others more malabsorptive (duodenal switch), or others mixed, such as the gastric “bypass”, which is currently considered the gold standard among the different alternatives of gastrointestinal “manipulations” in which obesity surgery consists.
Once bariatric surgery has been performed, what are the keys to the patient’s recovery?
The key to bariatric surgery procedures is that they are carried out in a minimally invasive manner through laparoscopic surgery as previously mentioned, since recovery is then faster and the patient can return to his/her normal life very soon.
Subsequently, patients should follow periodic reviews by the multidisciplinary team that should attend to them (surgeons, endocrinologists, nutritionists, psychologists, psychiatrists, etc.)
What results are being obtained in interventions on obesity?
The results of bariatric surgery are excellent in the long term, unlike other therapeutic alternatives that manage to control weight temporarily without maintaining their results over time.
Obesity surgery manages in the long term (more than 15 years) not only to reduce and maintain the weight loss of patients but also to correct and control associated diseases such as diabetes mellitus type 2, hypertension, sleep apnea, increased cholesterol, etc.
What have been the great advances or progress since it is used in obesity surgery?
In my opinion, the great advance in the implementation of obesity surgery is to have achieved that those patients with subsidiary obesity from being operated on live an average of 15 years longer than those with the same problem that are not operated on.
In addition, the ability to achieve improvements in diseases associated with obesity that represent a real social and economic burden for the health system today. I am referring to Diabetes Mellitus type 2, Hypertension, increased cholesterol, increased triglycerides, etc. This is independent of the gain in self-esteem of those patients who, prior to the surgery, were truly marginalized because of their image as an obese person.