BARIATRIC SURGERY
This is surgery for weight loss.Obesity has become the second biggest killer after tobacco and is fast overtaking it.The incidence of morbid obesity has doubled since the seventies.In Europe > 50% of the population is overweight.8% of total healthcare budget goes to obesity and related diseases.
Surgery has been shown to be the only long term effective solution .The success of diet and drugs long term is less than 1%.Surgery has > 90% long term success rate.
With one proven surgical procedure marked improvement in quality of life and rapid recovery with minimally invasive technique is garanteed.Many other associated diseases (comorbidity) and conditions are cured or improved including diabetes,hypertension, raised cholesterol,reflux(heartburn),osteoarthritis urinary incontinence,fertility and menstrual irregularity,sleep apnoea,liver disease,gallstones and venous stasis.(see IFSO statement)
WHO QUALIFIES.
BMI is the means to quantify obesity.
BMI=weight in kgs/height in meters squared.
BMI> 40 or > 35 with a comorbidity.
Mentally stable.
No addictions
No eating disorder
Well motivated
WHAT SURGICAL PROCEDURE.
Procedure may be restrictive by preventing too much intake ,malabsorbtive by not allowing all nutrients and minerals to be absorbed or a combination of both.
No one operation is perfect.
The ideal would have no side effects,be easy to do and be 100% successful (heaven is not here).
I personally prefer RYGB laparoscopically.(No large incision)
This entails a small gastric pouch and a 150cm Roux-y-limb.(see figure)
It is done by making 5 small holes in the abdominal wall which reduces pain and hastens recovery.The operation takes 90-180 mins depending on body habitus.3-4 day hospital stay and 2 week recovery period .
Advantages are low mortality, high long term success rate, rapid resolution of comorbidities, low incidence of malnutrition and loose stools, appetite reduction.
Complications are uncommon
Early; anastamotic leak,haemorrhage,respiratory difficulty,pulmonary embolism,mortality.
Late; vitamin deficiency,internal hernia and anastamotic stricture, marginal ulceration.
You can expect to lose 75% of your excess body weight over 2 year period.90% of your weight loss will occur during the first year.
Ten year success will be > 90%.
Special diet will be required for 3 months ,vitamin iron and calcium supplements will be lifelong.
Gastric banding is very popular but has many long term sequelae and is expensive long term. The incidence of reoperation is 30%.Failure to reach weight loss goals is 40% long term. Complications are haemorrhage, perforation, band slippage ,infection of port site or band, band leak, obstruction, nausea and vommitting erosion, oesophageal dilatation.
Advantages are short operating time, low mortality and no mineral or vitamin requirements.
I do not do biliopancreatic bypass due to higher mortality and malnutrition.There is no advantage in weight loss.
There are many other procedures which have been declining over the years due to the success of RYGB.
