BARIATRIC AND METABOLIC SURGERY

Types of Surgery

BARIATRIC AND METABOLIC SURGERY

Bariatric and metabolic surgery, also known as weight loss surgery, is a type of surgical procedure performed to help individuals with severe obesity lose weight and improve or resolve obesity-related health conditions. These surgeries alter the digestive system to limit food intake and/or reduce the absorption of nutrients, resulting in long term permanent weight loss.

What is obesity?

Obesity is a chronic medical condition characterized by excess accumulation of body fat to the extent that it may have a negative impact on health. Obesity is associated with an increased risk of numerous health complications and chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension, dyslipidemia, certain cancers, sleep apnea, osteoarthritis, and mental health disorders. It can also reduce quality of life, impair physical function, and shorten lifespan.

Classification of obesity:

It is typically defined based on body mass index (BMI), which is calculated by dividing a person's weight in kilograms by the square of their height in meters (kg/m²). The World Health Organization (WHO) classifies obesity based on the following BMI categories

When bariatric/metabolic surgery is indicated?

Bariatric surgery is indicated :

For patients with severe obesity (often defined as a body mass index (BMI) of 40 or higher)
Patients with a BMI of 35 or higher who have obesity-related health conditions such as type 2 diabetes, hypertension, sleep apnea, or joint problems that significantly impair quality of life
For patients with a BMI between 30 and 35 who have uncontrolled type 2 diabetes despite medical management.
When non-surgical approaches to weight loss, such as diet, exercise, behavioral therapy, and pharmacotherapy, have been ineffective in achieving significant and sustained weight loss or in improving obesity-related health conditions.

Preoperative assessment of bariatric patients:

The preoperative assessment of bariatric patients is a crucial step in determining their eligibility for surgery, evaluating their overall health status, identifying potential risk factors, and optimizing their readiness for bariatric surgery.

The patient will be fully informed about all the benefits and limitations of the surgery.
The patient is willing to cooperate postoperatively.
The patient does not exhibit any serious psychopathology or active neoplastic disease.

Before surgery, in order to minimize the risk of intraoperative and postoperative complications, the patient must undergo a series of examinations which include:

Cardiopulmonary evaluation to assess heart and lungs
An anesthesiologist evaluates the patient's anesthesia risk
Gastroenterology evaluation
Laboratory tests
Imaging studies
Psychological evaluation

Types of bariatric surgery:

The most effective and safe surgeries for obesity today are the following two:

Laparoscopic sleeve gastrectomy
Laparoscopic gastric bypass

The choice of bariatric surgery depends on factors such as the patient's BMI, obesity-related health conditions, surgical risk profile, and individual preferences.

Laparoscopic sleeve gastrectomy

Laparoscopic sleeve gastrectomy involves removing approximately 75-80% of the stomach to create a smaller, banana-shaped stomach pouch along the greater curvature. The remainder of the stomach is removed. Sleeve gastrectomy works primarily by reducing the size of the stomach, which restricts food intake and decreases the production of hunger-stimulating hormones such as ghrelin.

Benefits:

The procedure reduces the size of the stomach by removing approximately 75-80% of its volume. This restriction in stomach size limits the amount of food that can be consumed at one time, leading to reduced calorie intake and weight loss.
By removing a large portion of the stomach, sleeve gastrectomy can decrease ghrelin levels, leading to reduced hunger and appetite, as well as improved satiety and meal satisfaction
Laparoscopic sleeve gastrectomy preserves the natural gastrointestinal anatomy
Significant weight loss and long-term weight maintenance σταθερό.

BARIATRIC AND METABOLIC SURGERY

Types of Surgery