Weight loss surgery (bariatrics)

The gastrointestinal surgery, which is performed for the purpose of weight loss, is the applied intervention in obese patients. The condition for an obesity surgery is the presence of comorbidities, or if their risk is high. It is not a first line treatment, the surgery is preceded by numerous unsuccessful weight loss diets. The surgical treatment of overweight is the most drastic, but also the most effective solution; it is also the key for persistent weight loss.

The steps and technique of the bariatric procedure

The surgery is performed in general anesthesia. The intervention can be performed by opening the abdominal cavity with an incision (laparotomy), or by a minimally invasive method (laparoscopy) with several tiny incisions, sparing the abdominal wall.

Penetration methods during bariatric surgery

Minimally invasive, laparoscopic surgery

• The surgery is planned to be performed by laparoscopy, which means that the abdominal cavity is filled with carbon dioxide by using a special needle or an optical trocar through an incision of a few centimeters, which were made above the belly button. A camera is inserted through the same opening into the space, which was created like this. Once the abdominal cavity is reviewed, individually designed surgical devices (forceps, scissors, devices for bleeding reduction, stapler) are inserted into the abdominal cavity, usually through four additional, tiny skin incisions. The surgery itself is monitored on a screen.

Laparotomy – The surgery which involves the opening of the abdominal cavity

• The point of this surgery is not different from the laparoscopic technique’s, but that is performed with the extensive opening of the abdominal cavity.

Surgical solutions for weight reduction

Surgical solutions to reduce the volume of the stomach

Sleeve gastrectomy

• The stomach is transformed into a tube with a volume of about 200 ml (tube shaped stomach) with the help of staplers. The diameter of the tube is about 2 cm. The cut stomach bit is removed.

Solutions influencing digestion

Gastric bypass

• Roux-en-Y bypass 
  • A small stomach (pouch) with a volume of 50 ml is created with the help of staplers, and it is closed with metal clips. This is sewed together with the small intestine in a way that a 1.5-m segment of the small intestine, which is important for digestion, is eliminated from the way of the digestive enzymes and bile acids, then the segment ascending to the stomach is sewed to the small intensive coming from the liver, and pancreas (Roux-en-Y bypass). If the anatomical circumstances (the vascular system, which provides supply to the small intestine, is too short) that are revealed during surgical exploration do not allow performing the gastric bypass, or the omega loop gastric bypass procedure, a sleeve gastrectomy will be performed instead.
• Omega loop bypass 
  • In case of an omega loop bypass, the stomach pouch is created similarly to what was described in the Roux-en Y bypass procedure, then it is sewed together with the small intestine at a spot, which was selected based on the body mass index, and the planned weight loss. The small intestine will not be cut through.

Combined solutions

SASI bypass (single anastomotic sleeve ileostomy)

• After the sleeve gastrectomy is created, a small intestinal loop from 150 200 cm away is sewed to the lower one third of the stomach, but as opposed to the omega procedure, the stomach is not closed beneath the connection, instead, emptying is maintained in the direction of the duodenum. This way, the additional deficiency diseases, and malabsorption disorders, which otherwise develop with bypass surgery, can be minimized, although according to our experiences, its level of effectiveness is not the same as the effectiveness of bypass surgery.

Potential changes, complementary solutions after weight loss surgery

Changing the planned surgical solution by adjusting it to the given situation may become necessary due to unforeseeable circumstances (adhesions stemming from previous surgeries, inflammations, detecting other diseases in the abdominal cavity), and complications, which develop during the surgery (a rather massive bleeding). An example for this could be switching from a minimally invasive (laparoscopic) surgery to an operation which involves cutting the abdominal wall and opening the abdominal cavity.

Postoperative care and follow-up examinations after bariatric surgery

The success of the treatment only partially relies on the surgery. Achieving the expected weight loss is a complex task, which presumes cooperation, faith in the treatment, and willingness from the patient in addition to the help of the surgeon, treating physician, nutritionist, and psychologist. Patient behavior that is different from the given professional advice increases the chance of late complications and decreases the extent of weight loss.

It is necessary to regularly keep in touch with the operating physician for the purpose of detecting any potential health problems in time. If no symptoms are present, the appointments of follow up examinations according to the protocol are the following:

• Reporting over the telephone once a week in the first 3 weeks,
• 3 months after being discharged from the hospital,
• every 3 months for one year,
• every 6 months after that.

It is recommended that you take an acid reducing medication for 3 months to prevent gastric ulcer. If you have additional risk factors in terms of the development of gastric ulcer (frequently taking non steroid anti inflammatory and analgesic medications, steroid treatment, smoking, regular alcohol consumption), acid reducing treatment may be necessary even after 3 months too.

Potential dangers of not performing a weight loss intervention

The development, persistence, and aggravation of the known risks and complications of extreme overweight.