What is morbid obesity?
Morbid obesity referrers to a number of clinical conditions associated with severally increased body weight. It is estimated that nearly 30% of the global population is obese (34% in the USA) and two thirds of the population is either obese or overweight. The pathogenesis of obesity is not completely understood yet, but it is definitely related to both genetic and environmental factors.
Why is obesity a disease?
The additional body weight is known to be the cause of much co morbidity, both physical and psychological. Diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease, hormonal disorders, hypo fertility, arthritis, depression and social isolation are only some of the pathologies related to obesity. In addition, obesity is proved to be related with increased incidence of various malignancies (colorectal cancer, prostatic cancer etc.). For all those reasons the WHO (World Health Organisation) has characterised obesity as a disease and strongly recommends the timely treatment with either physical activity, diet, medical assistance or surgery. Bariatric surgery is offered to morbidly obese patients who have failed to lose their excess body weight by any other means.
Who is a candidate for bariatric surgery?
The terms overweight and obese refer to a different grade of the same condition. In order to classify the grade of obesity we use the term BMI (Body Mass Index) which correlates the body weight with the hight.
BMI= Body Weight(Kg) / Height(m)²
Bariatric surgery is appropriate for patients with a BMI> 40 Kg/m2 or BMI> 35 Kg/m2 and co morbidities, provided they have failed to lose weight with diet. Patients with BMI> 50 Kg/m2 could be offered surgery even if they have not tried to lose weight with diet
What types of bariatric procedures are available?
Bariatric surgery works by either limiting the stomach’s capacity for food or by bypassing the length of the small intestine to minimize nutrient absorption. A combination of both methods can also be applied to promote weight loss. Three common types of bariatric surgery performed at our bariatric unit are sleeve gastrectomy, laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass. All operations are performed laparoscopicaly with an overnight hospital stay.
Laparoscopic Adjustable Gastric Band
The adjustable gastric band is a procedure that limits the capacity of the stomach by placing an inflatable silicone device around the top portion of the stomach. The narrow opening of the band intends to slow the consumption of food and thus reduce the amount of food consumed. The band slows and limits the amount of food that can be consumed at one time, thus giving the opportunity for the sense of satiety to be met. As patients lose weight, their bands will need adjustments, or “fills”, to ensure comfort and effectiveness. The gastric band is adjusted by introducing a saline solution into a small access port placed just under the skin. In most cases the operation can be done in the Day Surgery Unit and the patient is discharged a few hours after the operation.
Laparoscopic sleeve gastrectomy
Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. It was originally used as the first step to perform duodenal switch in severely ill obese patients who could not stand a prolonged operation. However, it was noticed that those patients had achieved adequate and sustainable weight loss and most of them did not need to proceed to the second step of the duodenal switch. Today sleeve gastrectomy is the fastest-growing weight loss surgery option. In many cases, but not all, sleeve gastrectomy is as effective as gastric bypass surgery, including weight-independent benefits on glucose homeostasis. The additional benefit of the operation is the reduction of ghrelin levels (a hormone produced by the fundus of the stomach and is responsible to inform the hypothalamous that the stomach is empty) which significantly reduces the appetite. The operation is performed laparoscopically with an overnight hospital stay.
Laparoscopic gastric bypass
Gastric bypass surgery, also called Roux-en-Y gastric bypass, consists of two parts. First, we staple the stomach, creating a small pouch in the upper section. The staples make the stomach much smaller, so the patient eats less and feel full sooner.
Next, we cut the small intestine and attach the lower part of it directly to the small gastric pouch. Food then bypasses most of the stomach and the upper part of the small intestine so the body absorbs fewer calories. Then we connect the bypassed section farther down to the lower part of the small intestine. This bypassed section is still attached to the main part of the stomach, so digestive juices can move from the stomach and the first part of the small intestine into the lower part of the small intestine. The bypass surgery also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although we may do it if medically necessary. The operation is performed laparoscopically with an overnight hospital stay.
Which operation is the best for me?
All bariatric procedures, when performed by an experienced surgeon are safe and effective. Thorough and detailed information by your doctor about the pros and cons of each operation and knowing of how your life and eating will be after the operation are necessary to decide which of the bariatric procedures suits you the most. Our bariatric team (surgeon, endocrinologist, dietician and psychiatrist) are here to advise you and help you make the right choice.
