Bariatric & Metabolic Surgery 2017-06-12T10:33:31+00:00

Bariatric & Metabolic Surgery

What is morbid obesity?

Morbid obesity is a serious health condition involving an excessive amount of body fat developing in the human body. According to the quantity of fat, people are considered as normal weighted, overweighted, obese and finally, morbidly obese.

It ‘s worth mentioning that obesity was declared a dangerous medical condition by the World Health Organization (WHO) many years ago, as it increases the risk of diseases and health problems, such as heart disease, diabetes and high blood pressure. Because of obesity, the organs of the human body, as well as its functions eventually collapse, not from the extra kilos and amount of fat, though from the problems they create.

Worldwide, the number of adults with obesity problems is beyond 500 million, while the overweight people are 1,4 billions. The recent and updated demographics present a rapid increase of obese people, from all ages, especially younger ones.

When someone is considered to be obese?

Obesity is diagnosed when Body Mass Index (BMI) is 30 or higher. The body mass index is calculated by dividing weight in kilograms (kg) by height in meters (m) squared.

A normal person has BMI from 20 to 25, an overweight person from 25 to 30, while BMI from 30 to 35 is connected with obesity and over 35 to morbid obesity.

Is obesity connected with comorbidities?

The increase of fat amount in the human body, as happens to obese people, cause a simultaneous rapid increase of several inflammatory factors, responsible for comorbidities.

The most common diseases connected with obesity or appear as a result of it, are insulin resistance and diabetes type 2, obstructive pulmonary disease, arterial hypertension, infertility, as well as many systemic diseases as cardiovascular disease, respiratory insufficiency, strokes, cancer, physiological problems etc.

Which is the best choice: diet or surgery?

It is utopian to believe that choosing surgical treatment for obesity over diet is the easiest way to solve the problem. In order surgery to succeed, patient’s efforts and contribution are important factors.

However, surgical treatment for morbid obesity remains the only radical and permanent solution, as it leads to weight loss and contributes to conservation of normal weight over time.

When surgical treatment is the only solution?

Surgical treatment is the right and only solution, when BMI is over 35, as this is considered as morbid obesity. On the contrary, overweight people cannot simply get operated, taking into consideration that conservative methods of treatment are most appropriate, even though the effort required, in order to reach the desired outcome, is bigger.

In conclusion, according to guidelines published by the World Society for Metabolic & Bariatric Surgery, surgery is necessary for morbidly obese people.

What about child obesity?

Unfortunately, western way of living proved to be catastrophic for younger generations. Worldwide, the related data are extremely worrying, while the Scientists are already working on special protocols for treating child obesity.

In Greece, according to current law, specialized Surgeons can operate on children with morbid obesity, when they are over 16 years old, as by that time, their body development is completed.

Undoubtedly, the best way to prevent obesity is prevention, which includes nutritional support.

How many surgical options are available?

There are three types of surgical procedures:

  • the restrictive type, associated with the restriction of food intake,
  • the non-absorbable type, associated with the non-absorbance of food intake,
  • the mixed type, associated with restriction and non-absorbance at the same time.

Which are the restrictive types of operations?

The restrictive types of operations for treating morbid obesity are the following:

Α) Sleeve Gastrectomy (SG),

Β) Adjustable Silicone Gastric Banding (ASGB),

C) Gastric ByPass (GP),

D) Intragastric balloon.

The best candidates for that kind of surgery are:

– patients with specific eating habits -huge amount of food but no sweets-,

– patients with ΒΜΙ < 50,

– patients with increased basic metabolism (BMR).

Which are the non-absorbable types of operations?

The non-absorbable types of operations for treating morbid obesity are the following:

Α) Biliopancreatic Diversion (BPD – LL),

Β) Biliopancreatic Diversion Duodenal Switch (BPD – DS).

The best candidates for that type of surgery are:

– patients who have different kind of eating habits –big amount of food, sweets or both-,

– patients with metabolic syndrome,

– patients with ΒΜΙ > 50, independently on how high this score can be, as soon as the patient can be operated,

– patients with medical history of gastroesophageal reflux disease,

– patients who, during the past, underwent an unsuccessful relevant operation.

Which are the mixed types of operations?

The mixed types of operations for treating morbid obesity are the following:

Α) Roux-en-Y Gastric ByPass (RYGBP),

Β) Distal Roux-en-Y Gastric ByPass (Distal RYGBP),

C) Mini Gastric ByPass with one anastomosis (MGB/SAGB).

The best candidates for that kind of surgery are:

– patients with mixed eating habits –eating big amount of food and sweets-,
– patients with metabolic syndrome,
– patients with ΒΜΙ < 50,
– patients with medical history of gastroesophageal reflux disease,
– patients with low basic metabolism (BMR),
– patients who, during the past, underwent an unsuccessful relevant operation.

Additionally, it’s worth mentioning that Gastric ByPass with one anastomosis is a drastic surgical approach, comparing to the typical gastric ByPass, since the grade of non-absorbance can be modified per case.

Which type of surgery is the right choice?

The decision for the type of surgery will be performed per case, belongs to the Scientific Team of the Center of Excellence for Bariatric & Metabolic Surgery, established in Euromedica Kyanous Stavros Clinic. The specialized Surgeon, in cooperation with a Cardiologist, a Pulmonologist, a Gastroenterologist, an Anesthesiologist, a Psychiatrist, an Endocrinologist, a Radiologist and a Nutritionist will examine and evaluate several factors, as patient’s medical history, eating habits, psychological disorders, as well as existing comorbidities, in order to conclude on the type of surgery. The international guidelines of IFSO (International Federation for Surgery of Obesity and Metabolic Syndrome) will be also taken into consideration.

Can these operations be performed laparoscopically?

The Scientific Team of the Center of Excellence for Bariatric & Metabolic Surgery, established in Euromedica Kyanous Stavros Clinic is highly experienced and able to perform all the operations laparoscopically. Actually, more than 95% percent of the total operations are laparoscopic procedures.

The advanced 3D technology used for Laparoscopic Surgery assures that the patient will have small incisions, easier recovery and quicker mobilization, while at the same time helps the Surgeon to successfully operate on difficult cases.

Can patients with diabetes type 2 get operated?

First of all, it is important to mention that the combination of at least three comorbidities with morbid obesity creates a dangerous condition, called metabolic syndrome. Essentially, surgery for morbid obesity treats the co-existing diseases, while patient looses at the same time all the extra weight.

Consequently, patients with diabetes type 2 can get operated for morbid obesity. Moreover, if the type of surgery chosen is the right one, patient’s health condition will dramatically improve, or even complete recover may happen, only in a few days.

What happens before and after the operation?

The patient enters the hospital, only few hours before the operation is performed. However, pre-operative control has been completed few days earlier, from the Scientific Team of the Center of Excellence for Bariatric & Metabolic Surgery, established in Euromedica Kyanous Stavros Clinic.

The average stay in the hospital is around four (4) days. During the first three days, patient is hydrated with intravenous saline, while painkillers are also used directly into the vain, in order to reduce pain. Epidural injections can be also used, in case of open surgery. All the above, are eventually removed, depending on the progress and the recovery of the patient.

Postoperatively, during the fourth day of hospitalization, the Surgeon is checking the impermeability of the wound healing. At that time, the patient has to undergo a diagnostic examination –usually a CT-, with the use of special agent. This way, the Surgeon will be sure that the anastomosis is healed and sealed properly.

If the anastomosis is sealed, then the patient is ready to drink water orally. In case though, of delay in the process of healing, eating and drinking will be delayed also.

It’s worth mentioning, that Physiotherapist’s contribution is of high importance, since, in every day basis, he encourages the patient to breathe deeply, cough, helping at the same time in his mobilization. These simple steps will accelerate recovery and diminish any chance of developing pneumonia.

The stitches will be removed around seven days after patient’s discharge from the hospital, in consultation with the Surgeon.

What happens after the discharge from the hospital?

As expected, after such a difficult and long operation, full recovery demands time. Usually, patients feel good when discharged from the hospital and they are back to normal activities at will.

However, good rest is always a matter of high importance, in combination with everyday activities which will help to accelerate patient’s recovery. Weight lifting should be avoided, for about four weeks after the surgery. Driving also, for almost the same period of time.

Are there any complications?

In some cases, patients have reported sharp pain, located at the area of the wounds. This pain is not a serious indication, as the muscles are under the recovery phase. During the following weeks, patients are back to normal life, developing more activities and exercise.

Is diet or other advices given?

A special diet, combined with other medical advices, which will be given to the patient from the Nutritionist and the Surgeon, must be followed regularly. At the same time, the patient has to incorporate some physical activities, as walking, in his everyday life.

Will plastic surgery be needed?

In conclusion, how successful surgery for obesity can be?

The success of the surgical treatment for morbid obesity is associated with three important factors:

  • Firstly, patient’s awareness of the seriousness of his condition and his devoted contribution to his treatment,
  • secondly, the choice of the appropriate type of surgery will be performed and,
  •  thirdly, the quality of communication and cooperation with his Surgeon, before, during and after the operation.

When the above criteria are applied, the Scientific Team of the Center of Excellence for Bariatric & Metabolic Surgery, established in Euromedica Kyanous Stavros Clinic stands beside each patient, guaranteeing to him better health and even better quality of life.